生活空间流动性与老年日本人死亡率之间的剂量-反应关系：一项前瞻性队列研究。
Dose-Response Relationship Between Life-Space Mobility and Mortality in Older Japanese Adults: A Prospective Cohort Study.
机构信息
Faculty of Sport Sciences, Waseda University, Tokorozawa City, Saitama, Japan; National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan; Institute of Interdisciplinary Research, Institute for Active Health, Kyoto University of Advanced Science, Kameoka City, Kyoto, Japan.
National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan; Institute of Interdisciplinary Research, Institute for Active Health, Kyoto University of Advanced Science, Kameoka City, Kyoto, Japan; Senior Citizen's Welfare Section, Kameoka City Government, Kameoka City, Kyoto, Japan.
出版信息
J Am Med Dir Assoc. 2022 Nov;23(11):1869.e7-1869.e18. doi: 10.1016/j.jamda.2022.04.017. Epub 2022 May 28.
OBJECTIVES
Some epidemiological studies of older American adults have reported a relationship between life-space mobility (LSM) and mortality. However, these studies did not show a dose-response relationship and did not include individuals from other countries. Therefore, we evaluated the dose-response relationship between LSM and mortality in older adults.
DESIGN
Prospective cohort study.
SETTING AND PARTICIPANTS
We used the data of 10,014 older Japanese adults (aged ≥65 years) who provided valid responses to the Life-Space Assessment (LSA) in the Kyoto-Kameoka study in Japan.
METHODS
LSM was evaluated using the self-administered LSA consisting of 5 items regarding life-space from person's bedroom to outside town. The LSM score was calculated by multiplying life-space level by frequency score by independence score, yielding a possible range of 0 (constricted life-space) to 120 (broad life-space). These scores were categorized into quartiles (Qs). Mortality data were collected from July 30, 2011 to November 30, 2016. A multivariate Cox proportional hazards model that included baseline covariates were used to evaluate the relationship between LSM score and mortality risk.
RESULTS
A total of 1030 deaths were recorded during the median follow-up period of 5.3 years. We found a negative association between LSM score and overall mortality even after adjusting for confounders [Q1: reference; Q2: hazard ratio (HR) 0.81, 95% CI 0.69-0.95; Q3: HR 0.70, 95% CI 0.59-0.85; Q4: HR 0.68, 95% CI 0.55-0.84, P for trend < .001]. Similar results were observed for the spline model; up to a score of 60 points, LSM showed a strong dose-dependent negative association with mortality, but no significant differences were observed thereafter (L-shaped relationship).
CONCLUSIONS AND IMPLICATIONS
Our findings demonstrate an L-shaped relationship between LSM and mortality. This study will be useful in establishing target values for expanding the range of mobility among withdrawn older adults with a constricted life-space.
目的
一些针对美国老年人的流行病学研究报告了生活空间移动性（LSM）与死亡率之间的关系。然而，这些研究并未显示出剂量反应关系，也未包括来自其他国家的个体。因此，我们评估了老年人 LSM 与死亡率之间的剂量反应关系。
设计
前瞻性队列研究。
地点和参与者
我们使用了日本京都-龟冈研究中 10014 名年龄在 65 岁及以上、对生活空间评估（LSA）有有效应答的老年人的数据。
方法
使用由 5 个关于从人的卧室到城镇以外的生活空间的项目组成的自我管理 LSA 评估 LSM。LSM 评分通过将生活空间水平乘以频率评分乘以独立性评分计算得出，可能范围为 0（受限生活空间）至 120（广泛生活空间）。这些分数被分为四分之一（Qs）。死亡率数据从 2011 年 7 月 30 日至 2016 年 11 月 30 日收集。使用包含基线协变量的多变量 Cox 比例风险模型评估 LSM 评分与死亡率风险之间的关系。
结果
在中位随访 5.3 年期间，共记录了 1030 例死亡。即使在调整了混杂因素后，我们发现 LSM 评分与全因死亡率之间存在负相关关系[Q1：参考；Q2：危险比（HR）0.81，95%可信区间（CI）0.69-0.95；Q3：HR 0.70，95%CI 0.59-0.85；Q4：HR 0.68，95%CI 0.55-0.84，P 趋势 <0.001]。在样条模型中也观察到了类似的结果；在分数高达 60 分之前，LSM 与死亡率呈强烈的剂量依赖性负相关，但此后没有观察到显著差异（L 型关系）。
结论和意义
我们的研究结果表明 LSM 与死亡率之间存在 L 型关系。本研究将有助于确定扩大活动范围的目标值，以改善活动受限的老年人的生活空间。
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