Maccabi Kahn Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
Faculty of Medicine, Ariel University, Ariel, Israel.
JAMA Netw Open. 2019 Jan 4;2(1):e186643. doi: 10.1001/jamanetworkopen.2018.6643.
Previous studies have suggested that Holocaust survivors may experience different chronic comorbidities more often than the general population. However, the mortality hazard among these individuals has not been addressed.
To assess the overall mortality rate and comorbidities of a cohort of Holocaust survivors compared with an age-matched control group.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included all Holocaust survivors insured by Maccabi Healthcare Services in Israel who were born between 1911 and 1945 in Europe and control individuals born in Israel during the same years and insured by the same service. Data were collected from January 1, 1998, through December 31, 2017.
Rates of morbidities and mortality rates adjusted for sex, socioeconomic status, and body mass index using logistic regression, Cox regression, and Kaplan-Meier analysis.
The 38 597 Holocaust survivors included 22 627 women (58.6%) and had a mean (SD) age of 81.7 (5.4) years, and the 34 931 individuals in the control group included 18 615 women (53.3%) and had a mean (SD) age of 77.7 (5.3) years. The Holocaust survivors had higher rates than control individuals of reported hypertension (32 038 [83.0%] vs 23 285 [66.7]), obesity (12 838 [33.3%] vs 9254 [26.5]), chronic kidney disease (11 929 [30.9%] vs 6927 [19.8]), cancer (11 369 [29.5%] vs 9721 [27.8]), dementia (6389 [16.6%] vs 3355 [9.6]), ischemic heart disease, nonmyocardial infarction (5729 [14.8%] vs 4135 [11.8]), myocardial infarction (3641 [9.4%] vs 2723 [7.8]), and osteoporotic fractures among women (6429 [28.4%] vs 4120 [22.1]). In contrast, the overall mortality rate was lower among Holocaust survivors (25.3%) compared with the control group (41.1%). After adjustment for confounders, mean age at death was significantly higher in the survivor group compared with the control group.
The findings showed higher rates of comorbidities and lower mortality among Holocaust survivors, which may be associated with a combination of improved health literacy and unique resilience characteristics among Holocaust survivors. More research is needed to explore the biologic and psychosocial basis for these results.
先前的研究表明，大屠杀幸存者可能比一般人群更容易出现不同的慢性合并症。然而，这些个体的死亡率尚待解决。
评估大屠杀幸存者与年龄匹配的对照组相比的总体死亡率和合并症。
设计、地点和参与者：这项横断面研究包括以色列 Maccabi 医疗保健服务机构承保的所有 1911 年至 1945 年在欧洲出生的大屠杀幸存者和在同一时期出生并由同一服务机构承保的在以色列出生的年龄匹配对照组个体。数据收集自 1998 年 1 月 1 日至 2017 年 12 月 31 日。
使用逻辑回归、Cox 回归和 Kaplan-Meier 分析，根据性别、社会经济地位和体重指数调整发病率和死亡率。
38597 名大屠杀幸存者中包括 22627 名女性（58.6%），平均年龄（标准差）为 81.7（5.4）岁，对照组 34931 名个体中包括 18615 名女性（53.3%），平均年龄（标准差）为 77.7（5.3）岁。与对照组相比，大屠杀幸存者报告的高血压（32038 [83.0%] vs 23285 [66.7%]）、肥胖症（12838 [33.3%] vs 9254 [26.5%]）、慢性肾病（11929 [30.9%] vs 6927 [19.8%]）、癌症（11369 [29.5%] vs 9721 [27.8%]）、痴呆症（6389 [16.6%] vs 3355 [9.6%]）、缺血性心脏病、非心肌梗死（5729 [14.8%] vs 4135 [11.8%]）、心肌梗死（3641 [9.4%] vs 2723 [7.8%]）和女性骨质疏松性骨折（6429 [28.4%] vs 4120 [22.1%]）的发病率更高。相比之下，大屠杀幸存者的总体死亡率（25.3%）低于对照组（41.1%）。在调整混杂因素后，幸存者组的平均死亡年龄显著高于对照组。
研究结果表明，大屠杀幸存者的合并症发病率较高，死亡率较低，这可能与幸存者健康素养的提高和独特的适应能力特征有关。需要进一步研究来探索这些结果的生物学和心理社会基础。
