Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, Jiangxi, China.
Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Front Public Health. 2023 May 2;11:1024341. doi: 10.3389/fpubh.2023.1024341. eCollection 2023.
While both vitamin D deficiency and cognitive impairment have individually been linked to a greater risk of all-cause mortality, the combined effects of these two different conditions have not previously been explored in this context. We aimed to investigate the combined impact of vitamin D concentration and cognitive impairment on all-cause mortality in older adults.
The analyzed data were collected from community-dwelling adults ≥65 years of age that were enrolled in the Chinese Longitudinal Healthy Longevity Survey ( = 1,673). The Mini-Mental Status Examination (MMSE) was used to assess cognitive function, while the plasma 25-hydroxyvitamin D [25(OH)D] test was used to assess vitamin D status. The associations between vitamin D concentration, cognitive function, and all-cause mortality were assessed with Cox proportional hazards models. We used restricted cubic splines to examine the dose-response relationship between vitamin D and the risk of all-cause mortality and used joint effect testing to explore interactions between vitamin D concentration and cognitive function.
During a mean (SD) follow-up of 3.8 (1.9) years, 899 (53.7%) deaths occurred. A negative dose-response relationship was observed between 25(OH)D concentration and cognition impairment at baseline, as well as the odds of all-cause mortality during follow-up. Similarly, cognitive impairment was significantly related to all-cause mortality risk (HR 1.81, 95% CI: 1.54 to 2.12). The combined analyses showed positive associations, with the highest mortality risk observed in older adults with both low vitamin D and cognitive impairment (HR 3.04, 95% CI: 2.40 to 3.86). Moreover, the interaction between 25(OH)D concentration and cognitive function was found to be significant in relation to the risk of mortality ( for interaction <0.001).
Lower plasma 25(OH)D and cognitive impairment were, respectively, associated with increased all-cause mortality risks. The 25(OH)D concentration and cognitive impairment exhibited a combined additive effect on all-cause mortality among older Chinese adults.
虽然维生素 D 缺乏和认知障碍各自与全因死亡率的风险增加有关，但这两种不同情况的综合影响以前并未在这种情况下进行过探讨。我们旨在研究老年人维生素 D 浓度和认知障碍对全因死亡率的综合影响。
分析的数据来自参加中国长寿纵向研究（Chinese Longitudinal Healthy Longevity Survey，CLHLS）的社区居住的≥65 岁成年人（ = 1673）。使用简易精神状态检查（Mini-Mental Status Examination，MMSE）评估认知功能，使用血浆 25-羟维生素 D [25(OH)D]检测评估维生素 D 状态。使用 Cox 比例风险模型评估维生素 D 浓度、认知功能与全因死亡率之间的关联。我们使用限制性三次样条检验维生素 D 与全因死亡率风险之间的剂量-反应关系，并使用联合效应检验探索维生素 D 浓度与认知功能之间的相互作用。
在平均（标准差）3.8（1.9）年的随访期间，发生了 899 例（53.7%）死亡。在基线时，25(OH)D 浓度与认知障碍之间以及随访期间全因死亡率的发生均呈负剂量-反应关系。同样，认知障碍与全因死亡率风险显著相关（HR 1.81，95%CI：1.54 至 2.12）。联合分析显示存在正相关，维生素 D 和认知障碍均较低的老年人死亡率风险最高（HR 3.04，95%CI：2.40 至 3.86）。此外，发现 25(OH)D 浓度与认知功能之间的交互作用与死亡率风险相关（ for interaction <0.001）。
较低的血浆 25(OH)D 和认知障碍分别与全因死亡率风险增加相关。在老年中国成年人中，25(OH)D 浓度和认知障碍对全因死亡率表现出联合的附加效应。
