Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
BMC Public Health. 2023 Jan 6;23(1):35. doi: 10.1186/s12889-023-14978-4.
Lower physical activity and sedentary behavior have been identified as modifiable risk factors for cardiovascular disease (CVD). However, the quantitative, dose-response association between activity-to-sedentary ratio (ASR) and mortality is unknown.
Prospective cohort studies with participants 50 to 80 years that reported the association between recreational physical activity, sedentary behavior, and all-cause mortality were included from the 2007 to 2014 United States National Health and Nutrition Examination Survey (NHANES) and followed through December 31, 2015. Cox or Weibull regression models and restricted cubic splines were used to determine the association between ASR and all-cause mortality.
Sixty deaths occurred among 498 CVD survivors, with a median of 56 months of follow-up. After accounting for all covariates, CVD survivors with an ASR between 0.21 and 0.57 (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.25-0.87) and those with an ASR more than 0.57 (HR, 0.40; 95% CI, 0.20-0.81) were at significantly lower risk for mortality than participants with an ASR < 0.21. Moreover, a nonlinear negative association and an L-shaped association were observed for the level of ASR with risk of mortality among CVD survivors (P for nonlinearity = 0.004). What's more, adjusting for covariates, a statistically significant interaction (P for interaction = 0.016) between sex and ASR, an increase of ASR more than and equal to 0.18 was associated with a lower risk of mortality among males (HR, 0.23; 95% CI, 0.12-0.46).
An negative correlation between ASR and mortality in CVD survivors, especially in males when ASR is more than 0.18. Our novel findings provide further insights into easing the global burden of deaths.
体力活动减少和久坐行为增加已被确定为心血管疾病（CVD）的可改变危险因素。然而，活动-久坐比（ASR）与死亡率之间的定量、剂量反应关系尚不清楚。
纳入了 2007 年至 2014 年美国国家健康和营养调查（NHANES）中报告了休闲体力活动、久坐行为与全因死亡率之间关联的 50 至 80 岁的参与者的前瞻性队列研究，并随访至 2015 年 12 月 31 日。使用 Cox 或威布尔回归模型和限制三次样条来确定 ASR 与全因死亡率之间的关系。
在 498 名 CVD 幸存者中发生了 60 例死亡，中位随访时间为 56 个月。在考虑了所有协变量后，ASR 为 0.21 至 0.57（危险比[HR]，0.47；95%置信区间[CI]，0.25-0.87）和 ASR 大于 0.57（HR，0.40；95%CI，0.20-0.81）的 CVD 幸存者的死亡风险明显降低。此外，还观察到 CVD 幸存者中 ASR 水平与死亡率之间存在非线性负相关和 L 形关联（非线性检验 P=0.004）。更重要的是，在校正协变量后，性别和 ASR 之间存在统计学显著的交互作用（交互作用检验 P=0.016），ASR 增加 0.18 以上与男性死亡率降低相关（HR，0.23；95%CI，0.12-0.46）。
在 CVD 幸存者中，ASR 与死亡率呈负相关，尤其是当 ASR 大于 0.18 时，男性的相关性更强。我们的新发现为减轻全球死亡负担提供了进一步的见解。
