Childhood intelligence in relation to major causes of death in 68 year follow-up: prospective population study
Childhood intelligence in relation to major causes of death in 68 year follow-up: prospective population study
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DOI：
10.1136/bmj.j2708
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发表时间：
2017-06-28
影响因子：
105.7
通讯作者：
Deary, Ian J.
中科院分区：
文献类型：
--
作者：
Calvin, Catherine M.;Batty, G. David;Deary, Ian J.
目的研究儿童时期测量的智力与男性和女性一生中主要死亡原因之间的关系。基于1936年出生于苏格兰的整个参与者人群的前瞻性队列研究，并与随后68年的死亡率数据相关联。研究对象：33536名男性和32229名女性，他们是1947年苏格兰精神调查（SMS 1947）的参与者。和谁可能与截至2015年12月的死亡原因数据有关。主要结局指标原因特异性死亡率，包括冠心病、中风、特定癌症类型、呼吸系统疾病、消化系统疾病、外部原因，儿童智力与所有主要死亡原因呈负相关。年龄和性别调整的风险比（和95%置信区间）每1 SD（约15分）的优势，在呼吸系统疾病（0.72，0.70至0.74），冠心病（0.75，0.73至0.77）和中风（0.76，0.73至0.79）最强。其他显著的相关性（P< 0.001）包括受伤死亡（0.81，0.75至0.86），吸烟相关癌症（0.82，0.80至0.84），消化系统疾病（0.82，0.79至0.86）和痴呆（0.84，0.78至0.90）。自杀（0.87，0.74 - 1.02）和与吸烟无关的癌症死亡（0.96，0.93 - 1.00）的相关性较弱，其置信区间为1。有一种观点认为，儿童期智力与女性冠心病、吸烟相关癌症、呼吸系统疾病和痴呆症的关系比男性更为密切。（相互作用的P值分别< 0.001、0.02、< 0.001和0.02）。儿童智力与选定的癌症表现有关，包括肺癌。（0.75，0.72至0.77），胃（0.77，0.69至0.85），膀胱（0.81，0.71至0.91），食管（0.85，0.78至0.94）、肝脏（0.85，0.74至0.97）、结肠直肠（0.89，0.83至0.95）和造血（0.91，0.83至0.98）。对队列中代表性子样本的敏感性分析观察到，在调整潜在混杂因素（包括儿童社会经济地位的三个指标）后，智力的估计影响仅略有衰减（10-26%）。在苏格兰的重复样本中，在类似的出生年份队列和随访期内，吸烟和成人社会经济地位部分减弱（16-58%）智力与结果率的关联。结论在整个国家人口的出生年份队列中，儿童智力测试的得分越高，死于冠心病、中风、与吸烟有关的癌症的风险就越低（特别是肺和胃）、呼吸系统疾病、消化系统疾病、损伤和痴呆。
OBJECTIVESTo examine the association between intelligence measured in childhood and leading causes of death in men and women over the life course.DESIGNProspective cohort study based on a whole population of participants born in Scotland in 1936 and linked to mortality data across 68 years of follow-up.SETTINGScotland.PARTICIPANTS33 536 men and 32 229 women who were participants in the Scottish Mental Survey of 1947 (SMS1947) and who could be linked to cause of death data up to December 2015.MAIN OUTCOME MEASURESCause specific mortality, including from coronary heart disease, stroke, specific cancer types, respiratory disease, digestive disease, external causes, and dementia.RESULTSChildhood intelligence was inversely associated with all major causes of death. The age and sex adjusted hazard ratios (and 95% confidence intervals) per 1 SD (about 15 points) advantage in intelligence test score were strongest for respiratory disease (0.72, 0.70 to 0.74), coronary heart disease (0.75, 0.73 to 0.77), and stroke (0.76, 0.73 to 0.79). Other notable associations (all P< 0.001) were observed for deaths from injury (0.81, 0.75 to 0.86), smoking related cancers (0.82, 0.80 to 0.84), digestive disease (0.82, 0.79 to 0.86), and dementia (0.84, 0.78 to 0.90). Weak associations were apparent for suicide (0.87, 0.74 to 1.02) and deaths from cancer not related to smoking (0.96, 0.93 to 1.00), and their confidence intervals included unity. There was a suggestion that childhood intelligence was somewhat more strongly related to coronary heart disease, smoking related cancers, respiratory disease, and dementia in women than men (P value for interactions < 0.001, 0.02, < 0.001, and 0.02, respectively).Childhood intelligence was related to selected cancer presentations, including lung (0.75, 0.72 to 0.77), stomach (0.77, 0.69 to 0.85), bladder (0.81, 0.71 to 0.91), oesophageal (0.85, 0.78 to 0.94), liver (0.85, 0.74 to 0.97), colorectal (0.89, 0.83 to 0.95), and haematopoietic (0.91, 0.83 to 0.98). Sensitivity analyses on a representative subsample of the cohort observed only small attenuation of the estimated effect of intelligence (by 10-26%) after adjustment for potential confounders, including three indicators of childhood socioeconomic status. In a replication sample from Scotland, in a similar birth year cohort and follow-up period, smoking and adult socioeconomic status partially attenuated (by 16-58%) the association of intelligence with outcome rates.CONCLUSIONSIn a whole national population year of birth cohort followed over the life course from age 11 to age 79, higher scores on a well validated childhood intelligence test were associated with lower risk of mortality ascribed to coronary heart disease and stroke, cancers related to smoking (particularly lung and stomach), respiratory diseases, digestive diseases, injury, and dementia.