Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Family Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
Hypertens Res. 2024 Aug;47(8):2053-2063. doi: 10.1038/s41440-024-01717-4. Epub 2024 May 23.
It remains unclear the age-specific associations of risk factors with deaths and mortality burden attributable across age. In a territory-wide retrospective cohort, 1,012,228 adults with hypertension were identified. Comorbidities including diabetes, chronic kidney disease (CKD), cardiovascular disease (CVD), heart failure, and cancer, and risk factors including current smoking and suboptimal control of blood pressure (BP), glucose and low-density lipoprotein cholesterol were defined. Associations of comorbidities/risk factors with all-cause and cause-specific mortality across age groups (18-54, 55-64, 65-74, and ≥75 years) were assessed. Population attributable fractions were also quantified. During a median follow-up of 10.7 years, 244,268 (24.1%) patients died, with pneumonia (7.2%), cancer (5.1%), and CVD (4.2%) being the leading causes. Despite increasing deaths with age, relative risk of mortality related to comorbidities/risk factors decreased with age; similar patterns were found for cause-specific mortality. The assessed risk factors accounted for 24.0% (95% CI 22.5%, 25.4%) deaths, with highest proportion in the youngest group (33.5% [28.1%, 38.5%] in 18-54 years vs 19.4% [17.0%, 21.6%] in ≥75 years). For mortality burden, CKD was the overall leading risk factor (12.7% [12.4%, 12.9%]) with higher proportions in older patients (11.1-13.1% in ≥65 years), while diabetes was the leading risk factor in younger patients (15.9-13.5% in 18-54 years). The association of comorbidities or risk factors with mortality is stronger in younger patients with hypertension, despite lower absolute mortality in young patients than in the elderly. Leading risk factors differed across age, highlighting the importance of targeted and precise risk management.
目前尚不清楚特定年龄的风险因素与全因死亡和各年龄段归因死亡负担之间的关系。在一项全港范围的回顾性队列研究中，共确定了 1012228 名高血压成年人。共病包括糖尿病、慢性肾脏病（CKD）、心血管疾病（CVD）、心力衰竭和癌症，以及风险因素包括当前吸烟和血压（BP）、血糖和低密度脂蛋白胆固醇控制不理想。评估了共病/风险因素与各年龄段（18-54 岁、55-64 岁、65-74 岁和≥75 岁）全因和死因特异性死亡率之间的关系。还量化了人群归因分数。在中位随访 10.7 年后，244268 名（24.1%）患者死亡，主要死因是肺炎（7.2%）、癌症（5.1%）和 CVD（4.2%）。尽管随着年龄的增长，死亡人数不断增加，但与共病/风险因素相关的死亡率的相对风险随着年龄的增长而降低；死因特异性死亡率也存在类似的模式。评估的风险因素占死亡人数的 24.0%（95%CI 22.5%，25.4%），在最年轻的组中占比最高（18-54 岁组为 33.5%[28.1%，38.5%]，≥75 岁组为 19.4%[17.0%，21.6%]）。在死亡负担方面，CKD 是总体上的主要风险因素（12.7%[12.4%，12.9%]），在年龄较大的患者中占比更高（≥65 岁患者中为 11.1-13.1%），而在年轻患者中糖尿病是主要风险因素（18-54 岁患者中为 15.9-13.5%）。尽管年轻患者的绝对死亡率低于老年患者，但高血压合并共病或风险因素的患者与死亡率的关联更强。不同年龄的主要风险因素不同，突出了有针对性和精确的风险管理的重要性。
