VanEvery Hannah, Yang Wen-Hao, Olsen Nancy, Zhang Xinyuan, Shu Rong, Lu Bing, Wu Shouling, Cui Liufu, Gao Xiang
Pennsylvania State University, State College.
Kailuan General Hospital, Tangshan, China.
Arthritis Rheumatol. 2021 Apr;73(4):596-603. doi: 10.1002/art.41601. Epub 2021 Mar 7.
To investigate whether early life exposure to the Great Chinese Famine of 1959-1961 is associated with the risk of RA development in adulthood.
This study included 101,510 participants who were enrolled in the Kailuan Study in 2006. RA cases were confirmed by medical record review. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) for RA according to famine exposure status (exposed in utero or between ages 0 and 3 years, between ages 3 and 6 years, or at age 6 years or older), in comparison to participants born after 1961 who were not exposed to famine.
During 12 years of follow-up (2006-2018), we identified 187 RA cases. Individuals exposed to famine in utero or between ages 0 and 3 years had a higher prevalence of RA relative to other groups (0.2-0.35% versus 0.08-0.20%). After adjustment for potential confounders, the OR for RA was 2.95 (95% CI 1.55-5.59) for individuals exposed in utero, 4.53 (95% CI 2.72-7.54) for those exposed between ages 0 and 3 years, 2.55 (95% CI 1.43-4.57) for those exposed between ages 3 and 6 years, and 2.72 (95% CI 1.70-4.36) for those exposed at age 6 years or older versus individuals born after 1961. Similar associations with the risk of RA were observed for men and women when subjects were stratified by sex (P for interaction = 0.89).
Individuals exposed to famine in utero or in early childhood (between ages 0 and 3 years) were more likely to develop RA in adulthood, highlighting the importance of early life as a vulnerable developmental period.
探讨生命早期暴露于1959 - 1961年中国大饥荒是否与成年后患类风湿关节炎（RA）的风险相关。
本研究纳入了2006年参加开滦研究的101,510名参与者。通过病历审查确诊RA病例。采用逻辑回归分析，根据饥荒暴露状态（子宫内暴露、0至3岁暴露、3至6岁暴露或6岁及以上暴露）计算RA的比值比（OR）和95%置信区间（95%CI），并与1961年后出生未暴露于饥荒的参与者进行比较。
在12年的随访期（2006 - 2018年）内，共识别出187例RA病例。与其他组相比，子宫内或0至3岁暴露于饥荒的个体患RA的患病率更高（0.2 - 0.35%对0.08 - 0.20%）。在调整潜在混杂因素后，子宫内暴露个体患RA的OR为2.95（95%CI 1.55 - 5.59），0至3岁暴露个体为4.53（95%CI 2.72 - 7.54），3至6岁暴露个体为2.55（95%CI 1.43 - 4.57），6岁及以上暴露个体为2.72（95%CI 1.70 - 第4.36），与1961年后出生的个体相比。按性别分层时，男性和女性患RA风险的关联相似（交互作用P = 0.89）。
子宫内或幼儿期（0至3岁）暴露于饥荒的个体成年后患RA的可能性更大，凸显了生命早期作为脆弱发育阶段的重要性。
