刘雪娇,王炳源,任永成,赵阳,刘德臣,张冬冬,陈序,刘磊磊,程诚,刘飞燕,周琼桂,陈国桢,洪士皓,刘丹,胡思琦,张明,胡东生.高血压人群中体质指数与全死因死亡风险的队列研究[J].中华流行病学杂志,2018,39(7):914-919 |
高血压人群中体质指数与全死因死亡风险的队列研究 |
A cohort study on body mass index and risk of all-cause mortality among hypertensive population |
收稿日期:2018-01-14 出版日期:2018-07-17 |
DOI:10.3760/cma.j.issn.0254-6450.2018.07.010 |
中文关键词: 体质指数 死亡 高血压 肥胖悖论 |
英文关键词: Body mass index Mortality Hypertension Obesity paradox |
基金项目:国家自然科学基金(81373074,81402752,81673260) |
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中文摘要: |
目的 探讨高血压队列人群中BMI和全死因死亡风险的关系。方法 研究对象为河南省某农村地区高血压队列人群,应用Cox风险比例回归模型计算基线时不同BMI水平人群随访期间的全死因死亡比例HR值及其95% CI,并采用限制性立方样条模型拟合BMI与全死因死亡风险的剂量-反应关系。结果 5 461名高血压队列人群累积随访31 048.38人年,平均随访6年,随访期间死亡589人。控制潜在的混杂因素后,以基线正常体重组(18.5 kg/m2 < BMI < 24.0 kg/m2)为参照,低体重组(BMI<18.5 kg/m2)、超重组(24.0 kg/m2 < BMI < 28.0 kg/m2)和肥胖组(BMI≥28 kg/m2)人群发生死亡的HR值(95% CI)分别为0.83(0.37~1.87)、0.81(0.67~0.97)和0.72(0.56~0.91)。限制性立方样条模型分析结果显示,在高血压队列人群中,基线BMI和全死因死亡风险关联强度呈现倒“S”形非线性剂量反应关系(非线性检验P<0.001)。结论 超重和肥胖可能是高血压人群死亡风险的保护因素,与“肥胖悖论”一致。 |
英文摘要: |
Objective To investigate the relationship between body mass index (BMI) and all-cause mortality in hypertensive population. Methods All participants were selected from a prospective cohort study based on a rural population from Henan province, China. Cox proportional hazards regression models were used to estimate the associations of different levels of BMI stratification with all-cause mortality. Restricted cubic spline models were used to detect the dose-response relation. Results Among the 5 461 hypertensive patients, a total of 31 048.38 person-years follow-up was conducted. The median of follow-up time was 6 years, and 589 deaths occurred during the follow-up period. Compared to normal weight group (18.5 kg/m2 < BMI < 24.0 kg/m2) the multivariate-adjusted hazard ratios for all-cause mortality associated with BMI levels (<18.5 kg/m2, 24-28 kg/m2, and ≥ 28 kg/m2) were 0.83 (95%CI:0.37-1.87), 0.81 (95%CI:0.67-0.97), and 0.72 (95%CI:0.56-0.91), respectively. The dose-response analysis showed a nonlinear, reverse "S" shaped relationship (non-linearity P<0.001). Conclusion Overweight or obese might have a protective effect on all-cause mortality in hypertensive population, which supports the "obesity paradox" phenomenon. |
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