背痛与老年女性全因死亡率和死因特异性死亡率的关联：一项队列研究。
Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.
机构信息
Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA, USA.
Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
出版信息
J Gen Intern Med. 2019 Jan;34(1):90-97. doi: 10.1007/s11606-018-4680-7. Epub 2018 Oct 22.
BACKGROUND
The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear.
OBJECTIVE
To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability.
DESIGN
Prospective cohort study.
SETTING
The Study of Osteoporotic Fractures.
PARTICIPANTS
Women aged 65 or older.
MEASUREMENT
Our primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators.
RESULTS
Of 8321 women (mean age 71.5, SD = 5.1), 4975 (56%) died over a median follow-up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR] = 1.24 [95% CI, 1.11-1.39]), cardiovascular (HR = 1.34 [CI, 1.12-1.62]), and cancer (HR = 1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p < 0.001), respectively.
LIMITATIONS
Only white women were included.
CONCLUSION
Frequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.
背景
背痛对老年女性残疾的影响已得到充分认识，但背痛对死亡率的影响尚不清楚。
目的
研究背痛是否与老年女性的全因死亡率和死因特异性死亡率相关，以及残疾是否对此关联起中介作用。
设计
前瞻性队列研究。
地点
骨质疏松性骨折研究。
参与者
年龄在 65 岁或以上的女性。
测量方法
我们的主要结局是死亡时间，使用全因和死因特异性调整后的 Cox 模型进行评估。我们采用了一种四分类背痛暴露（无背痛、非持续性、不频繁持续性或频繁持续性背痛），这种暴露方式结合了基线（1986-1988 年）和第一次随访（1989-1990 年）访谈时背痛的频率和持续性。1991 年的残疾测量（工具性日常生活活动受限、椅子站立时间慢和行走速度慢）被认为是潜在的中介因素。
结果
在 8321 名女性（平均年龄 71.5 岁，标准差=5.1）中，4975 名（56%）在中位随访 14.1 年后死亡。有频繁持续性背痛的女性中，死亡比例较高（65.8%），而无背痛的女性中，死亡比例较低（53.5%）。在完全调整的模型中，有频繁持续性背痛的女性全因（危险比 [HR] = 1.24 [95%CI，1.11-1.39]）、心血管（HR = 1.34 [CI，1.12-1.62]）和癌症（HR = 1.33，[CI 1.03-1.71]）死亡率更高。其他背痛类别与死亡率无关。在中介分析中，IADL 受限解释了持续性频繁背痛对全因死亡率的 47%的影响，椅子站立时间和行走速度分别解释了 27%和 24%（均有显著意义，p<0.001）。
局限性
仅纳入了白人女性。
结论
频繁持续性背痛与老年女性的死亡率增加有关。这种关联的大部分是由残疾引起的。
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