Matsuzaki Hideaki, Tsuji Taishi, Chen Tao, Chen Sanmei, Nofuji Yu, Narazaki Kenji
Department of Rehabilitation Center, Fukuoka Mirai Hospital.
Institute of Health and Sport Sciences, University of Tsukuba.
Nihon Koshu Eisei Zasshi. 2024 Oct 3;71(9):466-473. doi: 10.11236/jph.23-111. Epub 2024 Jun 24.
Objectives This study aimed to examine the cut-off point of the Risk Assessment Scale (RAS) for predicting the 9-year risk of functional disability among older Japanese adults.Methods This prospective, 9-year follow-up study used data from the Sasaguri Genkimon Study in Fukuoka. Of the 2,629 older adults who did not have functional disabilities and participated in the baseline survey in 2011, 2,254 with complete data were included in the analysis. The RAS was assessed using a questionnaire that showed good predictive and external validity for the 3-year risk of functional disability. The outcome was the incidence of functional disability during follow-up, which was defined as a new certification for the need for support or care. The cut-off point of the RAS was estimated as the point indicating the maximum χ value of the log-rank test. The predictive validity of the RAS for functional disability was examined using C-statistics for the total score, and sensitivity and specificity for the cut-off point, respectively. Participants were then categorized into two groups according to the cut-off point (high-score and low-score groups). Hazard ratio (HR) and 95% confidence interval (95% CI) of the 9-year risk of functional disability for the high-score group compared with the low-score group were calculated using the Cox proportional hazard model. In the multivariate model, HR was adjusted for living alone, education, economic status, drinking, smoking, and multimorbidity.Results New functional disability was certified in 647 participants (28.7%) during a median follow-up period of 8.75 years. The cut-off point for functional disability was 13/14. The C-statistic was 0.774, and the sensitivity and specificity were 0.726 and 0.712, respectively. Compared to the low-score group (0-13 points), the HR (95% CI) of the high-score group (≥ 14 points) for incident functional disability in 9 years was 5.50 (4.62-6.54) in the crude model, and 4.81 (4.00-5.78) in the multivariate model (P<.001).Conclusion This study, with its long follow-up period of 9 years, demonstrated that the 13/14 cut-off point of the RAS is suitable for the long-term assessment of functional disability risk. Our results suggest the possibility of using the 13/14 cut-off point of the RAS as a promising tool to grasp the risk of functional disability over a longer time frame, highlighting the potential for early prevention and intervention.
目的 本研究旨在探讨风险评估量表（RAS）在预测日本老年人群9年功能残疾风险时的截断点。
方法 这项前瞻性的9年随访研究使用了来自福冈笹栗健康调查的数据。在2011年参加基线调查且无功能残疾的2629名老年人中，2254名数据完整者纳入分析。使用一份对功能残疾3年风险具有良好预测效度和外部效度的问卷对RAS进行评估。结局为随访期间功能残疾的发生率，定义为新的需要支持或护理的认证。RAS的截断点估计为对数秩检验χ值最大时的点。分别使用总分的C统计量以及截断点的敏感度和特异度来检验RAS对功能残疾的预测效度。然后根据截断点将参与者分为两组（高分和低分两组）。使用Cox比例风险模型计算高分组合低分相比9年功能残疾风险的风险比（HR）和95%置信区间（95%CI）。在多变量模型中，对HR进行了独居、教育程度、经济状况、饮酒、吸烟和多种疾病并存情况的校正。
结果 在中位随访期8.75年期间，647名参与者（28.7%）被新认证为功能残疾。功能残疾的截断点为13/14。C统计量为0.774，敏感度和特异度分别为0.726和0.712。与低分组合（0 - 13分）相比，高分组合（≥14分）9年发生功能残疾的HR（95%CI）在粗模型中为5.50（4.62 - 6.54），在多变量模型中为4.81（4.00 - 5.78）（P <.001）。
结论 本研究长达9年的随访表明，RAS的13/14截断点适用于功能残疾风险的长期评估。我们的结果提示，RAS的13/14截断点有可能作为一种有前景的工具，用于在更长时间范围内把握功能残疾风险，凸显了早期预防和干预的潜力。
