定期健康检查与 625279 名高血压老年患者死亡率降低的关联：一项基于人群的队列研究。

Association of regular health check-ups with a reduction in mortality in 625,279 elderly participants with hypertension: A population-based cohort study.

机构信息

Clinical Research Center, Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China.

Clinical Research Center, Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China; Postdoctoral Station of Clinical Medicine, The Third Xiangya Hospital, Central South University, Changsha, 410013, China.

出版信息

Public Health. 2024 Dec;237:458-465. doi: 10.1016/j.puhe.2024.10.024. Epub 2024 Nov 14.

DOI:10.1016/j.puhe.2024.10.024

PMID:39547841

Abstract

OBJECTIVES

Health check-ups constitute an essential part of China's primary health care policy and a key measure for health screening and risk assessment for elderly people with hypertension and chronic diseases. The role of health check-ups in reducing the incidence of cardiovascular and all-cause mortality remains controversial. This study aimed to investigate the relationship between health check-ups and cardiovascular and all-cause mortality in elderly individuals with hypertension.

STUDY DESIGN

Retrospective cohort study.

METHODS

This study included 625,279 elderly participants with hypertension. Associations of regular and irregular health check-ups with cardiovascular disease related (CVD-related) mortality, all-cause mortality and non-CVD-related mortality were tested via the inverse probability of treatment weighting (IPTW) matching and Cox proportional hazard models. Adjusted hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated for mortality.

RESULTS

A total of 625,279 participants completed health assessments. During a median follow-up of 5.43 years, 45,927 CVD-related deaths and 25,519 non-CVD-related deaths were recorded. After IPTW, regular health check-ups were significantly associated with reduced CVD-related mortality and all-cause mortality (HR: 0.442, 95 % CI: 0.434-0.450; and HR: 0.441, 95 % CI: 0.435-0.448, respectively). An even stronger association between regular health check-ups and reduced CVD-related mortality was observed in participants with diabetes (HR: 0.40, 95 % CI: 0.39-0.42, P for interaction <0.001), dyslipidaemia (HR: 0.43, 95 % CI: 0.42-0.44, P for interaction <0.001) and a high risk or very high risk of hypertension (HR: 0.41, 95 % CI: 0.40-0.42, P for interaction <0.001).

CONCLUSIONS

Regular health check-ups may be associated with reductions in CVD mortality and all-cause mortality in the elderly population with hypertension, especially in individuals with diabetes, dyslipidaemia and a high risk or very high risk of hypertension.

摘要

目的

体检是中国初级卫生保健政策的重要组成部分，也是高血压和慢性病老年人群健康筛查和风险评估的关键措施。体检在降低心血管疾病发病率和全因死亡率方面的作用仍存在争议。本研究旨在探讨体检与高血压老年人群心血管疾病相关死亡率、全因死亡率和非心血管疾病相关死亡率之间的关系。

研究设计

回顾性队列研究。

方法

本研究纳入了 625279 名高血压老年患者。采用逆概率治疗加权（IPTW）匹配和 Cox 比例风险模型，检验定期和不定期体检与心血管疾病相关死亡率、全因死亡率和非心血管疾病相关死亡率之间的关联。采用调整后的风险比（HR）和 95%置信区间（CI）评估死亡率。

结果

共有 625279 名参与者完成了健康评估。在中位随访 5.43 年期间，记录到 45927 例心血管疾病相关死亡和 25519 例非心血管疾病相关死亡。经 IPTW 校正后，定期体检与心血管疾病相关死亡率和全因死亡率降低显著相关（HR：0.442，95%CI：0.434-0.450；HR：0.441，95%CI：0.435-0.448）。在患有糖尿病（HR：0.40，95%CI：0.39-0.42，P 交互<0.001）、血脂异常（HR：0.43，95%CI：0.42-0.44，P 交互<0.001）和高血压高危或极高危（HR：0.41，95%CI：0.40-0.42，P 交互<0.001）的参与者中，定期体检与心血管疾病相关死亡率降低之间的关联更为显著。