4种慢性病共病模式及运动与全因死亡的相关性研究

孙明希; 温启邦; 涂华康; 李舒; 冯旋; 王思聪; 吴息凤

文章摘要

孙明希,温启邦,涂华康,李舒,冯旋,王思聪,吴息凤.4种慢性病共病模式及运动与全因死亡的相关性研究[J].中华流行病学杂志,2022,43(12):1952-1958

4种慢性病共病模式及运动与全因死亡的相关性研究

Associations between multimorbidity patterns of 4 chronic diseases and physical activity with all-cause mortality

收稿日期:2022-01-27 出版日期:2022-12-17

DOI：10.3760/cma.j.cn112338-20220127-00084

中文关键词: 慢性病共病共病模式运动预期寿命

英文关键词: Multimorbidity Multimorbidity patterns Exercise Life expectancy

基金项目:浙江省智能预防医学重点实验室（2020E10004）；浙江省领军型创新创业团队（2019R01007）；浙江省重点研发计划（2020C03002）

作者	单位	E-mail
孙明希	浙江大学医学院附属第二医院临床大数据与统计中心, 杭州 310003
温启邦	浙江大学健康医疗大数据国家研究院, 杭州 310058
涂华康	浙江大学健康医疗大数据国家研究院, 杭州 310058
李舒	浙江大学公共卫生学院大数据健康科学系, 杭州 310058
冯旋	阿里巴巴-浙江大学未来数字医疗联合研究中心, 杭州 311121
王思聪	浙江省智能预防医学重点实验室, 杭州 310058
吴息凤	浙江大学医学院附属第二医院临床大数据与统计中心, 杭州 310003 浙江大学公共卫生学院大数据健康科学系, 杭州 310058	xifengw@zju.edu.cn

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中文摘要:

目的了解人群慢性病共病罹患现状、不同共病模式的全因死亡风险及运动对共病相关死亡风险和寿命损失的影响。方法研究纳入我国台湾地区美兆健康管理中心437 408名体检者，采用分类决策树对高血压、糖尿病、慢性肾功能不全（CKD）和慢性阻塞性肺疾病（COPD）4种疾病进行组合，使用Cox比例风险回归模型计算共病模式的危险比（HR）及其95%CI，采用蒋式寿命表法计算人群预期寿命。结果人群中共病检出率为8.7%，二元、三元、四元共病组合中检出率最高的分别为“高血压+CKD”（3.6%）、“高血压+糖尿病+CKD”（1.1%）、“高血压+糖尿病+CKD+COPD”（0.1%）；与健康人群相比，全因死亡风险最高的组合分别为“糖尿病+CKD”（HR=3.80，95%CI：3.45~4.18）、“糖尿病+COPD+CKD”（HR=4.34，95%CI：3.43~5.49）、“高血压+糖尿病+CKD+COPD”（HR=4.75，95%CI：4.15~5.43）。与不运动人群相比，进行低强度运动和中高强度运动均降低了由共病升高的死亡风险。单一疾病和共病带来4.6、13.4年的人群寿命损失，运动可分别挽回2.3、4.6年的寿命损失年，低强度和中高强度运动分别挽回1.5、3.7年由慢性病造成的寿命损失。结论基于“糖尿病+CKD”的共病模式死亡风险最高。运动能降低共病患者的死亡风险。运动强度越大，降低效果越显著。

英文摘要:

Objective To identify the prevalence of multimorbidity among a Chinese population, analyze the risk of all-cause mortality with different multimorbidity patterns, and the impact of exercise on the risk of multimorbidity-related mortality and life lost. Methods The study was based on 437 408 MJ Health Management Center participants. The classification decision tree was used to explore multimorbidity patterns composed of hypertension, diabetes, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). The Cox proportional hazards model was used to calculate the all-cause mortality hazard ratio (HR) for different multimorbidity patterns. Using Chiang's life table method, years of life lost were the difference in life expectancy for those with and without multimorbidity. Results The prevalence rate of multimorbidity was 8.7%. Among multivariate patterns, the most common ones were "hypertension+CKD" (3.6%), "hypertension + diabetes + CKD" (1.1%) and "hypertension+diabetes+CKD+COPD" (0.1%). Compared with a healthy population, patterns with the highest mortality risk were "diabetes+CKD" (HR=3.80, 95%CI: 3.45-4.18), "diabetes+CKD+COPD" (HR=4.34, 95%CI: 3.43-5.49) and "hypertension+ diabetes+CKD+COPD" (HR=4.75,95%CI:4.15-5.43). Through low-intensity and moderate to high-intensity exercise, the increased HRs were attenuatedcompared with the inactive population. People with single disease and multimorbidity shortened life by 4.6 and 13.4 years, while exercise attenuated 2.3 and 4.6 years of life lost, of which low-intensity and moderate to high-intensity exercise saved 1.5 and 3.7 years of life lost due to chronic diseases. Conclusions Multimorbidity patterns based on "diabetes + CKD" cause the highest mortality risk, and physical activity in reducing mortality was significant for either with or without multimorbidity. Higher exercise intensity leads to a greater relative reduction of mortality risk.

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