Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA.
Prev Med. 2019 Mar;120:131-139. doi: 10.1016/j.ypmed.2019.01.012. Epub 2019 Jan 18.
Evidence suggests interdependent associations of individual modifiable behaviors with health outcomes. However, such interrelations have not been accounted for in previous behavior-outcome associations. We conducted latent profile analysis (LPA) on self-reported levels of alcohol consumption, restaurant dining, vitamin/mineral supplement use, physical activity (PA) and smoke exposure (first- and second-hand smoke) separately for smokers (N = 4530) and non-smokers (N = 13,421) using data from the third National Health and Nutrition Examination Survey (NHANES III) to identify subgroups with similar levels within and across behaviors. Cox-proportional hazards models were used to compare mortality rates between subgroups from cancer, cardiovascular disease (CVD) and all-causes at an average of 16.4 (±6.1) years follow-up. Five behavioral typologies were identified in non-smokers ("Moderates", "Low Risk Factors", "Restaurant Diners", "Moderate Passive Smokers" and "Heavy Passive Smokers"), and four in smokers ("Moderates", "Low Risk Factors", "Heavy Smokers" and "Physically Active"). As a group, "Moderates" had levels of each behavior that were not significantly different from at least one other group. Compared to "Moderates", in non-smokers "Restaurant Diners" had lower hazard from all-cause (hazard ratio (HR):0.84, 95% CI:0.74-0.97) and CVD (HR:0.59, 0.43-0.82) mortality, while "Low Risk Factors" had higher cancer mortality (HR:1.38,1.03-1.84). In smokers, compared to "Moderates", higher hazards for mortality were found for "Heavy Smokers" (all cause: HR:1.34, 1.12-1.60; CVD: HR:1.52, 1.04-2.23; cancer: HR:1.41 1.02-1.96) and "Low Risk Factors" (all-cause: HR:1.58, 1.14-2.17). Taken together, when restaurant dining, PA and smoking exposures are grouped together, novel predictions for mortality occur, suggesting data on multiple behaviors may be informative for risk stratification.
有证据表明，个体可改变行为与健康结果之间存在相互依存的关联。然而，以前的行为与结果的关联并没有考虑到这些相互关系。我们使用第三次国家健康和营养检查调查（NHANES III）的数据，对吸烟者（N=4530）和不吸烟者（N=13421）分别进行了饮酒、餐厅用餐、维生素/矿物质补充剂使用、身体活动（PA）和吸烟暴露（一手和二手烟）的自我报告水平进行了潜在剖面分析（LPA），以识别在行为内和跨行为中具有相似水平的亚组。在平均 16.4（±6.1）年的随访中，使用 Cox 比例风险模型比较了亚组之间癌症、心血管疾病（CVD）和所有原因的死亡率。在不吸烟者中确定了五种行为类型（“适度者”、“低风险因素”、“餐厅食客”、“中度被动吸烟者”和“重度被动吸烟者”），在吸烟者中确定了四种行为类型（“适度者”、“低风险因素”、“重度吸烟者”和“身体活跃者”）。作为一个群体，“适度者”的每种行为水平与至少一个其他群体没有显著差异。与“适度者”相比，在不吸烟者中，“餐厅食客”的全因（风险比（HR）：0.84，95%CI：0.74-0.97）和 CVD（HR：0.59，0.43-0.82）死亡率较低，而“低风险因素”的癌症死亡率较高（HR：1.38，1.03-1.84）。在吸烟者中，与“适度者”相比，“重度吸烟者”（全因：HR：1.34，1.12-1.60；CVD：HR：1.52，1.04-2.23；癌症：HR：1.41，1.02-1.96）和“低风险因素”（全因：HR：1.58，1.14-2.17）的死亡率更高。总的来说，当将餐厅用餐、PA 和吸烟暴露归为一组时，死亡率出现了新的预测结果，这表明关于多种行为的数据可能有助于风险分层。
