Hu Yizhen, Sun Qiufen, Han Yuting, Yu Canqing, Guo Yu, Sun Dianjianyi, Pang Yuanjie, Pei Pei, Yang Ling, Chen Yiping, Du Huaidong, Wang Mengwei, Stevens Rebecca, Chen Junshi, Chen Zhengming, Li Liming, Lv Jun
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350000, China.
Chin Med J (Engl). 2025 Jun 20;138(12):1456-1464. doi: 10.1097/CM9.0000000000003160. Epub 2024 Aug 28.
Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization.
Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality.
Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases.
In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.
坚持健康的生活方式是否与较低的肺炎发病风险及更好的长期预后相关尚不清楚。本研究旨在调查个体及综合生活方式因素（LFs）与肺炎住院的发病风险及长期预后之间的关联。
利用中国嘉道理生物银行研究的数据，我们使用多状态模型来研究五个高危LFs的作用，包括吸烟、过量饮酒、不健康的饮食习惯、缺乏身体活动和不健康的体型，单独或联合作用于从基线时的一般健康状态到肺炎住院或心血管疾病（CVD，视为对照结局），随后至死亡的转变过程。
五个高危LFs中的大多数与从基线到肺炎以及从肺炎到死亡的转变风险增加相关，但风险估计有所不同。高危LFs的数量越多，发生肺炎的风险以及肺炎后的长期死亡风险越高，关联强度与LFs和CVD相当。与有0 - 1个高危LF的参与者相比，有五个高危LF的参与者从基线到肺炎以及从肺炎到死亡的调整后风险比（HRs）和95%置信区间（CIs）分别为1.43（1.28 - 1.60）和1.98（1.61 - 2.42）。相应地，从基线到CVD以及从CVD到死亡的各自HRs（95% CIs）分别为2.00（1.89 - 2.11）和1.44（1.30 - 1.59）。在进一步调整主要慢性病的存在情况后，风险估计略有变化。
在这一中国人群中，不健康的LFs与肺炎发病率增加及长期死亡风险相关。
