Trajectories of Unhealthy Behaviors in Midlife and Risk of Disability at Older Ages in the Whitehall II Cohort Study
Trajectories of Unhealthy Behaviors in Midlife and Risk of Disability at Older Ages in the Whitehall II Cohort Study
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DOI：
10.1093/gerona/glw060
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发表时间：
2016-11-01
影响因子：
5.1
通讯作者：
Elbaz, Alexis
中科院分区：
文献类型：
--
作者：
Artaud, Fanny;Sabia, Severine;Elbaz, Alexis
大多数关于不健康行为与残疾之间关联的证据来自老年人的研究，其中反向因果关系和选择偏差可能会扭曲关联;因此，需要基于中年健康行为轨迹的研究。在白厅II队列研究中，我们检查了从中年开始到20岁以上的四种健康行为（体力活动、水果和蔬菜消费、吸烟、饮酒）的轨迹与随后的老年早期（范围= 54-84岁）残疾风险的关联。构建了一个分级残疾指标;如果参与者报告在日常生活的移动性和工具性活动方面或在日常生活的移动性和工具性和基本活动方面有困难，则被视为残疾。使用基于组的轨迹模型定义行为轨迹。多变量广义估计方程logistic模型被用来检验他们与残疾的独立关联。在6,825名参与者中，19.2%的人报告至少有一次残疾。在相互调整的模型中，持续不活动或身体活动减少的参与者，最近的前吸烟者或当前吸烟者，以及持续/最近的戒酒者或持续大量饮酒者具有更高的残疾风险，而水果和蔬菜消费与残疾无关。残疾风险随着不健康行为轨迹的数量而逐渐增加：2-3个不健康行为轨迹的残疾优势比为2.69（95%置信区间= 2.26-3.19）;在对广泛的协变量进行调整后，这些关联仍然存在。中年不健康行为轨迹与以后生活中更大的残疾风险相关。
Most of the evidence on the association between unhealthy behaviors and disability comes from studies in the elderly, where reverse causation and selection bias may distort associations; thus, studies based on midlife trajectories of health behaviors are needed. We examined the association of trajectories of four health behaviors (physical activity, fruit and vegetable consumption, smoking, alcohol), starting in midlife and over 20 years, with subsequent disability risk in early old age (range = 54-84 years) in the Whitehall II cohort study.Disability was assessed three times over 3 years. A hierarchical disability indicator was constructed; participants were considered disabled if they reported difficulties with mobility and instrumental activities of daily living or with mobility and instrumental and basic activities of daily living. Behavior trajectories were defined using group-based trajectory models. Multivariable generalized estimating equations logistic models were used to examine their independent associations with disability.Of 6,825 participants, 19.2% reported being disabled at least once. In mutually adjusted models, participants with persistent inactivity or declining physical activity, recent ex- or current smokers, and persistent/recent abstainers or persistent heavy drinkers had a higher disability risk, whereas fruit and vegetable consumption was not associated with disability. Disability risk increased progressively with the number of unhealthy behavior trajectories: the odds ratio of disability for 2-3 unhealthy trajectories was 2.69 (95% confidence interval = 2.26-3.19); these associations remained after adjustment for a wide range of covariates.Unhealthy behavior trajectories in midlife are associated with greater disability risk later in life.