RESPIRATORY SYMPTOMS AS PREDICTORS OF 27-YEAR MORTALITY IN A REPRESENTATIVE SAMPLE OF BRITISH ADULTS
RESPIRATORY SYMPTOMS AS PREDICTORS OF 27-YEAR MORTALITY IN A REPRESENTATIVE SAMPLE OF BRITISH ADULTS
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DOI：
10.1136/bmj.299.6695.357
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发表时间：
1989-08-05
影响因子：
105.7
通讯作者：
INSKIP, H
中科院分区：
文献类型：
--
作者：
CARPENTER, L;BERAL, V;INSKIP, H
目的：研究报告的呼吸道症状（通过问卷调查）和随后的死亡率之间的关系。设计：前瞻性队列研究。设置：92在英国的一般做法。参与者：1532名年龄在40至64岁之间的英国男性和女性的全国代表性样本。主要结果测量--全因死亡率、心血管疾病、肺癌和慢性支气管炎。结果如下：受试者于1958年就各种呼吸道症状（包括咳嗽、痰、呼吸困难和喘息）进行了问卷调查，该问卷是医学研究委员会呼吸道症状问卷的基础。到1985年底，据报有889人死亡，其中51人死于慢性支气管炎。在对年龄和吸烟习惯的差异进行调整后，报告症状的男性中慢性支气管炎的死亡率高于未报告症状的男性。校正后的死亡率为：早晨咳嗽3.4（95%可信区间1.8 ~ 6.5），早晨痰3.7（2.0 ~ 6.9），平地行走时呼吸困难6.4（3.0 ~ 13.8），大多数白天或夜晚喘息10.5（4.4 ~ 24.6）。在最近的呼吸道症状问卷中，四种偶发症状的死亡率也显著升高，即偶发喘息，（死亡率比6.0; 95%置信区间，2.4至15.1），天气影响胸部（5.7; 3.1 ~ 10.3），夏季呼吸不同（4.9; 2.8 ~ 8.6），感冒多在胸（3.7; 2.0 ~ 6.8）。在进一步调整呼吸困难或痰后，与这些症状相关的额外死亡率仍然显著。大多数呼吸道症状的男性和女性全因死亡率也显著升高，在调整年龄、性别和吸烟后，报告症状的人的死亡率高出约20-50%。呼吸困难是与心血管疾病死亡率显著相关的唯一症状（在水平上行走时呼吸困难的死亡率为1.4（95%置信区间为1.0至1.9））。比率通常在1左右，对于肺癌死亡率并不显著。结论：结果表明，在标准的呼吸问卷调查中通常不会出现的偶发症状可以预测慢性阻塞性气道疾病的后续死亡率。这支持了以下假设：可逆的气流阻塞可能是通气功能进行性和不可逆转下降的前兆。
Objective: To examine associations between reported respiratory symptoms (as elicited by questionnaire) and subsequent mortality. Design: Prospective cohort study. Setting: 92 General practices in Great Britain. Participants: A nationally representative sample of 1532 British men and women aged between 40 and 64. Main outcome measures-Mortality from all causes, cardiovascular disease, lung cancer, and chronic bronchitis. Results: Subjects were interviewed in 1958 regarding various respiratory symptoms (including cough, phlegm, breathlessness, and wheeze) by using a questionnaire which formed the basis of the Medical Research Council''s questionnaire on respiratory symptoms. By the end of 1985, 889 deaths had been reported, including 51 in men due to chronic bronchitis. After adjustment for differences in age and smoking habits death rates from chronic bronchitis in men who reported symptoms were greater than those in men who did not for each of the symptoms examined. The adjusted mortality ratios were 3.4 (95% confidence interval 1.8 to 6.5) for morning cough, 3.7 (2.0 to 6.9) for morning phlegm, 6.4 (3.0 to 13.8) for breathlessness when walking on the level, and 10.5 (4.4 to 24.6) for wheeze most days or nights. Mortality ratios were also significantly raised for four episodic symptoms not usually included in more recent respiratory symptom questionnaires.sbd.namely, occasional wheeze (mortality ratio 6.0; 95% confidence interval, 2.4 to 15.1), weather affects chest (5.7; 3.1 to 10.3), breathing different in summer (4.9; 2.8 to 8.6), and cold usually goes to chest (3.7; 2.0 to 6.8). The excess mortality associated with these symptoms remained significant after further adjustment for breathlessness or phlegm. Ratios for all cause mortality in men and women were also significantly raised for most respiratory symptoms, death rates being some 20-50% higher in people reporting symptoms after adjustment for age, sex, and smoking. Breathlessness was the only symptom significantly associated with excess mortality from cardiovascular disease (mortality ratio 1.4 (95% confidence interval 1.0 to 1.9) for breathlessness when walking on the level). Ratios were generally around unity and not significant for mortality due to lung cancer. Conclusions: The results suggest that episodic symptoms, which often do not appear in standard respiratory questionnaires, predict subsequent mortality from chronic obstructive airways disease. This supports the hypothesis that reversible airflow obstruction may be a precursor of progressive and irreversible decline in ventilatory function.