Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study.
Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study.
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DOI：
10.1186/s12916-016-0662-y
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发表时间：
2016-08-20
期刊：
影响因子：
9.3
通讯作者：
Myint PK
中科院分区：
文献类型：
--
作者：
Basu N;Yang X;Luben RN;Whibley D;Macfarlane GJ;Wareham NJ;Khaw KT;Myint PK
严重疲劳是一般人群寻求医疗建议的常见原因。然而，患者通常认为他们的投诉被忽视了。这种情况可能是因为临床医生认为疲劳是良性的，与传统的生物医学结果无关，如过早死亡。本研究的目的是调查显著疲劳和死亡率之间是否确实存在关联，如果存在，则确定这种关联的潜在机制。一项基于人群的队列研究，包括18，101名年龄在40-79岁之间的男性和女性，他们完成了一项疲劳测量（简表36活力领域，SF 36-VT），此外还提供了可能混杂因素的信息（年龄、性别、体重指数、婚姻状况、吸烟、教育水平、饮酒、社会阶层、抑郁症、身体疼痛、糖尿病、β受体阻滞剂的使用，身体活动和饮食）和机制（血红蛋白，C反应蛋白和甲状腺功能）进行了前瞻性随访长达20年。通过与联合王国国家统计局的死亡证明联系，确定了所有原因、癌症和心血管疾病造成的死亡率。在300，322人年的随访期间（平均16.6年），发生了4397例死亡。调整混杂因素后，与报告最低疲劳（最高SF 36-VT四分位数）的患者相比，报告最高疲劳（最低SF 36-VT四分位数）的患者的全因死亡率的风险比（HR）为1.40（95%置信区间[CI] 1.25-1.56）。在与心血管疾病（HR 1.45，95% CI 1.18-1.78）相关的死亡中特别观察到这种显著相关性，但与癌症（HR 1.09，95% CI 0.90-1.32）无关。在所考虑的机制中，甲状腺功能对减弱这种关联最显着。然而，即使在考虑所有假定的混杂因素和机制后，全因死亡的风险仍然显著（HR 1.26，95% CI 1.10-1.45）。高水平的疲劳与一般人群的死亡率过高有关。这种通常被忽视的症状需要更多的评估，不应该自动被认为是良性的。本文的在线版本（doi：10.1186/s12916-016-0662-y）包含补充材料，可供授权用户使用。
Significant fatigue is a frequent reason for seeking medical advice in the general population. Patients, however, commonly feel their complaint is ignored. This situation may be because clinicians perceive fatigue to be benign, unrelated to traditional biomedical outcomes such as premature mortality. The present study aimed to investigate whether an association between significant fatigue and mortality actually exists, and, if so, to identify potential mechanisms of this association. A population-based cohort of 18,101 men and women aged 40–79 years who completed a measure of fatigue (Short Form 36 vitality domain, SF36-VT) in addition to providing information on possible confounding factors (age, sex, body mass index, marital status, smoking, education level, alcohol consumption, social class, depression, bodily pain, diabetes, use of β blockers, physical activity and diet) and mechanisms (haemoglobin, C-reactive protein and thyroid function) were followed up prospectively for up to 20 years. Mortality from all causes, cancer and cardiovascular disease was ascertained using death certification linkage with the UK Office of National Statistics. During 300,322 person years of follow-up (mean 16.6 years), 4397 deaths occurred. After adjusting for confounders, the hazard ratio (HR) for all-cause mortality was 1.40 (95 % confidence interval [CI] 1.25–1.56) for those reporting the highest fatigue (bottom SF36-VT quartile) compared with those reporting the lowest fatigue (top SF36-VT quartile). This significant association was specifically observed for those deaths related to cardiovascular disease (HR 1.45, 95 % CI 1.18–1.78) but not cancer (HR 1.09, 95 % CI 0.90–1.32). Of the considered mechanisms, thyroid function was most notable for attenuating this association. The risk of all-cause mortality, however, remained significant even after considering all putative confounders and mechanisms (HR 1.26, 95 % CI 1.10–1.45). High levels of fatigue are associated with excess mortality in the general population. This commonly dismissed symptom demands greater evaluation and should not automatically be considered benign. The online version of this article (doi:10.1186/s12916-016-0662-y) contains supplementary material, which is available to authorized users.