Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan; Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
J Am Med Dir Assoc. 2019 Aug;20(8):971-976. doi: 10.1016/j.jamda.2019.01.155. Epub 2019 Mar 20.
To estimate quantitatively whether the presence of cough associated with dysphagia (laryngeal cough reflex) increased mortality through respiratory disease among community-dwelling older Japanese.
A 6-year follow-up prospective cohort study (from 2010 to 2017).
Thirteen municipalities in Japan.
Community-dwelling individuals aged 65 years or older (N = 32,682).
The baseline survey was conducted through self-reported questionnaire. Exposure was experience of laryngeal cough reflex while drinking. The outcome was all-cause mortality. All covariates were selected from demographic, socioeconomic variables, baseline health and functional status, smoking, alcohol drinking, number of remaining teeth, and stroke. The mediator variable was respiratory disease. Cox proportional hazards regression was used to estimate hazard ratios (HRs) for mortality. Parametric mediation analysis was conducted to estimate the effect of laryngeal cough reflex on the mean residual time to death mediated through respiratory disease.
Among the 32,682 participants (mean age = 74.1 years, standard deviation = 5.9 years), 5550 (17.0%) experienced laryngeal cough reflex at baseline. A total of 4037 deaths occurred. Crude mortality rates of the participants with or without laryngeal cough reflex were 16.3% and 11.6%, respectively. After adjusting for covariates, laryngeal cough reflex [HR = 1.10; 95% confidence interval (CI) = 1.02 to 1.19] and respiratory disease (HR = 1.80; 95% CI = 1.62 to 2.00) were associated with mortality. The mediation analysis showed that respiratory disease significantly (P < .001) and partially mediated the association between laryngeal cough reflex, an indicator of 1 or more conditions such as chronic aspiration and mortality.
CONCLUSIONS/IMPLICATIONS: Laryngeal cough reflex was a prevalent condition, and it was associated with all-cause mortality in community-dwelling older Japanese individuals. Clinicians could contribute to reduce mortality risk by addressing swallowing function problems using their interprofessional collaboration team (speech-language pathologist, dentist, rehabilitation doctor, otolaryngologist, respiratory physician, and gerontologist).
定量评估社区居住的老年日本人中存在与吞咽相关的咳嗽（喉反射性咳嗽）是否会因呼吸疾病导致死亡率增加。
一项为期 6 年的前瞻性队列研究（2010 年至 2017 年）。
日本 13 个市。
年龄在 65 岁或以上的社区居住者（N=32682）。
基线调查通过自报问卷进行。暴露因素为饮水时出现喉反射性咳嗽。结局为全因死亡率。所有协变量均选自人口统计学、社会经济变量、基线健康和功能状况、吸烟、饮酒、剩余牙齿数量以及中风。中介变量为呼吸疾病。使用 Cox 比例风险回归估计死亡率的危险比（HR）。进行参数中介分析，以估计喉反射性咳嗽对通过呼吸疾病导致的死亡平均余寿的影响。
在 32682 名参与者中（平均年龄 74.1 岁，标准差 5.9 岁），5550 人（17.0%）在基线时出现喉反射性咳嗽。共有 4037 人死亡。有或没有喉反射性咳嗽的参与者的粗死亡率分别为 16.3%和 11.6%。调整协变量后，喉反射性咳嗽[HR=1.10；95%置信区间（CI）=1.02 至 1.19]和呼吸疾病（HR=1.80；95%CI=1.62 至 2.00）与死亡率相关。中介分析表明，呼吸疾病显著（P<.001）且部分介导了喉反射性咳嗽（慢性误吸等一种或多种情况的指标）与死亡率之间的关联。
结论/意义：喉反射性咳嗽是一种普遍存在的情况，与社区居住的日本老年个体的全因死亡率相关。临床医生可以通过他们的多专业合作团队（言语语言病理学家、牙医、康复医生、耳鼻喉科医生、呼吸内科医生和老年病学家）解决吞咽功能问题，为降低死亡率风险做出贡献。
