Schmader K, George L K, Burchett B M, Hamilton J D, Pieper C F
Department of Medicine, Duke University Medical Center, and Durham Veterans Affairs Medical Center, North Carolina 27710, USA.
J Am Geriatr Soc. 1998 Aug;46(8):973-7. doi: 10.1111/j.1532-5415.1998.tb02751.x.
To examine the effect of black race and acute (negative life events) and chronic (lack of social support) psychological stress on the risk of herpes zoster in late life.
A population-based, prospective cohort study.
Central North Carolina.
Duke Established Populations for Epidemiological Studies of the Elderly, a stratified probability sample of community-dwelling persons more than 65 years of age.
Interviewers administered a comprehensive health survey to the participants in 1986-1987 (P1, n = 4162), 1989-1990 (P2, n = 3336), and 1992-1994 (P3, n = 2568). Incident cases of zoster between P1 and P2 and P2 and P3 served as the dependent variable. Hypothesis-testing variables included race, negative life events, and five measures of social support. Control variables included age, sex, education, cancer, chronic diseases, basic ADLs, instrumental ADLs, depression, self-rated health, hospitalization, and cigarette smoking. Statistical analyses employed chi-square tests and proportional hazards model.
At baseline, the sample had a mean age of 73.6 years and was 55% black, 45% white, and 65% female. There were 65 cases of zoster between P1 and P2 and 102 cases of zoster between P2 and P3. From P1 to P2, 1.4% of blacks and 3.4% of whites developed zoster (P < .001). From P2 to P3, 2.9% of blacks and 7.5% of whites developed zoster (P < .001). After controlling for the above variables, blacks were significantly less likely to develop zoster (adjusted risk ratio = 0.35; 95% confidence interval (CI), 0.24-0.51; P < .001). Negative life events increased the risk of zoster, but the result was borderline for statistical significance (adjusted RR = 1.38, 95% CI 0.96-1.97; P = .078). No measures of social support were significantly associated with zoster.
Black race decreased the risk of zoster in late life significantly. Measures of stress were not significantly related to zoster, but study limitations preclude definitive conclusions. Future research should focus on these factors in larger samples and different populations.
研究黑人种族、急性（负面生活事件）和慢性（缺乏社会支持）心理压力对晚年带状疱疹风险的影响。
一项基于人群的前瞻性队列研究。
北卡罗来纳州中部。
杜克老年人流行病学研究既定人群，这是一个对65岁以上社区居住者进行分层概率抽样的样本。
访谈者在1986 - 1987年（P1，n = 4162）、1989 - 1990年（P2，n = 3336）和1992 - 1994年（P3，n = 2568）对参与者进行了全面的健康调查。P1与P2之间以及P2与P3之间的带状疱疹发病病例作为因变量。假设检验变量包括种族、负面生活事件和五项社会支持指标。控制变量包括年龄、性别、教育程度、癌症、慢性病、基本日常生活活动能力、工具性日常生活活动能力、抑郁、自评健康状况、住院情况和吸烟情况。统计分析采用卡方检验和比例风险模型。
在基线时，样本的平均年龄为73.6岁，55%为黑人，45%为白人，65%为女性。P1与P2之间有65例带状疱疹病例，P2与P3之间有102例带状疱疹病例。从P1到P2，1.4%的黑人及3.4%的白人患上带状疱疹（P < .001）。从P2到P3，2.9%的黑人及7.5%的白人患上带状疱疹（P < .001）。在对上述变量进行控制后，黑人患带状疱疹的可能性显著降低（调整风险比 = 0.35；95%置信区间（CI），0.24 - 0.51；P < .001）。负面生活事件会增加带状疱疹的风险，但结果在统计学显著性方面处于临界状态（调整风险比 = 1.38，95% CI 0.96 - 1.97；P = .078）。没有任何社会支持指标与带状疱疹有显著关联。
黑人种族在晚年显著降低了带状疱疹的风险。压力指标与带状疱疹无显著关联，但研究局限性使得无法得出确定性结论。未来研究应在更大样本和不同人群中关注这些因素。
