Asthma in the elderly - Mortality rate and associated risk factors for mortality
Asthma in the elderly - Mortality rate and associated risk factors for mortality
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DOI：
10.1378/chest.06-2824
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发表时间：
2007-10-01
期刊：
影响因子：
9.6
通讯作者：
Incalzi, Raffaele Antonelli
中科院分区：
文献类型：
--
作者：
Bellia, Vincenzo;Pedone, Claudio;Incalzi, Raffaele Antonelli
背景资料：老年人哮喘的预后信息明显缺乏。方法：为了比较有哮喘和无哮喘的老年人的死亡率，并确定哮喘患者的死亡危险因素，1,233例年龄≥ 65岁、诊断为哮喘（n = 210）或慢性非呼吸系统疾病的门诊患者（n = 1，023）入组了一项多中心研究。患者接受基线肺功能测定和多维评估，然后平均随访57.9个月（SD 16.9）。我们比较了两组的死亡率，并使用多变量生存分析确定了死亡的预测因素。结果：哮喘患者的5年死亡率为24.3%，对照组为16.3%（p < 0.01），但哮喘本身并不能解释死亡的过度风险。哮喘患者和非哮喘患者的主要死因分别为心血管疾病（36.4%和21.3%）、非肿瘤性肺病（28.8%和5.4%）和肿瘤（7.6%和22.6%）。在没有哮喘的人群中，死亡与年龄、性别、吸烟、心血管疾病、6分钟步行测试表现较差、认知障碍、抑郁和呼吸功能较差有关。在哮喘患者中，只有死亡与年龄，吸烟和抑郁症之间的联系得到了证实。与对照组不同的是，我们发现哮喘患者超重与死亡之间呈负相关（风险比[HR]，0.35; 95%置信区间[CI]，0.13至0.94）和体重指数< 22 kg/m2的人群死亡率更高的趋势（2）结论：老年人哮喘与较高的死亡率相关，尽管这种情况不是一个独立的危险因素。哮喘患者和非哮喘患者的死亡原因和死亡相关因素有所不同。
Background: There is a distinct lack of information on the prognosis of asthma in the elderly.Methods: In order to compare mortality rates of elderly people with and without asthma and to identify mortality risk factors in those with asthma, 1,233 ambulatory patients aged >=, 65 years with a diagnosis of asthma (n = 210) or chronic nonrespiratory conditions (n = 1,023) were enrolled in a multicentric study. Patients underwent baseline spirometry and multidimensional assessment and were then followed up for a mean of 57.9 months (SD 16.9). We compared mortality rates in the two groups and identified predictors of death using multivariable survival analysis.Results: The 5-year mortality rate in people with asthma was 24.3%, compared to 16.3% in control subjects (p < 0.01), but asthma per se did not explain the excess risk of death. The main causes of death among people with and without asthma were cardiovascular diseases (36.4% and 21.3%, respectively), nonneoplastic lung diseases (28.8% vs 5.4%), and neoplasms (7.6% vs 22.6%). In people without asthma, death was associated with age, gender, smoking, cardiovascular diseases, worse performance on a 6-min walking test, cognitive impairment, depression, and worse respiratory function. In people with asthma, only the association between death and age, smoking, and depression was confirmed. At variance with control subjects, in asthmatics we found an inverse correlation between being overweight and death (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.13 to 0.94) and a trend toward a higher mortality rate in people with a body mass index < 22 kg/m(2) (HR, 2.21; 95% CI, 0.94 to 5.18).Conclusions: Asthma in the elderly was associated with higher mortality rate, although this condition was not an independent risk factor. Causes of death and factors associated with death were somewhat different between people with and without asthma.