Damián Javier, Padron-Monedero Alicia, Almazán-Isla Javier, García López Fernando J, de Pedro-Cuesta Jesús, Pastor-Barriuso Roberto
National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain.
Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
J Epidemiol Community Health. 2021 Nov 19;76(5):485-9. doi: 10.1136/jech-2021-217421.
There are scant studies focused on measuring the association between disability and all-cause mortality based on large representative national samples of the community-dwelling adult population; moreover, the number of such studies which also include cause-specific mortality is yet lower.
Longitudinal cohort study that used baseline data from 162 381 adults who participated in a countrywide disability survey (2008). A nationally representative sample was selected and interviewed in their homes. We present data on people ≥18 years. Disability was considered as any substantial limitation found on a list of 44 life activities that have lasted or are expected to last more than 1 year and originate from an impairment. Cause-specific mortality data were obtained from the Spanish Statistical Office. Subjects contributed follow-up time from baseline interview until death or the censoring date (31 December 2017). We computed standardised rate ratios (SRRs), with age, sex, living with a partner and education level distribution of the total group as standard population.
Adults with disability (11%) had an adjusted mortality rate more than twice as high as adults without disability (SRR 2.37, 95% CI 2.24 to 2.50). The increased mortality risk remained over the 10-year follow-up period. Mortality due to diseases of the nervous system (SRR 4.86, 95% CI 3.93 to 6.01), diseases of the musculoskeletal system (SRR 3.45, 95% CI 2.18 to 5.47), infectious diseases (SRR 3.38, 95% CI 2.27 to 5.01) and diabetes mellitus (SRR 3.56, 95% CI 2.71 to 4.68) was particularly high in those with disability.
All-cause mortality rates are markedly higher among adults with disability. Preventive measures and health promotion initiatives are needed to reduce mortality risk in this population. Special attention should be paid to disabled people with certain specific diseases.
基于具有全国代表性的社区居住成年人口大样本，针对测量残疾与全因死亡率之间关联的研究很少；此外，纳入特定病因死亡率的此类研究数量更少。
纵向队列研究，使用了162381名参与全国残疾调查（2008年）的成年人的基线数据。选取了具有全国代表性的样本并在其家中进行访谈。我们呈现了18岁及以上人群的数据。残疾被定义为在44项持续或预计持续超过1年且由损伤引起的生活活动清单中发现的任何严重限制。特定病因死亡率数据来自西班牙统计局。研究对象从基线访谈开始直至死亡或审查日期（2017年12月31日）提供随访时间。我们以总体人群的年龄、性别、是否有伴侣同住和教育水平分布作为标准人群，计算标准化率比（SRR）。
残疾成年人（11%）的校正死亡率比无残疾成年人高出两倍多（SRR 2.37，95%置信区间2.24至2.50）。在10年随访期内，死亡风险持续增加。残疾人群中，神经系统疾病（SRR 4.86，95%置信区间3.93至6.01）、肌肉骨骼系统疾病（SRR 3.45，95%置信区间2.18至5.47）、传染病（SRR 3.38，95%置信区间2.27至5.01）和糖尿病（SRR 3.56，95%置信区间2.71至4.68）导致的死亡率尤其高。
残疾成年人的全因死亡率明显更高。需要采取预防措施和健康促进举措来降低该人群的死亡风险。应特别关注患有某些特定疾病的残疾人。
