From the Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Epidemiology. 2021 Mar 1;32(2):179-188. doi: 10.1097/EDE.0000000000001316.
The UK Biobank (UKB) has been used widely to examine associations between lifestyle risk factors and mortality outcomes. It is unknown whether the extremely low UKB response rate (5.5%) and lack of representativeness materially affects the magnitude and direction of effect estimates.
We used poststratification to match the UKB sample to the target population in terms of sociodemographic characteristics and prevalence of lifestyle risk factors (physical inactivity, alcohol intake, smoking, and poor diet). We compared unweighted and poststratified associations between each lifestyle risk factor and a lifestyle index score with all-cause, cardiovascular disease (CVD), and cancer mortality. We also calculated the unweighted to poststratified ratio of HR (RHR) and 95% confidence interval as a marker of effect-size difference.
Of 371,974 UKB participants with no missing data, 302,009 had no history of CVD or cancer, corresponding to 3,298,958 person years of follow-up. Protective associations between alcohol use and CVD mortality observed in the unweighted UKB were substantially altered after poststratification, for example, from a hazard ratio (HR) of 0.63 (0.45-0.87) unweighted to 0.99 (0.65-1.50) poststratified for drinking ≥5 times/week versus never drinking. The magnitude of the poststratified all-cause mortality hazard ratio comparing least healthy with healthiest tertile of lifestyle risk factor index was 9% higher (95% confidence interval: 4%, 14%) than the unweighted estimates.
Lack of representativeness may distort the associations of alcohol with CVD mortality, and may underestimate health hazards among those with cumulatively the least healthy lifestyles.
英国生物库（UKB）已被广泛用于研究生活方式风险因素与死亡率结果之间的关联。目前尚不清楚 UKB 极低的响应率（5.5%）和缺乏代表性是否会实质性地影响效应估计值的大小和方向。
我们使用后分层法，根据社会人口统计学特征和生活方式风险因素（身体活动不足、饮酒、吸烟和不良饮食）的流行率，将 UKB 样本与目标人群相匹配。我们比较了每种生活方式风险因素与生活方式指数评分之间的未加权和后分层关联与全因、心血管疾病（CVD）和癌症死亡率。我们还计算了未加权与后分层 HR（RHR）的比值和 95%置信区间，作为效应大小差异的标志物。
在 371974 名无缺失数据的 UKB 参与者中，有 302009 名没有 CVD 或癌症病史，对应 3298958 人年的随访。在未加权的 UKB 中，饮酒与 CVD 死亡率之间的保护关联在经过后分层后发生了实质性改变，例如，每周饮酒≥5 次与从不饮酒相比，风险比（HR）从未加权的 0.63（0.45-0.87）变为后分层的 0.99（0.65-1.50）。与生活方式风险因素指数最不健康与最健康三分位相比，后分层全因死亡率危险比的幅度高出 9%（95%置信区间：4%，14%），高于未加权估计值。
缺乏代表性可能会扭曲酒精与 CVD 死亡率之间的关联，并且可能低估生活方式最不健康人群的健康危害。
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