Salive M E, Satterfield S, Ostfeld A M, Wallace R B, Havlik R J
Demography and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, MD.
Public Health Rep. 1993 May-Jun;108(3):314-22.
The role of functional and cognitive limitations in the risk of pneumonia-related mortality in older adults was examined. As part of a cohort study in 3 communities (East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA), 6,234 women and 4,035 men ages 65 or older completed baseline interviews between 1981 and 1983 and were followed for up to 6 years. Sex-specific Cox proportional-hazards regression models were used to examine the association of baseline physical and cognitive functioning with report of pneumonia (ICD9 480-486) as an underlying, immediate, or contributing cause of death. During followup, a total of 243 men and 160 women died with pneumonia. Adjusting for age, race, education, evidence of five chronic diseases, and smoking status, a significantly increased risk of pneumonia mortality (P < 0.05) was found for limitations in activities of daily living and cognitive impairment among both men and women. Inability to walk a half mile, climb stairs, or perform heavy housework was significantly associated with increased risk of pneumonia mortality for women but not for men in the same multivariate models. Men and women whose body-mass index was above the median had significantly lower risk of pneumonia mortality compared with those in the lowest quartile. Further elucidation of the sequence between physical and cognitive impairment and risk of pneumonia will be important in reducing pneumonia-associated morbidity and mortality.
研究了功能和认知障碍在老年人肺炎相关死亡风险中的作用。作为在3个社区（马萨诸塞州东波士顿；康涅狄格州纽黑文；爱荷华州和华盛顿县）进行的队列研究的一部分，6234名65岁及以上的女性和4035名男性在1981年至1983年期间完成了基线访谈，并随访了长达6年。使用特定性别的Cox比例风险回归模型来检验基线身体和认知功能与肺炎报告（国际疾病分类第九版480 - 486）作为潜在、直接或促成死亡原因之间的关联。在随访期间，共有243名男性和160名女性死于肺炎。在调整年龄、种族、教育程度、五种慢性病的证据和吸烟状况后，发现男性和女性日常生活活动受限和认知障碍的肺炎死亡风险显著增加（P < 0.05）。在相同的多变量模型中，女性无法行走半英里、爬楼梯或进行繁重家务与肺炎死亡风险增加显著相关，而男性则不然。体重指数高于中位数的男性和女性与四分位数最低者相比，肺炎死亡风险显著较低。进一步阐明身体和认知障碍与肺炎风险之间的先后顺序对于降低肺炎相关的发病率和死亡率将具有重要意义。
