Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University.
Japan Health Insurance Association Kyoto.
J Epidemiol. 2022 Jul 5;32(7):323-329. doi: 10.2188/jea.JE20200422. Epub 2021 Jul 10.
The transtheoretical model (TTM) is composed of the multiple stages according to patient's consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR).
We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup.
We analyzed 239,755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65-0.91); stage 4 group (HR 0.80; 95% CI, 0.65-0.98); and stage 5 group (HR 0.79; 95% CI, 0.66-0.95).
Compared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.
跨理论模型（TTM）由多个阶段组成，根据患者的意识，被认为可以引导人们认识到更健康行为的重要性。我们研究了 TTM 阶段与估算肾小球滤过率（eGFR）下降的关系。
我们使用了京都健康保险协会在 2012 年 4 月至 2016 年 3 月期间进行的年度健康检查数据和健康保险索赔数据。通过第一次健康检查的问卷获得 TTM 阶段变化，并将其分为六组。主要结局定义为 eGFR 从第一次健康检查下降超过 30%。我们拟合了多变量 Cox 比例风险模型，用于时间事件分析，调整了年龄、性别、eGFR、体重指数、血压、血糖、血脂异常、尿酸、尿蛋白和第一次健康检查时存在的肾脏疾病。
我们分析了 239755 名员工，平均随访时间为 2.9（标准差 1.2）年。与第 1 阶段组相比，第 3 阶段组（HR 0.77；95%可信区间 [CI]，0.65-0.91）；第 4 阶段组（HR 0.80；95% CI，0.65-0.98）；和第 5 阶段组（HR 0.79；95% CI，0.66-0.95）的 eGFR 下降风险显著降低。
与前沉思阶段（第 1 阶段）相比，准备、行动和维持阶段（第 3、4 和 5 阶段）与 eGFR 下降风险降低相关。
