Bai Anying, Chen Qiushi, Geldsetzer Pascal, Gray Muir, Xie Zhilan, Zhang Daqian, Baernighausen Till, Hu Yixin, Jiang Yu, Chen Simiao
Chinese Academy of Medical Sciences & Peking Union Medical College, School of Population Medicine and Public Health, Beijing, China.
The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, 302 Leonhard Building, University Park, PA 16802, USA.
Age Ageing. 2024 Nov 28;53(12). doi: 10.1093/ageing/afae269.
The impact of cardiometabolic multimorbidity (CMM) on functional dependency (FD) is well established, but the temporal effect of FD on CMM and its mechanisms remain underexplored.
A multicohort study pooled data from three international cohorts.
Data were sourced from the Health and Retirement Study (USA), the China Health and Retirement Longitudinal Study (China) and the Survey of Health, Ageing and Retirement in 18 European countries.
FD was defined as the inability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs) independently. CMM was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease and stroke. Generalised estimating equation models assessed associations between FD and CMM, with mediation analysis using the Karlson, Holm and Breen method to explore the effects of hypertension and depressive symptoms. Sensitivity analyses ensured robustness.
The final cohort included 157 512 and 190 249 individuals for ADL and IADL analyses, respectively. CMM prevalence was 18.97% and 16.65% in these groups. FD was consistently associated with higher CMM risk, with odds ratios ranging from 1.47 (95% confidence interval: 1.33-1.63) to 1.56 (1.42-1.73). Hypertension and depressive symptoms increased CMM risk, particularly at higher FD levels. Mediation analysis showed hypertension and depressive symptoms accounted for 8.01%-16.43% and 12.04%-18.36% of the adverse effect of FD on CMM, respectively, with more pronounced effects among smokers and heavy drinkers.
Targeted interventions focusing on hypertension, mental wellness, lifestyle factors, and integrated treatments for FD are crucial to prevent CMM in older adults.
心血管代谢共病（CMM）对功能依赖（FD）的影响已得到充分证实，但FD对CMM的时间效应及其机制仍未得到充分探索。
一项多队列研究汇总了来自三个国际队列的数据。
数据来源于健康与退休研究（美国）、中国健康与养老追踪调查（中国）以及18个欧洲国家的健康、老龄化和退休调查。
FD被定义为无法独立进行日常生活基本活动（ADL）和工具性日常生活活动（IADL）。CMM被定义为同时出现两种或三种心血管代谢疾病，包括糖尿病、心脏病和中风。广义估计方程模型评估FD与CMM之间的关联，并使用卡尔森、霍尔姆和布林方法进行中介分析，以探讨高血压和抑郁症状的影响。敏感性分析确保了稳健性。
最终队列分别包括157512名和190249名个体用于ADL和IADL分析。这些组中CMM的患病率分别为18.97%和16.65%。FD始终与较高的CMM风险相关，比值比范围为1.47（95%置信区间：1.33 - 1.63）至1.56（1.42 - 1.73）。高血压和抑郁症状增加了CMM风险，尤其是在较高的FD水平时。中介分析表明，高血压和抑郁症状分别占FD对CMM不良影响的8.01% - 16.43%和12.04% - 18.36%，在吸烟者和重度饮酒者中影响更为明显。
针对高血压、心理健康、生活方式因素的针对性干预以及FD的综合治疗对于预防老年人的CMM至关重要。
