Killie Ida Løken, Braaten Tonje, Lorem Geir Fagerjord, Borch Kristin Benjaminsen
Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
Department of Psychology, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
Clin Epidemiol. 2024 Feb 20;16:109-120. doi: 10.2147/CLEP.S433965. eCollection 2024.
We investigated the association between self-rated health (SRH) and cancer incidence and SRH and all-cause mortality among Norwegian women.
We used data from 110,104 women in the Norwegian Women and Cancer (NOWAC) cohort aged 41-70 years at baseline. We used flexible parametric survival analysis with restricted cubic splines to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and mortality in the entire cohort. We employed the same method in a multistate design to assess associations between baseline SRH and 1) cancer incidence, and 2) all-cause mortality in subgroups of women who did and did not receive a cancer diagnosis during follow-up.
With very good SRH as reference category for all associations and median age at end of follow-up, lower SRH was associated with increased mortality (HR 1.19, 95% CI 1.12-1.26) and HR 1.81, 95% CI 1.66-1.97). Lower SRH at baseline was associated with cancer incidence (HR 1.14, 95% CI 1.08-1.20 and HR 1.44, 95% CI: 1.32-1.58). Poor baseline SRH was associated with increased mortality for women who received a cancer diagnosis (HR 1.20, 95% CI 1.04-1.39), and SRH showed a strong association with increased mortality for women who stayed cancer free (HR 1.59, 95% CI 1.44-1.77 and HR 3.34, 95% CI 2.91-3.84).
Lower SRH at baseline predicted increased cancer risk and all-cause mortality in middle-aged to older women. Poor SRH at baseline predicted all-cause mortality in women who later received a cancer diagnosis. Both good and poor SRH at baseline predicted all-cause mortality in women who stayed cancer-free, and the association was stronger for these women compared to both the entire cohort and to women who were subsequently diagnosed with cancer.
我们研究了挪威女性自我评估健康状况（SRH）与癌症发病率以及SRH与全因死亡率之间的关联。
我们使用了挪威女性与癌症（NOWAC）队列中110104名基线年龄在41至70岁之间的女性的数据。我们采用带有受限立方样条的灵活参数生存分析来计算整个队列中SRH与死亡率之间关联的风险比（HRs）和95%置信区间（CIs）。我们在多状态设计中采用相同方法来评估基线SRH与以下两者之间的关联：1）癌症发病率，以及2）在随访期间接受或未接受癌症诊断的女性亚组中的全因死亡率。
以所有关联的“非常好的SRH”作为参考类别以及随访结束时的中位年龄，较低的SRH与死亡率增加相关（HR 1.19，95% CI 1.12 - 1.26）以及HR 1.81，95% CI 1.66 - 1.97）。基线时较低的SRH与癌症发病率相关（HR 1.14，95% CI 1.08 - 1.20以及HR 1.44，95% CI：1.32 - 1.58）。基线SRH较差与接受癌症诊断的女性死亡率增加相关（HR 1.20，95% CI 1.04 - 1.39），并且SRH与未患癌症的女性死亡率增加有很强的关联（HR 1.59，95% CI 1.44 - 1.77以及HR 3.34，95% CI 2.91 - 3.84）。
基线时较低的SRH预示中年至老年女性患癌风险和全因死亡率增加。基线时较差的SRH预示后来接受癌症诊断的女性的全因死亡率。基线时良好和较差的SRH都预示未患癌症的女性的全因死亡率，并且与整个队列以及随后被诊断患有癌症的女性相比，这些女性的这种关联更强。
