Luoto R, Prättälä R, Uutela A, Puska P
Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
Prev Med. 1998 Jan-Feb;27(1):93-100. doi: 10.1006/pmed.1997.0249.
Our aim was to study how combinations of three unhealthy behaviors (smoking, physical inactivity, and use of dairy fat) and an index describing their number were associated with the risk of cardiovascular mortality in a society showing remarkable improvement in health behaviors.
The material consisted of random samples of annual adult health behavior surveys from 1978 to 1991; included were 8,869 men and 10,105 women ages 45 to 64 years. The mortality follow-up covered Years 1978 to 1993. The study period was divided into four phases on the basis of number of deaths and timing of health behavior changes. Poisson multivariate models were used to determine the risk of cardiovascular mortality by all combinations of unhealthy behaviors and the index. In the models age, education, chronic morbidity, and body mass index were adjusted for.
Each unhealthy behavior was found to be a risk factor for cardiovascular mortality when the whole study period was examined. Among men, daily smoking was a significant predictor of cardiovascular mortality in the first three phases, among women in the first and third phase. Among men physical inactivity became significant only in the last phase, among women in all except the last phase. The combinations of physical inactivity with use of dairy fat or with smoking were more significant for women than for men. The combination of smoking and use of dairy fat was significant only for men. The association of the index with cardiovascular mortality was slightly stronger among women than among men.
The predictive values of unhealthy behaviors on cardiovascular mortality changed by period depending on their frequency. The combinations of unhealthy behaviors are to be preferred over the index in description of lifestyle determinants of cardiovascular mortality.
我们的目的是研究在一个健康行为有显著改善的社会中，三种不健康行为（吸烟、缺乏身体活动和食用乳脂肪）的组合以及描述这些行为数量的指数与心血管疾病死亡率风险之间的关联。
材料包括1978年至1991年年度成人健康行为调查的随机样本；其中有8869名年龄在45至64岁的男性和10105名女性。死亡率随访涵盖1978年至1993年。根据死亡人数和健康行为变化的时间，将研究期分为四个阶段。使用泊松多变量模型来确定不健康行为和指数的所有组合导致心血管疾病死亡的风险。在模型中对年龄、教育程度、慢性发病率和体重指数进行了调整。
在对整个研究期进行检查时，发现每种不健康行为都是心血管疾病死亡的危险因素。在男性中，每日吸烟在前三个阶段是心血管疾病死亡的显著预测因素，在女性中是第一和第三阶段。在男性中，缺乏身体活动仅在最后一个阶段变得显著，在女性中除最后一个阶段外的所有阶段都显著。缺乏身体活动与食用乳脂肪或吸烟的组合对女性比对男性更显著。吸烟与食用乳脂肪的组合仅对男性显著。该指数与心血管疾病死亡率之间的关联在女性中比在男性中略强。
不健康行为对心血管疾病死亡率的预测价值因时期而异，取决于其频率。在描述心血管疾病死亡率的生活方式决定因素时，不健康行为的组合比指数更可取。
