Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
Spine (Phila Pa 1976). 2021 Jul 15;46(14):E784-E790. doi: 10.1097/BRS.0000000000003912.
This prospective cohort study analyzed data from the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study.
To investigate the association between lumbar spinal stenosis (LSS) and severe disability and mortality among community-dwelling older adults.
Only a few studies have investigated LSS longitudinally, and the study participants were limited to selected patients diagnosed with LSS during a hospital visit. Additionally, the prognosis of LSS remains unclear.
We enrolled independent community-dwelling older adults aged 65 years or older at the time of a baseline health checkup in 2008. LSS was diagnosed using a validated diagnostic support tool for LSS. The primary endpoint was a composite of severe disability (long-term care insurance certification grade 4 or 5) and mortality. We used 1 minus Kaplan-Meier failure estimates and the log-rank test to compare the interval between baseline and the predetermined endpoint as well as a Cox proportional hazards model to estimate hazard ratios (HRs) for the LSS group with adjustment for possible confounders. Multiple imputation by chained equations was performed for sensitivity analysis.
Of 2058 subjects enrolled, 1560 did not have missing covariates; 269 (17%) were diagnosed with LSS. After a median follow-up of 5.8 years, the rates of severe disability and mortality were 0.022 per year in subjects with LSS and 0.012 per year in those without (P = 0.006). The adjusted HR for the composite endpoint in the LSS group was 1.55 (95% confidence interval [CI], 1.01-2.38). A similar association was observed after multiple imputation of missing covariates (adjusted HR, 1.51 [95% CI, 1.06-2.16]).
LSS was associated with severe disability and mortality in community-dwelling older adults. Detection of adults with LSS in the community may contribute to local health promotion.Level of Evidence: 2.
本前瞻性队列研究分析了来自会津地区生活方式与健康结局队列研究的数据。
调查社区居住的老年人中腰椎管狭窄症（LSS）与严重残疾和死亡之间的关联。
仅有少数研究对 LSS 进行了纵向研究，且研究参与者仅限于在医院就诊时被诊断为 LSS 的选定患者。此外，LSS 的预后仍不清楚。
我们纳入了 2008 年基线健康检查时年龄在 65 岁及以上的独立社区居住的老年人。使用经过验证的 LSS 诊断支持工具诊断 LSS。主要终点是严重残疾（长期护理保险认证等级 4 或 5）和死亡的复合终点。我们使用 1 减去 Kaplan-Meier 失败估计值和对数秩检验来比较基线和预定终点之间的间隔，以及 Cox 比例风险模型来估计 LSS 组的风险比（HR），同时对可能的混杂因素进行调整。使用链式方程进行多重插补进行敏感性分析。
在纳入的 2058 名受试者中，1560 名受试者无缺失协变量；269 名（17%）被诊断为 LSS。中位随访 5.8 年后，LSS 组的严重残疾和死亡率分别为每年 0.022，无 LSS 组为每年 0.012（P=0.006）。LSS 组复合终点的调整 HR 为 1.55（95%置信区间 [CI]，1.01-2.38）。在缺失协变量的多重插补后也观察到类似的关联（调整 HR，1.51[95%CI，1.06-2.16]）。
LSS 与社区居住的老年人严重残疾和死亡相关。在社区中检测到患有 LSS 的成年人可能有助于当地的健康促进。
2。
