文章摘要
林进龙,魏玥,陈功,林是琦,裴丽君.慢性病对中老年人跌倒伤害影响的队列研究[J].中华流行病学杂志,2022,43(2):218-226
慢性病对中老年人跌倒伤害影响的队列研究
A cohort study on the influence of the chronic diseases on falls among middle-aged and older Chinese
收稿日期:2021-05-06  出版日期:2022-02-16
DOI:10.3760/cma.j.cn112338-20210506-00375
中文关键词: 中老年人  跌倒伤害  慢性病  队列研究  交互作用
英文关键词: Middle aged and older adults  Fall  Chronic disease  Cohort study  Interaction
基金项目:国家自然科学基金(41871360);国家重点研发计划(2018YFC2000603)
作者单位E-mail
林进龙 北京大学人口研究所/北京大学中国人口健康与发展研究中心, 北京 100871  
魏玥 北京大学人口研究所/北京大学中国人口健康与发展研究中心, 北京 100871  
陈功 北京大学人口研究所/北京大学中国人口健康与发展研究中心, 北京 100871  
林是琦 北京大学人口研究所/北京大学中国人口健康与发展研究中心, 北京 100871  
裴丽君 北京大学人口研究所/北京大学中国人口健康与发展研究中心, 北京 100871 peilj@pku.edu.cn 
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中文摘要:
      目的 分析慢性病对我国中老年人跌倒伤害风险的影响。方法 数据来源于中国健康与养老追踪调查(CHARLS),以2011年基线调查募集的13 670名≥45岁中老年人作为研究对象并追踪至2018年,其中45~59岁中年人7 443例(54.45%),≥60岁老年人6 227例(45.55%)。采用Cox比例风险模型分析不同年龄人群慢性病种类、患慢性病数目及与其他暴露因素的交互作用对中老年人跌倒伤害风险的影响。结果 调整混杂因素后,与未患慢性病的中年人相比,患呼吸系统疾病和关节炎使跌倒伤害风险分别增加21%(HR=1.21,95%CI:1.02~1.45)和27%(HR=1.27,95%CI:1.12~1.43);与未患慢性病的老年人相比,患肾脏病使跌倒伤害风险增加26%(HR=1.26,95%CI:1.03~1.53)。中老年人群患慢性病数与跌倒伤害风险存在剂量-反应关系(χ2=133.61,P<0.001),且是线性关系;与男性、日常生活活动能力完好和无跌倒伤害史的非慢性病中老年人相比,女性、日常生活活动能力受损和有跌倒伤害史的中老年慢性病患者的跌倒伤害风险分别增加了64%(HR=1.64,95%CI:1.43~1.89)、66%(HR=1.66,95%CI:1.39~1.99)和158%(HR=2.58,95%CI:2.24~2.97)。结论 患慢性病数与我国中老年人跌倒伤害风险呈正向线性关系,女性、日常生活活动能力受损和有跌倒伤害史的中老年慢性病患者是重点干预的高危人群,建议及时将跌倒伤害预防窗口前移至中年期。
英文摘要:
      Objective To analyze the influence of chronic diseases on falls among middle-aged and older Chinese. Methods Baseline data of 13 670 middle-aged and older adults recruited from China Health and Retirement Longitudinal Study (CHARLS) in 2011 were used and followed up to 2018, among those were 7 443 (54.45%) middle-aged people aged 45-59 and 6 227 (45.55%) older adults aged 60 and above. The Cox proportional hazards model was used to analyze the effects of different types, the number of chronic diseases and the interaction between chronic illness and other factors on the fall risk of middle-aged and older people. Results After adjusting for confounding factors, respiratory diseases increased the risk of falls by 21% (HR=1.21, 95%CI:1.02-1.45), and arthritis increased the risk of falls by 27% (HR=1.27,95%CI: 1.12-1.43) in the group aged 45-59, kidney disease increased the risk of falls by 26% (HR=1.26, 95%CI: 1.03-1.53) in the group aged 60 and above. A linear dose-response relationship between the number of chronic diseases and fall risk (χ2=133.61, P<0.001) was found in all the age groups. The interaction between having chronic diseases and the factors of females (HR=1.64, 95%CI: 1.43-1.89), impaired activities of daily living (ADL) (HR=1.66, 95%CI: 1.39-1.99), and having a fall history (HR=2.58, 95%CI: 2.24-2.97) increased the risk of falls. Conclusions There is a positive linear relationship between the number of chronic diseases and the fall risk among Chinese aged 45 and above. The female middle-aged and elderly patients with chronic diseases and the middle-aged and elderly patients with impaired ADL or a history of falls are the high-risk groups for falls that need to be focused on intervention. The window of fall injury prevention should be moved forward to the middle-aged stage in time.
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