Nosraty Lily, Turunen Esko, Kyrönlahti Saila, Nygård Clas-Håkan, Kc Prakash, Neupane Subas
Faculty of Social Sciences, Centre of Excellence in Research on Ageing and Care, University of Helsinki, Helsinki, Finland.
Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere Universities, Tampere, Finland.
BMC Med Res Methodol. 2025 Jan 27;25(1):20. doi: 10.1186/s12874-025-02477-6.
This study set out to identify the factors and combinations of factors associated with the individual's premature death, using data from the Finnish Longitudinal Study on Ageing Municipal Employees (FLAME) which involved 6,257 participants over a 29-year follow-up period. Exact dates of death were obtained from the Finnish population register. Premature death was defined as a death occurring earlier than the age- and sex-specific actuarial life expectancy indicated by life tables for 1981, as the baseline, with the threshold period of nine months. Explanatory variables encompassed sociodemographic characteristics, health and functioning, health behaviors, subjective experiences, working conditions, and work abilities. Data were mined using the General Unary Hypothesis Automaton (GUHA) method, implemented with LISp-Miner software. GUHA involves an active dialogue between the user and the LISp-Miner software, with parameters tailored to the data and user interests. The parameters used are not absolute but depend on the data to be mined and the user's interests.
Over the follow-up period, 2,196 deaths were recorded, of which 70.4% were premature. Seven single factors and 67 sets of criteria (paths) were statistically significantly associated with premature mortality, passing the one-sided Fisher test. Single predicates of premature death included smoking, consuming alcohol a few times a month or once a week, poor self-rated fitness, incompetence to work and poor assured workability in two years' time, and diseases causing work disability. Notably, most of the factors selected as single predicates of premature mortality did not appear in the multi-predicate paths. Factors appearing in the paths were smoking more than 20 cigarettes a day, symptoms that impaired functioning, past smoking, absence of musculoskeletal diseases, poor self-rated health, having pain, male sex, being married, use of medication, more physical strain compared to others, and high life satisfaction, intention to retire due to reduced work ability caused by diseases and demanding work. Sex-specific analysis revealed similar findings.
The findings indicate that associations between single predictors and premature mortality should be interpreted with caution, even when adjusted for a limited number of other factors. This highlights the complexity of premature mortality and the need for comprehensive models considering multiple interacting factors.
本研究旨在利用芬兰市政雇员老龄化纵向研究（FLAME）的数据，确定与个体过早死亡相关的因素及因素组合。该研究在29年的随访期内涉及6257名参与者。确切的死亡日期来自芬兰人口登记处。过早死亡定义为早于以1981年生命表所示的年龄和性别特异性精算预期寿命死亡，以九个月为阈值期。解释变量包括社会人口学特征、健康与功能、健康行为、主观体验、工作条件和工作能力。数据使用通用一元假设自动机（GUHA）方法挖掘，该方法通过LISp-Miner软件实现。GUHA涉及用户与LISp-Miner软件之间的积极对话，其参数根据数据和用户兴趣进行调整。所使用的参数并非绝对，而是取决于要挖掘的数据和用户兴趣。
在随访期内，记录了2196例死亡，其中70.4%为过早死亡。七个单一因素和67组标准（路径）与过早死亡率在统计学上显著相关，通过了单侧Fisher检验。过早死亡的单一预测因素包括吸烟、每月饮酒几次或每周饮酒一次、自我评定的健康状况不佳、工作能力不足以及两年内工作可保障性差，还有导致工作残疾的疾病。值得注意的是，大多数被选为过早死亡率单一预测因素的因素并未出现在多因素路径中。出现在路径中的因素包括每天吸烟超过20支、功能受损症状、既往吸烟、无肌肉骨骼疾病、自我评定的健康状况不佳、疼痛、男性、已婚、使用药物、与他人相比身体压力更大、生活满意度高、因疾病导致工作能力下降和工作要求高而打算退休。按性别进行的分析得出了类似的结果。
研究结果表明，即使在对有限数量的其他因素进行调整后，单一预测因素与过早死亡率之间的关联也应谨慎解释。这凸显了过早死亡的复杂性以及需要考虑多个相互作用因素的综合模型。
