Department of Epidemiology, University of Washington, Seattle.
New York Academy of Medicine, New York.
JAMA Netw Open. 2023 May 1;6(5):e2311476. doi: 10.1001/jamanetworkopen.2023.11476.
To our knowledge, no published studies have investigated the association of ambulatory activity with risk of death among young and middle-aged American Indian individuals. The burden of chronic disease and risk of premature death is higher among American Indian individuals than among the general US population, so better understanding of the association of ambulatory activity with risk of death is needed to inform public health messaging in tribal communities.
To examine the association of objectively measured ambulatory activity (ie, steps per day) with risk of death among young and middle-aged American Indian individuals.
DESIGN, SETTING, AND PARTICIPANTS: The ongoing longitudinal Strong Heart Family Study (SHFS) is being conducted with participants aged 14 to 65 years in 12 rural American Indian communities in Arizona, North Dakota, South Dakota, and Oklahoma and includes up to 20 years of follow-up (February 26, 2001, to December 31, 2020). This cohort study included SHFS participants who had available pedometer data at baseline. Data analysis was performed on June 9, 2022.
Objectively measured ambulatory activity at baseline.
Outcomes of interest were total and cardiovascular-related mortality. Mixed-effects Cox proportional hazards regression was used to estimate hazard ratios for risk of death, with entry at the time of the pedometer assessment and time at risk until death or the latest adjudicated date of follow-up.
A total of 2204 participants were included in this study. Their mean (SD) age was 41.0 (16.8) years; 1321 (59.9%) were female and 883 (40.1%) were male. During a mean follow-up of 17.0 years (range, 0-19.9 years), 449 deaths occurred. Compared with participants in the lowest quartile of steps per day (<3126 steps), individuals in the upper 3 quartiles of steps per day had lower risk of mortality, with hazard ratios of0.72 (95% CI, 0.54-0.95) for the first quartile, 0.66 (95% CI, 0.47-0.93) for the second quartile, and 0.65 (95% CI, 0.44-0.95) for the third quartile after adjustment for age, sex, study site, education, smoking status, alcohol use, diet quality, body mass index, systolic blood pressure, prevalent diabetes, prevalent cardiovascular disease, biomarker levels (fibrinogen, low-density lipoprotein cholesterol, and triglycerides), medication use (hypertensive or lipid-lowering agents), and self-reported health status. The magnitude of the hazard ratios was similar for cardiovascular mortality.
In this cohort study, American Indian individuals who took at least 3126 steps/d had a lower risk of death compared with participants who accumulated fewer steps per day. These findings suggest that step counters are an inexpensive tool that offers an opportunity to encourage activity and improve long-term health outcomes.
据我们所知，尚无已发表的研究调查美国印第安年轻和中年个体的日间活动与死亡风险之间的关联。与美国一般人群相比，美国印第安个体的慢性病负担和过早死亡风险更高，因此，为了为部落社区的公共卫生信息传递提供依据，更深入地了解日间活动与死亡风险之间的关联非常重要。
检测美国印第安年轻和中年个体中，经客观测量的日间活动（即每天的步数）与死亡风险之间的关联。
设计、地点和参与者：正在进行的纵向“强壮心脏家族研究”（SHFS）纳入了亚利桑那州、北达科他州、南达科他州和俄克拉荷马州的 12 个农村美国印第安社区中年龄在 14 岁至 65 岁之间的参与者，最长随访时间为 20 年（2001 年 2 月 26 日至 2020 年 12 月 31 日）。本队列研究纳入了基线时具有可用计步器数据的 SHFS 参与者。数据分析于 2022 年 6 月 9 日进行。
基线时经客观测量的日间活动。
感兴趣的结局是总死亡率和心血管相关死亡率。采用混合效应 Cox 比例风险回归估计风险比，风险从计步器评估时开始计算，风险时间一直持续到死亡或最近的随访裁定日期。
本研究共纳入 2204 名参与者。他们的平均（SD）年龄为 41.0（16.8）岁；1321 名（59.9%）为女性，883 名（40.1%）为男性。在平均 17.0 年（0-19.9 年）的随访期间，发生了 449 例死亡。与每天步数处于最低四分位（<3126 步）的参与者相比，每天步数处于较高 3 个四分位的参与者死亡风险更低，风险比分别为 0.72（95%CI，0.54-0.95）（第 1 四分位）、0.66（95%CI，0.47-0.93）（第 2 四分位）和 0.65（95%CI，0.44-0.95）（第 3 四分位），校正年龄、性别、研究地点、教育程度、吸烟状况、饮酒情况、饮食质量、体重指数、收缩压、现患糖尿病、现患心血管疾病、生物标志物水平（纤维蛋白原、低密度脂蛋白胆固醇和甘油三酯）、药物使用（降压或降脂药物）和自我报告的健康状况后。心血管死亡率的危险比幅度相似。
在本队列研究中，每天至少走 3126 步的美国印第安个体与每天步数较少的参与者相比，死亡风险较低。这些发现表明，计步器是一种廉价工具，可以鼓励活动并改善长期健康结局。
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