Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles.
Royal College of Surgeons in Ireland, Dublin.
JAMA Otolaryngol Head Neck Surg. 2021 Jan 1;147(1):49-55. doi: 10.1001/jamaoto.2020.3502.
A study of olfactory dysfunction and mortality in a large national cohort will aid in better understanding their association when accounting for multiple relevant factors and possible underlying mechanisms.
To investigate the association of olfactory dysfunction with all-cause 5-year mortality in US adults.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included participants 40 years or older from the 2013-2014 National Health and Nutritional Examination Survey who had data on olfaction and mortality (n = 3503). Olfaction was assessed by self-report and objective test (8-odor Pocket Smell Test). Mortality was determined by linking with the National Death Index through February 24, 2019. Data were analyzed from July 1 to September 30, 2019.
Olfaction and 5-year mortality. Cox proportional regression models were used to examine the associations between olfaction and mortality while adjusting for demographics and medical comorbidities. Multivariate models were further adjusted for depression and cognitive assessments.
Among the 3503 participants (1831 women [52.3%]; mean [SD] age, 59.0 [12.0] years), the prevalence of olfactory dysfunction was 13.5% (95% CI, 11.0%-16.0%) based on results of an objective smell test and 21.6% (95% CI, 18.9%-24.2%) based on self-report. Risk of mortality increased by 18% (95% CI, 7%-29%) per 1-point decrease in smell test score in a multivariate model. The association was significant among adults 65 years or older in association with binary (hazard ratio [HR], 1.95; 95% CI, 1.19-3.21) and linear (HR, 1.19; 95% CI, 1.08-1.31) measures of objective olfactory dysfunction, but not among adults aged 40 to 64 years. There was no association between self-reported olfactory dysfunction and mortality. The association between objective olfactory dysfunction and mortality remained after further adjusting for cognitive assessment battery and depression among older adults (HR, 1.18; 95% CI, 1.01-1.37).
These findings suggest that objective olfactory dysfunction is associated with increased mortality among older adults. In addition to its effect on quality of life, the association of olfactory dysfunction with mortality has implications for physical and cognitive health.
对嗅觉功能障碍和大量人群死亡率的研究将有助于在考虑多种相关因素和可能的潜在机制的情况下，更好地理解它们之间的关联。
调查美国成年人嗅觉功能障碍与全因 5 年死亡率之间的关联。
设计、地点和参与者：这项队列研究纳入了 2013-2014 年全国健康与营养调查中年龄在 40 岁及以上的参与者，这些参与者有嗅觉和死亡率的数据（n=3503）。嗅觉通过自我报告和客观测试（8-气味口袋嗅觉测试）来评估。通过与国家死亡索引链接，确定截止到 2019 年 2 月 24 日的死亡率。数据于 2019 年 7 月 1 日至 9 月 30 日进行分析。
嗅觉和 5 年死亡率。使用 Cox 比例风险回归模型来检查嗅觉和死亡率之间的关联，同时调整人口统计学和合并症。多变量模型进一步调整了抑郁和认知评估。
在 3503 名参与者中（1831 名女性[52.3%]；平均[标准差]年龄为 59.0[12.0]岁），基于客观嗅觉测试结果，嗅觉功能障碍的患病率为 13.5%（95%CI，11.0%-16.0%），基于自我报告结果，患病率为 21.6%（95%CI，18.9%-24.2%）。在多变量模型中，嗅觉测试得分每降低 1 分，死亡率的风险增加 18%（95%CI，7%-29%）。在与二元（危险比[HR]，1.95；95%CI，1.19-3.21）和线性（HR，1.19；95%CI，1.08-1.31）客观嗅觉功能障碍测量指标相关的 65 岁及以上成年人中，这种关联是显著的，但在 40 至 64 岁成年人中并不显著。自我报告的嗅觉功能障碍与死亡率之间没有关联。在老年人中，进一步调整认知评估和抑郁后，客观嗅觉功能障碍与死亡率之间的关联仍然存在（HR，1.18；95%CI，1.01-1.37）。
这些发现表明，客观的嗅觉功能障碍与老年人死亡率的增加有关。除了对生活质量的影响外，嗅觉功能障碍与死亡率的关联对身体和认知健康也有影响。
