Cai Minglong, Wu Xiaoting, Jin Huizhi, Li Zhenyu, Li Yujing, Chen Zhu
Department of Rheumatology and Immunology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, 230001, Hefei, Anhui, China.
Department of Gynecology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, 230001, Hefei, Anhui, China.
BMC Public Health. 2024 Dec 18;24(1):3494. doi: 10.1186/s12889-024-21004-8.
Patients with arthritis exhibit abnormal serum folate concentrations and have a higher incidence of cancer. The aim of this study was to investigate the association of serum folate concentrations with cancer mortality among individuals with arthritis.
This cohort study included 7,514 patients with arthritis from National Health and Nutrition Examination Survey (NHANES) 1999 to 2016 and NHANES III (1988-1994). Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. Serum folate concentrations were categorized into 4 groups, group 1 (≤ 17 nmol/L); group 2 (17-≤34 nmol/L); group 3 (34-≤51 nmol/L); and group 4 (> 51 nmol/L). Cox regression models were used to calculate hazard ratios and 95% confidence intervals for the associations between folate concentrations and the risk of mortality.
During a median follow-up of 9.75 [interquartile range, IQR, 5.75-14.5] years, there were 2,602 all-cause deaths, 949 deaths due to cardiovascular disease, and 478 deaths due to cancer. A non-linear association was observed for folate concentrations with the risk of cancer mortality (P < 0.001) among arthritis patients. Compared with the reference group 2, the hazard ratios for cancer mortality were 1.75 (95% CI, 1.15-2.69) in group 1, 1.70 (95% CI, 1.17-2.46) in group 3, and 1.60 (95% CI, 1.13-2.25) in group 4.
This study shows that both low and high levels of serum folate are associated with an increased risk of cancer mortality among individuals with arthritis, indicating a potential beneficial role of maintaining moderate serum folate concentrations in decreasing the risk of cancer mortality among this population.
关节炎患者血清叶酸浓度异常，且患癌几率更高。本研究旨在调查关节炎患者血清叶酸浓度与癌症死亡率之间的关联。
这项队列研究纳入了1999年至2016年美国国家健康与营养检查调查（NHANES）以及第三次NHANES（1988 - 1994年）中的7514例关节炎患者。通过与国家死亡指数记录相链接，确定截至2019年12月31日的死亡结局。血清叶酸浓度分为4组，第1组（≤17 nmol/L）；第2组（17 - ≤34 nmol/L）；第3组（34 - ≤51 nmol/L）；第4组（>51 nmol/L）。采用Cox回归模型计算叶酸浓度与死亡风险之间关联的风险比及95%置信区间。
在中位随访9.75年[四分位间距（IQR）为5.75 - 14.5年]期间，共有2602例全因死亡、949例心血管疾病死亡和478例癌症死亡。在关节炎患者中，观察到叶酸浓度与癌症死亡风险呈非线性关联（P < 0.001）。与参照组2相比，第1组癌症死亡的风险比为1.75（95%置信区间为1.15 - 2.69），第3组为1.70（95%置信区间为1.17 - 2.46），第4组为1.60（95%置信区间为1.13 - 2.25）。
本研究表明，血清叶酸水平过低或过高均与关节炎患者癌症死亡风险增加相关，这表明维持适度的血清叶酸浓度对于降低该人群的癌症死亡风险可能具有有益作用。
