Leigh J P, Fries J F
San Jose State University, CA 95192-0114.
Bull N Y Acad Med. 1994 Summer;71(1):69-86.
Subsets were analyzed of respondents from the Epidemiological Follow-up to the National Health and Nutrition Examination Survey I (NHANES I) who (1) answered a general arthritis question reflecting whether a doctor told the respondent that she or he had arthritis, (2) answered seven pain, swelling, and stiffness questions, and (3) had radiographs of knees and hips assessed for osteoarthritis at the time of the initial survey during the early 1970s. Data for the follow-up were collected between 1982 and 1984 and included 1,491 fatalities in the largest subsample analyzed here. The dependent variable was months of survival after the initial interview. No distinction was drawn between rheumatoid arthritis versus osteoarthritis. The NHANES I contained only limited information on rheumatoid arthritis versus osteoarthritis. Additional covariates included age, age squared, education, race, marital status, diastolic blood pressure, and body mass. After adjusting for age, no statistically significant associations emerged between answers to the general arthritis questions or any of the seven pain questions on the one hand, and mortality on the other. Similar statistically insignificant results were found when the association between radiographic diagnoses of osteoarthritis in the hips and months of survival was considered after adjusting for age. These statistically insignificant results persisted in repeated testing, which alternately included and excluded a number of covariates, and in separate subsamples of women, men, and persons older and younger than age 50. Some evidence was found, however, for a negative, statistically significant association between radiographic knee diagnoses of osteoarthritis and survival, especially among women, even after adjusting for covariates. These mixed results (1) do not discredit findings elsewhere suggesting that rheumatoid arthritis is associated with early death, since it is likely that the great majority of respondents answering in the affirmative to the general arthritis or seven pain questions in the NHANES I had osteoarthritis, and (2) suggest that future surveys should make greater attempts to distinguish between rheumatoid arthritis and osteoarthritis.
对来自第一次全国健康与营养检查调查（NHANES I）流行病学随访的受访者子集进行了分析，这些受访者满足以下条件：（1）回答了一个关于是否有医生告知其患有关节炎的一般性关节炎问题；（2）回答了七个关于疼痛、肿胀和僵硬的问题；（3）在20世纪70年代初的初次调查时，其膝盖和臀部的X光片被评估是否患有骨关节炎。随访数据收集于1982年至1984年之间，在此分析的最大子样本中包括1491例死亡病例。因变量是初次访谈后的存活月数。类风湿关节炎和骨关节炎之间未作区分。NHANES I中关于类风湿关节炎和骨关节炎的信息有限。其他协变量包括年龄、年龄平方、教育程度、种族、婚姻状况、舒张压和体重。在调整年龄后，一方面，一般性关节炎问题或七个疼痛问题中的任何一个的回答与另一方面的死亡率之间未出现统计学上显著的关联。在调整年龄后，考虑臀部骨关节炎的X光诊断与存活月数之间的关联时，也发现了类似的无统计学意义的结果。这些无统计学意义的结果在反复测试中持续存在，反复测试交替纳入和排除了一些协变量，并且在女性、男性以及年龄大于和小于50岁的人群的单独子样本中也是如此。然而，即使在调整协变量后，仍发现一些证据表明，骨关节炎的膝盖X光诊断与存活之间存在负面的、统计学上显著的关联，尤其是在女性中。这些混合结果：（1）并不否定其他地方表明类风湿关节炎与早死相关的研究结果，因为很可能在NHANES I中对一般性关节炎或七个疼痛问题回答为肯定的绝大多数受访者患有骨关节炎；（2）表明未来的调查应更加努力地区分类风湿关节炎和骨关节炎。
