Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: A population-based cohort study
Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: A population-based cohort study
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DOI：
10.1371/journal.pmed.1002741
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发表时间：
2019-02-01
期刊：
影响因子：
15.8
通讯作者：
Ikram, M. Arfan
中科院分区：
文献类型：
--
作者：
Licher, Silvan;Heshmatollah, Alis;Ikram, M. Arfan
背景非传染性疾病（NCD）是全世界过早残疾和死亡的主要原因。然而，罹患任何非传染性疾病的终生风险尚不清楚，同样的共同风险因素对该风险的影响也是未知的。方法和结果在 1989 年 7 月 6 日至 2012 年 1 月 1 日期间，我们对鹿特丹前瞻性研究中年龄 45 岁及以上的参与者进行了跟踪，这些参与者在基线时没有中风、心脏病、糖尿病、慢性呼吸道疾病、癌症和神经退行性疾病的非传染性疾病。我们在竞争风险框架中量化了任何非传染性疾病的发生/共现和剩余终生风险。我们还研究了任何非传染性疾病的终生风险、发病年龄和基线时 3 个共享风险因素的总体预期寿命：吸烟、高血压和超重。在对 9,061 名参与者（平均年龄 63.9 岁，60.1% 为女性）进行的 75,354 人年随访中，814 名参与者被诊断患有中风，1,571 名参与者患有心脏病，625 名参与者患有糖尿病，1,004 名参与者患有慢性呼吸道疾病，1,538 名参与者患有癌症，1,065 名参与者患有神经退行性疾病。非传染性疾病往往同时发生，有 1,563 名参与者（占非传染性疾病患者的 33.7%）在随访期间被诊断出患有多种疾病。从 45 岁起，男性终生患任何非传染性疾病的风险为 94.0% (95% CI 92.9%-95.1%)，女性为 92.8% (95% CI 91.8%-93.8%)。即使对于那些没有吸烟、高血压和超重这 3 个危险因素的人来说，这些风险仍然很高 (> 90.0%)。不吸烟、高血压和超重与任何非传染性疾病的发病年龄延迟 9.0 年 (95% CI 6.3-11.6) 相关。此外，没有这些风险因素的参与者的总体预期寿命比具有所有 3 个风险因素的参与者长 6.0 年 (95% CI 5.2-6.8)。基线时不存在吸烟、高血压和超重 3 种危险因素的 45 岁及以上参与者，其剩余寿命中 21.6% 患有 1 种或多种非传染性疾病，而基线时具有所有这些危险因素的参与者，其剩余寿命中这一比例为 31.8%。这一差异相当于非传染性疾病发病率的两年压缩。这项研究的局限性包括潜在的残留混杂因素、随访期间风险因素概况的未测量变化，以及对不同医疗环境和非欧洲血统人群的普遍适用性可能有限。结论我们的研究表明，在这个西欧社区，十分之九的 45 岁及以上的人在其余生中患上非传染性疾病。在患有非传染性疾病的人中，至少有三分之一随后被诊断出患有多种非传染性疾病。缺乏 3 种共同的危险因素与非传染性疾病发病率的降低有关。这些发现强调了避免这些常见风险因素对于减少非传染性疾病导致的过早发病和死亡的重要性。
BackgroundNon-communicable diseases (NCDs) are leading causes of premature disability and death worldwide. However, the lifetime risk of developing any NCD is unknown, as are the effects of shared common risk factors on this risk.Methods and findingsBetween July 6, 1989, and January 1, 2012, we followed participants from the prospective Rotterdam Study aged 45 years and older who were free from NCDs at baseline for incident stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease. We quantified occurrence/co-occurrence and remaining lifetime risk of any NCD in a competing risk framework. We additionally studied the lifetime risk of any NCD, age at onset, and overall life expectancy for strata of 3 shared risk factors at baseline: smoking, hypertension, and overweight. During 75,354 person-years of follow-up from a total of 9,061 participants (mean age 63.9 years, 60.1% women), 814 participants were diagnosed with stroke, 1,571 with heart disease, 625 with diabetes, 1,004 with chronic respiratory disease, 1,538 with cancer, and 1,065 with neurodegenerative disease. NCDs tended to co-occur substantially, with 1,563 participants (33.7% of those who developed any NCD) diagnosed with multiple diseases during follow-up. The lifetime risk of any NCD from the age of 45 years onwards was 94.0% (95% CI 92.9%-95.1%) for men and 92.8% (95% CI 91.8%-93.8%) for women. These risks remained high (> 90.0%) even for those without the 3 risk factors of smoking, hypertension, and overweight. Absence of smoking, hypertension, and overweight was associated with a 9.0-year delay (95% CI 6.3-11.6) in the age at onset of any NCD. Furthermore, the overall life expectancy for participants without these risk factors was 6.0 years (95% CI 5.2-6.8) longer than for those with all 3 risk factors. Participants aged 45 years and older without the 3 risk factors of smoking, hypertension, and overweight at baseline spent 21.6% of their remaining lifetime with 1 or more NCDs, compared to 31.8% of their remaining life for participants with all of these risk factors at baseline. This difference corresponds to a 2-year compression of morbidity of NCDs. Limitations of this study include potential residual confounding, unmeasured changes in risk factor profiles during follow-up, and potentially limited generalisability to different healthcare settings and populations not of European descent.ConclusionsOur study suggests that in this western European community, 9 out of 10 individuals aged 45 years and older develop an NCD during their remaining lifetime. Among those individuals who develop an NCD, at least a third are subsequently diagnosed with multiple NCDs. Absence of 3 common shared risk factors is associated with compression of morbidity of NCDs. These findings underscore the importance of avoidance of these common shared risk factors to reduce the premature morbidity and mortality attributable to NCDs.