Risk factors for 5-year mortality in older adults - The cardiovascular health study
Risk factors for 5-year mortality in older adults - The cardiovascular health study
复制标题
DOI：
10.1001/jama.279.8.585
复制
发表时间：
1998-02-25
影响因子：
120.7
通讯作者：
Gardin, JM
中科院分区：
文献类型：
--
作者：
Fried, LP;Kronmal, RA;Gardin, JM
上下文。-多种因素导致老年人死亡，但亚临床疾病和其他因素对死亡风险的独立影响程度尚不清楚。目的：确定共同预测65岁及以上社区居民男女死亡率的疾病、功能和个人特征。-前瞻性人群队列研究，随访5年，非洲裔美国人验证队列，随访4.25年。-四个美国社区，参与者。-原始和非裔美国人队列中65岁及以上的男性和女性分别为5201和685人。主要结果测量。五年mortality.Results。在主要队列中，646例死亡（12%）发生在5年内。使用Cox比例风险模型，在评估的78个特征中，有20个特征（P169 mm Hg）均显著（P169 mm Hg），其中，低收缩压（小于或等于127 mm Hg）、无高血压或充血性心力衰竭患者使用利尿剂、空腹血糖升高（>7.2 mmol/L [130 mg/dL]）、低白蛋白水平（小于或等于37 g/L）、高肌酐水平（大于或等于106 mu mol/L [1.2 mg/dL]）、低强迫肺活量（12.06 mL）、主动脉狭窄（中度或重度）和左心室射血分数异常（超声心动图），主要心电图异常，颈内动脉狭窄（超声心动图），充血性心力衰竭，日常生活工具活动困难，认知功能低下（数字符号替代测试分数）。高密度脂蛋白胆固醇和低密度脂蛋白胆固醇都与死亡率无关。在对其他因素进行调整后，年龄和死亡率之间的联系减弱了，但女性死亡率的下降持续存在。最后，在第二个队列中验证了死亡风险；在两个队列中，五分位数的风险范围为2%至39%，0%至26%。-亚临床疾病和疾病严重程度的客观指标是老年人5年死亡率的独立和联合预测因素，此外还有男性、相对贫困、体力活动、吸烟、虚弱和残疾指标。除了充血性心力衰竭的病史外，客观的、定量的疾病测量比临床病史更能预测死亡率。
Context.-Multiple factors contribute to mortality in older adults, but the extent to which subclinical disease and other factors contribute independently to mortality risk is not known.Objective.-To determine the disease, functional, and personal characteristics that jointly predict mortality in community-dwelling men and women aged 65 years or older.Design.-Prospective population-based cohort study with 5 years of follow-up and a validation cohort of African Americans with 4.25-year follow-up.Setting.-Four US communities.Participants.-A total of 5201 and 685 men and women aged 65 years or older in the original and African American cohorts, respectively.Main Outcome Measures.-Five-year mortality.Results.-In the main cohort, 646 deaths (12%) occurred within 5 years. Using Cox proportional hazards models, 20 characteristics (of 78 assessed) were each significantly (P169 mm Hg) and low tibial (less than or equal to 127 mm Hg) systolic blood pressure, diuretic use by those without hypertension or congestive heart failure, elevated fasting glucose level (>7.2 mmol/L [130 mg/dL]), low albumin level (less than or equal to 37 g/L), elevated creatinine level (greater than or equal to 106 mu mol/L [1.2 mg/dL]), low forced vital capacity (12.06 mL), aortic stenosis (moderate or severe) and abnormal left ventricular ejection fraction (by echocardiography), major electrocardiographic abnormality, stenosis of internal carotid artery (by ultrasound), congestive heart failure, difficulty in any instrumental activity of daily living, and low cognitive function by Digit Symbol Substitution test score. Neither high-density lipoprotein cholesterol nor low-density lipoprotein cholesterol was associated with mortality. After adjustment for other factors, the association between age and mortality diminished, but the reduction in mortality with female sex persisted. Finally, the risk of mortality was validated in the second cohort; quintiles of risk ranged from 2% to 39% and 0% to 26% for the 2 cohorts.Conclusions.-Objective measures of subclinical disease and disease severity were independent and joint predictors of 5-year mortality in older adults, along with male sex, relative poverty, physical activity, smoking, indicators of frailty, and disability. Except for history of congestive heart failure, objective, quantitative measures of disease were better predictors of mortality than was clinical history of disease.