伊朗德黑兰血脂和血糖研究队列人群中过早死亡的发生率及相关危险因素。
Incidence and associated risk factors for premature death in the Tehran Lipid and Glucose Study cohort, Iran.
机构信息
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, ShahidChamran Highway, P.O. Box: 19395-4763, Tehran, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
出版信息
BMC Public Health. 2019 Jun 10;19(1):719. doi: 10.1186/s12889-019-7056-y.
BACKGROUND
The incidence and associated risk factors for premature death were investigated in a population-based cohort study in Iran.
METHODS
A total of 7245 participants (3216 men), aged 30-70 years, were included. We conducted Cox proportional hazards models to identify the risk factors for premature death. For each risk factor, hazard ratio (HR), 95% confidence intervals (95% CI) and population attributable fraction (PAF) were calculated.
RESULTS
After a median follow-up of 13.8 years, 262 premature deaths (153 in men) occurred. Underlying causes of premature deaths were cardiovascular disease (CVD) (n = 126), cancer (n = 51), road injuries (n = 15), sepsis and pneumonia (n = 9) and miscellaneous reasons (n = 61). The age-standardized incident rate of premature death was 2.35 per 1000 person years based on WHO standard population. Hypertension [HR 1.40, 95% CI (1.07-1.83)], diabetes (2.53, 1.94-3.29) and current smoking (1.58, 1.16-2.17) were significant risk factors for premature mortality; corresponding PAFs were 12.3, 22.4 and 9.2%, respectively. Overweight (body mass index (BMI): 25-29.9 kg/m) (0.65, 0.49-0.87) and obesity (BMI ≥30 kg/m) (0.67, 0.48-0.94) were associated with decreased premature mortality. After replacing general adiposity with central adiposity, we found no significant risk for the latter (0.92, 0.71-1.18). Moreover, when we excluded current smokers, those with prevalent cancer/cardiovascular disease and those with survival of less than 3 years, the inverse association between overweight (0.59, 0.39-0.88) and obesity (0.67, 0.43-1.04), generally remained unchanged; although, diabetes still showed a significant risk (2.62, 1.84-3.72).
CONCLUSIONS
Controlling three modifiable risk factors including diabetes, hypertension and smoking might potentially reduce mortality events by over 40%, and among these, prevention of diabetes should be prioritized to decrease burden of events. We didn't confirm a negative impact of overweight and obesity status on premature mortality events.
背景
本研究通过伊朗的一项基于人群的队列研究，调查了过早死亡的发生率及其相关危险因素。
方法
共纳入 7245 名参与者（3216 名男性），年龄 30-70 岁。我们采用 Cox 比例风险模型来确定过早死亡的危险因素。对于每个危险因素，计算了风险比（HR）、95%置信区间（95%CI）和人群归因分数（PAF）。
结果
中位随访 13.8 年后，共有 262 例过早死亡（男性 153 例）发生。过早死亡的根本原因是心血管疾病（CVD）（n=126）、癌症（n=51）、道路伤害（n=15）、脓毒症和肺炎（n=9）和其他原因（n=61）。基于世界卫生组织标准人口，年龄标准化的过早死亡发生率为 2.35/1000 人年。高血压[HR 1.40，95%CI（1.07-1.83）]、糖尿病（2.53，1.94-3.29）和当前吸烟[HR 1.58，1.16-2.17]是过早死亡的显著危险因素；相应的 PAF 分别为 12.3%、22.4%和 9.2%。超重（体重指数（BMI）：25-29.9kg/m）[HR 0.65，0.49-0.87]和肥胖（BMI≥30kg/m）[HR 0.67，0.48-0.94]与过早死亡风险降低相关。当用中心性肥胖替代总体肥胖时，我们发现后者与过早死亡没有显著关联[HR 0.92，0.71-1.18]。此外，当排除当前吸烟者、有现患癌症/心血管疾病者和生存时间少于 3 年者后，超重[HR 0.59，0.39-0.88]和肥胖[HR 0.67，0.43-1.04]与过早死亡之间的反比关联总体上保持不变；尽管糖尿病仍显示出显著的风险[HR 2.62，1.84-3.72]。
结论
控制糖尿病、高血压和吸烟这三个可改变的危险因素，可能会使死亡率降低 40%以上，其中预防糖尿病应作为降低事件负担的优先事项。我们没有证实超重和肥胖状态对过早死亡事件有负面影响。
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