Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Int J Epidemiol. 2020 Feb 1;49(1):113-130. doi: 10.1093/ije/dyz078.
This study examined the incidence of a person's first diagnosis of a selected chronic disease, and the relationships between modifiable lifestyle risk factors and age to first of six chronic diseases.
Ontario respondents from 2001 to 2010 of the Canadian Community Health Survey were followed up with administrative data until 2014 for congestive heart failure, chronic obstructive respiratory disease, diabetes, lung cancer, myocardial infarction and stroke. By sex, the cumulative incidence function of age to first chronic disease was calculated for the six chronic diseases individually and compositely. The associations between modifiable lifestyle risk factors (alcohol, body mass index, smoking, diet, physical inactivity) and age to first chronic disease were estimated using cause-specific Cox proportional hazards models and Fine-Gray competing risk models.
Diabetes was the most common disease. By age 70.5 years (2015 world life expectancy), 50.9% of females and 58.1% of males had at least one disease and few had a death free of the selected diseases (3.4% females; 5.4% males). Of the lifestyle factors, heavy smoking had the strongest association with the risk of experiencing at least one chronic disease (cause-specific hazard ratio = 3.86; 95% confidence interval = 3.46, 4.31). The lifestyle factors were modelled for each disease separately, and the associations varied by chronic disease and sex.
We found that most individuals will have at least one of the six chronic diseases before dying. This study provides a novel approach using competing risk methods to examine the incidence of chronic diseases relative to the life course and how their incidences are associated with lifestyle behaviours.
本研究调查了一个人首次被诊断出某种选定的慢性疾病的发病率，以及可改变的生活方式风险因素与首次发生六种慢性疾病的年龄之间的关系。
本研究对 2001 年至 2010 年参加加拿大社区健康调查的安大略省受访者进行了随访，并利用行政数据对他们进行了随访，直至 2014 年，随访终点为充血性心力衰竭、慢性阻塞性呼吸道疾病、糖尿病、肺癌、心肌梗死和中风。按性别，计算了六种慢性疾病各自以及复合的累积发病率函数。利用特定原因的 Cox 比例风险模型和 Fine-Gray 竞争风险模型，估计了可改变的生活方式风险因素（饮酒、体重指数、吸烟、饮食、身体活动不足）与首次发生慢性疾病的年龄之间的关系。
糖尿病是最常见的疾病。到 70.5 岁（2015 年全球预期寿命）时，50.9%的女性和 58.1%的男性至少患有一种疾病，很少有患者在所选疾病中无死亡（女性 3.4%；男性 5.4%）。在生活方式因素中，重度吸烟与至少患有一种慢性疾病的风险关联最强（特定原因的危险比=3.86；95%置信区间=3.46，4.31）。分别对每种疾病进行了生活方式因素建模，且这些关联因慢性疾病和性别而异。
我们发现，大多数人在死亡前至少会有一种六种慢性疾病之一。本研究使用竞争风险方法提供了一种新的方法，用于检查慢性疾病的发病率与生命历程的关系，以及它们的发病率与生活方式行为的关系。
