The effect of socioeconomic deprivation on the association between an extended measurement of unhealthy lifestyle factors and health outcomes: a prospective analysis of the UK Biobank cohort
The effect of socioeconomic deprivation on the association between an extended measurement of unhealthy lifestyle factors and health outcomes: a prospective analysis of the UK Biobank cohort
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DOI：
10.1016/s2468-2667(18)30200-7
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发表时间：
2018-12-01
影响因子：
50
通讯作者：
Mair, Frances S.
中科院分区：
文献类型：
--
作者：
Foster, Hatnish M. E.;Celis-Morales, Carlos A.;Mair, Frances S.
背景生活方式因素的组合相互作用会增加死亡率。吸烟和酗酒等传统因素的组合得到了很好的描述，但电视观看时间等新兴因素的额外影响却没有得到很好的描述。社会经济上的剥夺对这些延长的生活方式风险的影响也尚不清楚。我们的目的是检验剥夺是否改变了与生活方式相关的风险因素的扩展得分与健康结果之间的联系。方法这项前瞻性分析的数据来自英国生物库，一项基于人群的前瞻性队列研究。我们为所有参与者分配了一个扩展的生活方式评分，每个不健康的生活方式因素(包括睡眠时间和长时间看电视，以及吸烟、过量饮酒、不良饮食[低油腻鱼类或水果和蔬菜的摄入量，以及高红肉或加工肉类的摄入量]和低体力活动)被归类为最健康(得分0-2)、中等健康(得分3-5)或最不健康(得分6-9)。使用COX比例风险模型来检验生活方式评分和健康结果(全因死亡率和心血管疾病死亡率和发病率)之间的关联，以及这种关联是否被剥夺所改变。所有分析都是里程碑式的分析，如果参与者在招募后2年内发生过事件(死亡或心血管疾病事件)，则将其排除在外。患有非传染性疾病(高血压除外)和丢失协变量数据的参与者被排除在分析之外。如果参与者报告了不可信的体力活动、睡眠时间和总屏幕时间的值，他们也会被排除在外。所有的分析都根据年龄、性别、种族、评估月份、高血压病史、收缩压、治疗高胆固醇血症或高血压的药物以及体重指数类别进行了调整。研究发现，328 594名年龄在40-69岁的参与者参与了这项研究，在各种原因和心血管疾病死亡率里程碑式的时期之后，平均随访期为4.9年(SD 0.83)，心血管疾病发病率为4.1年(0.81)。在最贫困的五分位数中，与最健康的类别相比，最不健康的生活方式类别的调整后风险比(HR)为全因死亡率1.65(95%可信区间1.25-2.19)，心血管疾病死亡率1.93(1.16-3.20)，心血管疾病发病率1.29(1.10-1.52)。最贫困的五分位数的等值比分别为2.47(95%CI 2.04~3.00)、3.36(2.36~4.76)和1.41(1.25~1.60)。最贫困五分位数与最贫困五分位数相比，每增加一次，全因死亡率分别为1.25(95%CI 1.12~1.39)和1.55(1.40~1.70)，心血管疾病死亡率分别为1.30(1.05~1.61)和1.83(1.54~2.18)，心血管疾病发病率分别为1.10(1.04~1.17)和1.16(1.09~1.23)。在生活方式和剥夺各种原因和心血管疾病死亡率之间发现了显著的交互作用(P(交互作用)
Background Combinations of lifestyle factors interact to increase mortality. Combinations of traditional factors such as smoking and alcohol are well described, but the additional effects of emerging factors such as television viewing time are not. The effect of socioeconomic deprivation on these extended lifestyle risks also remains unclear. We aimed to examine whether deprivation modifies the association between an extended score of lifestyle-related risk factors and health outcomes.Methods Data for this prospective analysis were sourced from the UK Biobank, a prospective population-based cohort study. We assigned all participants an extended lifestyle score, with 1 point for each unhealthy lifestyle factor (incorporating sleep duration and high television viewing time, in addition to smoking, excessive alcohol, poor diet [low intake of oily fish or fruits and vegetables, and high intake of red meat or processed meats], and low physical activity), categorised as most healthy (score 0-2), moderately healthy (score 3-5), or least healthy (score 6-9). Cox proportional hazards models were used to examine the association between lifestyle score and health outcomes (all-cause mortality and cardiovascular disease mortality and incidence), and whether this association was modified by deprivation. All analyses were landmark analyses, in which participants were excluded if they had an event (death or cardiovascular disease event) within 2 years of recruitment. Participants with non-communicable diseases (except hypertension) and missing covariate data were excluded from analyses. Participants were also excluded if they reported implausible values for physical activity, sleep duration, and total screen time. All analyses were adjusted for age, sex, ethnicity, month of assessment, history of hypertension, systolic blood pressure, medication for hypercholesterolaemia or hypertension, and body-mass index categories.Findings 328 594 participants aged 40-69 years were included in the study, with a mean follow-up period of 4.9 years (SD 0.83) after the landmark period for all-cause and cardiovascular disease mortality, and 4.1 years (0.81) for cardiovascular disease incidence. In the least deprived quintile, the adjusted hazard ratio (HR) in the least healthy lifestyle category, compared with the most healthy category, was 1.65 (95% CI 1.25-2.19) for all-cause mortality, 1.93 (1.16-3.20) for cardiovascular disease mortality, and 1.29 (1.10-1.52) for cardiovascular disease incidence. Equivalent HRs in the most deprived quintile were 2.47 (95% CI 2.04-3.00), 3.36 (2.36-4.76), and 1.41 (1.25-1.60), respectively. The HR for trend for one increment change towards least healthy in the least deprived quintile compared with that in the most deprived quintile was 1.25 (95% CI 1.12-1.39) versus 1.55 (1.40-1.70) for all-cause mortality, 1.30 (1.05-1.61) versus 1.83 (1.54-2.18) for cardiovascular disease mortality, and 1.10 (1.04-1.17) versus 1.16 (1.09-1.23) for cardiovascular disease incidence. A significant interaction was found between lifestyle and deprivation for all-cause and cardiovascular disease mortality (both p(interaction)