Thyroid function and life expectancy with and without noncommunicable diseases: A population-based study
Thyroid function and life expectancy with and without noncommunicable diseases: A population-based study
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DOI：
10.1371/journal.pmed.1002957
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发表时间：
2019-10-01
期刊：
影响因子：
15.8
通讯作者：
Franco, Oscar H.
中科院分区：
文献类型：
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作者：
Bano, Arjola;Chaker, Layal;Franco, Oscar H.
背景甲状腺功能在参考范围内的变化与疾病和死亡风险的增加有关。然而，甲状腺功能对有无非传染性疾病(NCDs)的预期寿命(LE)的影响仍不清楚。因此，我们的目标是在甲状腺功能正常的个体中调查甲状腺功能与总的LE和伴有和不伴有NCD的LE的关系。方法和结果这项研究被嵌入鹿特丹研究，这是一项在荷兰进行的基于人群的前瞻性研究。总共有7644名没有已知甲状腺疾病且促甲状腺激素(TSH)和游离甲状腺素(FT4)水平在参考范围内的参与者符合条件。非传染性疾病被定义为存在心血管疾病、2型糖尿病或癌症。我们使用多状态生命表的人口统计学工具来计算50岁时的LE估计，使用三种转变(健康到非传染性疾病、健康到死亡和非传染性疾病到死亡)的患病率、发病率和风险比。分别计算男性和女性TSH和FT4三分体中的总LE和有无NCD的LE。分析调整了社会人口学和心血管危险因素。参与者的平均年龄(标准差)为64.5岁(9.7岁)，其中52.3%是女性。在中位数8年(四分位间隔2.7-9.9年)的随访中，发生了1396起非传染性疾病事件和1422例死亡。与TSH值最低的三分位数相比，TSH值最高的三分位数的男性和女性的预期寿命分别延长1.5年(95%可信区间0.8-2.3，p<；0.001)和1.5年(CI0.8-2.2p<；0.001)，其中患非CD的男性和女性分别多活1.4年(CI0.5-2.3，p=0.002)和1.3年(CI0.3-2.1p=0.004)。与FT4最低三分位数相比，FT4最高三分位数的男女LE分别为-3.7年(CI-5.1to-2.2p<；0.001)和-3.3年(CI-4.7to-1.9p<；0.001)，其中-1.8a(CI-3.1to-0.7p=0.003)和-2.0a(CI-3.4to-0.7p=0.003)。这项研究的一个局限性是观察性设计。因此，不能完全排除残留混杂的可能性。结论在本研究中，我们发现甲状腺功能正常低者(即TSH最高三分位数和FT4参考范围最低三分位数)与甲状腺功能正常高者(TSH最低三分位数和FT4参考范围最低三分位数)相比，NCD患者的预期寿命更长。这些发现为重新评估当前甲状腺功能的参考范围提供了支持。作者总结：为什么要进行这项研究？甲状腺功能障碍是一个重要的公共卫生问题，它与心血管疾病、糖尿病和癌症等非传染性疾病(NCDs)的风险增加有关。甲状腺功能障碍的诊断和治疗是基于促甲状腺激素和游离甲状腺激素的测定。越来越多的证据表明，即使在促甲状腺激素和游离甲状腺素水平的参考范围内，甲状腺功能障碍的临床后果也会扩大。然而，甲状腺功能对NCD患者和非NCD患者预期寿命的影响尚不清楚。研究人员做了什么并发现了什么？我们在鹿特丹研究的框架内进行了一项基于人群的大型前瞻性队列研究。在甲状腺功能正常的个体中，我们研究了甲状腺功能与非传染性疾病患者的预期寿命之间的关系。我们发现，总体而言，甲状腺功能正常偏低的人比甲状腺功能正常偏高的人多活3.7年，其中患有NCD的人最多多活1.9年。这些发现意味着什么？我们的研究为甲状腺功能对预期寿命的定性和定量影响提供了新的见解。我们的发现为重新评估中老年人甲状腺功能的参考范围提供了支持。这对甲状腺疾病的诊断和治疗有进一步的指导意义。
Background Variations in thyroid function within reference ranges are associated with increased risk of diseases and death. However, the impact of thyroid function on life expectancy (LE) with and without noncommunicable diseases (NCDs) remains unknown. We therefore aimed to investigate the association of thyroid function with total LE and LE with and without NCD among euthyroid individuals. Methods and findings The study was embedded in the Rotterdam Study, a prospective population-based study carried out in the Netherlands. In total, 7,644 participants without known thyroid disease and with thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels within reference ranges were eligible. NCDs were defined as presence of cardiovascular disease, diabetes mellitus type 2, or cancer. We used the demographic tool of multistate life tables to calculate LE estimates at the age of 50 years, using prevalence, incidence rates, and hazard ratios for three transitions (healthy to NCD, healthy to death, and NCD to death). The total LE and LE with and without NCD among TSH and FT4 tertiles were calculated separately in men and women. Analyses were adjusted for sociodemographic and cardiovascular risk factors. The mean (standard deviation) age of the participants was 64.5 (9.7) years, and 52.3% were women. Over a median follow-up of 8 years (interquartile range 2.7-9.9 years), 1,396 incident NCD events and 1,422 deaths occurred. Compared with those in the lowest TSH tertile, men and women in the highest TSH tertile were expected to live 1.5 years (95% confidence interval [CI] 0.8-2.3, p < 0.001) and 1.5 years (CI 0.8-2.2, p < 0.001) longer, respectively, of which 1.4 years (CI 0.5-2.3, p = 0.002) and 1.3 years (CI 0.3-2.1, p = 0.004) with NCD. Compared with those in the lowest FT4 tertile, the difference in LE for men and women in the highest FT4 tertile was -3.7 years (CI -5.1 to -2.2, p < 0.001) and -3.3 years (CI -4.7 to -1.9, p < 0.001), respectively, of which -1.8 years (CI -3.1 to -0.7, p = 0.003) and -2.0 years (CI -3.4 to -0.7, p = 0.003) without NCD. A limitation of the study is the observational design. Thus, the possibility of residual confounding cannot be entirely ruled out. Conclusions In this study, we found that people with low-normal thyroid function (i.e., highest tertile of TSH and lowest tertile of FT4 reference ranges) are expected to live more years with and without NCD than those with high-normal thyroid function (i.e., lowest tertile of TSH and highest tertile of FT4 reference ranges). These findings provide support for a re-evaluation of the current reference ranges of thyroid function.Author summaryWhy was this study done? Thyroid dysfunction is an important public health problem that is associated with an increased risk of noncommunicable diseases (NCDs), such as cardiovascular diseases, diabetes, and cancer. The diagnosis and treatment of thyroid dysfunction is based on thyrotropin and free thyroxine measurements. Accumulating evidence has suggested that the clinical consequences of thyroid dysfunction are extended even within the reference ranges of thyrotropin and free thyroxine levels. However, the impact of thyroid function on life expectancy with and without NCD remains unknown. What did the researchers do and find? We performed a large prospective population-based cohort study within the framework of the Rotterdam Study. We investigated the association of thyroid function with life expectancy with and without NCD among euthyroid individuals. We found that individuals with low-normal thyroid function live up to 3.7 years longer overall, of which up to 1.9 years longer with NCD, than individuals with high-normal thyroid function. What do these findings mean? Our study provides novel insights about the qualitative and quantitative impact of thyroid function on life expectancy. Our findings provide support for a re-evaluation of the reference ranges of thyroid function in middle-aged and older adults. This can have further implications on the diagnosis and treatment of thyroid disease.