Smoking, Body Weight, Physical Exercise, and Risk of Lower Limb Total Joint Replacement in a Population-Based Cohort of Men
Smoking, Body Weight, Physical Exercise, and Risk of Lower Limb Total Joint Replacement in a Population-Based Cohort of Men
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DOI：
10.1002/art.30400
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发表时间：
2011-08-01
影响因子：
--
通讯作者：
Hiller, Janet E.
中科院分区：
文献类型：
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作者：
Mnatzaganian, George;Ryan, Philip;Hiller, Janet E.
目标。在以人群为基础的男性队列中，评估吸烟、体重和体力活动与接受全关节置换术（TJR）风险的关系。对11,388名男性进行了一项队列研究，将临床数据与医院发病率数据和死亡率记录相结合。采用Cox比例风险回归和竞争风险回归（CRRs），对3个不同年龄组的基线体重、身高、合并症、社会经济地位、吸烟年数和运动进行TJR风险建模。观察体重与TJR风险、吸烟与TJR风险之间的剂量-反应关系。超重会增加患TJR的风险，而吸烟则会降低这一风险。Cox和CRR模型都证明了吸烟者的风险降低，并在23年后变得明显。最高四分位数（>= 48年吸烟）的男性比从不吸烟的男性发生TJR的可能性低42-51%。对吸烟和体重分位数的对数风险比（hr）趋势的检验产生了显著的P值。剧烈运动增加TJR的危险性；然而，只有70-74岁年龄组的相关性才有统计学意义（调整后HR为1.64[95%可信区间1.19-2.24]）。调整Deyo-Charlson指数或Elixhauser的合并症测量并不能消除这些关联。我们的研究结果表明，超重和剧烈运动增加了TJR的风险。这项研究首次证明了吸烟时间与TJR风险之间存在强烈的反向剂量反应关系。需要更多的研究来更好地了解吸烟在骨关节炎发病机制中的作用。
Objective. To assess the associations of smoking, body weight, and physical activity with risk of undergoing total joint replacement (TJR) in a population-based cohort of men.Methods. A cohort study of 11,388 men that integrated clinical data with hospital morbidity data and mortality records was undertaken. The risk of undergoing TJR was modeled on baseline weight, height, comorbidity, socioeconomic status, years of smoking, and exercise in 3 separate age groups, using Cox proportional hazards regressions and competing risk regressions (CRRs).Results. Dose-response relationships between weight and risk of TJR and between smoking and risk of TJR were observed. Being overweight independently increased the risk of TJR, while smoking lowered the risk. The decreased risk among smokers was demonstrated in both Cox and CRR models and became apparent after 23 years of exposure. Men who were in the highest quartile (>= 48 years of smoking) were 42-51% less likely to undergo TJR than men who had never smoked. Tests for trend in the log hazard ratios (HRs) across both smoking and weight quantiles yielded significant P values. Vigorous exercise increased the hazard of TJR; however, the association reached statistical significance only in the 70-74-year-old age group (adjusted HR 1.64 [95% confidence interval 1.19-2.24]). Adjusting for Deyo-Charlson Index or Elixhauser's comorbidity measures did not eliminate these associations.Conclusion. Our findings indicate that being overweight and reporting vigorous physical activity increase the risk of TJR. This study is the first to demonstrate a strong inverse dose-response relationship between duration of smoking and risk of TJR. More research is needed to better understand the role of smoking in the pathogenesis of osteoarthritis.