西安地区干休所老年男性保健人群全死因谱的30年随访观察
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摘要
目的明确西安地区军队30年队列老年男性干部死亡率、构成及危险因素。方法选取1987年起在西安市22个军队干休所的全部老年男性(55岁及以上),共计1 268人。终点指标为各类死亡,采用Cox模型进行分析。结果截止2016年9月30日,共观察23,661.00人年,平均随访18.66年。存活363例(28.63%),年龄(89.13±3.78)岁,死亡889例(70.11%),年龄(78.84±8.34)岁,失访16例(1.26%)。死因构成顺位前5位的分别是恶性肿瘤333例(37.46%)、冠心病192例(21.6%)、呼吸系统疾病132例(14.85%)、脑卒中104例(11.7%)和糖尿病36例(4.05%),标化死亡率分别为875.39/10万、504.73/10万、347.00/10万、273.40/10万、94.64/10万,总死亡率为2335.17/10万,与全国同龄男性组(85岁以上)死亡率比较,前5位疾病死亡率及全因死亡率均较低。恶性肿瘤构成比前5位分别为肺癌(31.83%)、胃癌(16.52%)、肠癌(11.71%)、肝癌(9.3%)及胆囊癌(3.9%),标化死亡率分别为278.65/10万、144.58/10万、102.52/10万、81.49/10万、34.17/10万,与全国同龄男性组(85岁以上)标化死亡率比较,肺癌、胃癌、肠癌及肝癌死亡率均低于全国同龄组标化死亡率,胆囊癌死亡率高于全国同龄组标化死亡率;随访年龄、负性生活事件、吸烟、既往慢性阻塞性肺疾病(COPD)史和既往癌症史的相对危险度及95%可信区间分别为0.759(0.724～0.796)、2.130(1.274～3.563)、1.299(1.081～1.561)、2.831(1.753～4.571)及8.383(2.039～34.460)。结论该队列人群主要死因为恶性肿瘤、冠心病、呼吸系统系统疾病、脑卒中及糖尿病;其中恶性肿瘤以肺癌及消化系统肿瘤为主;全死因相关因素分别为年龄、吸烟、负性生活事件、既往COPD史和既往癌症史。
Objective To find out the main causes of death,mortality and risk factors in a 30-year retired military cadres cohort from Xi'an city. Methods A cohort study was carried out on the retired male military cadres from 22 cadre 's sanitariums in Xi'an,China from 1987. A total of 1 268 cadres aged 55 years or older were enrolled. The endpoint was settled as all-cause death.Results By Sep 30 th 2016,1268 person had been visited,total person-year of follow-up was 23,661.00,the mean follow-up time was 18.66 years,a total of 889(70.11%) had died(age:89.13 ± 3.78),363(28.63%) were alive(age:78.84 ± 8.34)and 16(1.26%)were lost. The five leading causes of death are carcinoma(333 cases,37.46%),coronary heart diseases(192 cases,21.6%,respiratory diseases(132 cases,14.85%),apoplexy(104 cases,11.7%) and diabetes mellitus(36 cases,4.05%),and the standardized mortality ratio are 875.39,504.73,347.00,273.40 and 94.64 per one hundred thousand person year. Compared with age standardized mortality of males in the same age group(≥55 years old),the first five death rates were lower than those of the national standard. The five leading proportion of malignant tumors was lung cancer(31.83%),gastric cancer(16.52%),intestinal cancer(11.71%),liver cancer(9.3%)and carcinoma of gallbladder(3.9%),and the standardized mortality are 278.65,144.58,102.52,81.49 and 34.17 per hundred thousand person year. The leading four death rates were lower than those of the national standard and the carcinoma of gallbladder was higher than it. The HR(95% CI) of the age of follow-up,negative life events,smoking,history disease of COPD and cancer were0.759(0.724 ～ 0.796),2.130(1.274 ～ 3.563),1.299(1.081 ～ 1.561),2.831(1.753 ～ 4.571) and 8.383(2.039 ～ 34.460).Conclusion The leading causes of death are carcinoma,coronary heart diseases,respiratory diseases,apoplexy and diabetes mellitus.Lung cancer and gastrointestinal tumor are main causes of death among carcinoma patients,screening and prevention measures for carcinoma of gallbladder should be more effective. Age of follow-up,smoking,negative life events,history disease of COPD and cancer are related with all causes of death.
Objective To find out the main causes of death,mortality and risk factors in a 30-year retired military cadres cohort from Xi'an city. Methods A cohort study was carried out on the retired male military cadres from 22 cadre 's sanitariums in Xi'an,China from 1987. A total of 1 268 cadres aged 55 years or older were enrolled. The endpoint was settled as all-cause death.Results By Sep 30 th 2016,1268 person had been visited,total person-year of follow-up was 23,661.00,the mean follow-up time was 18.66 years,a total of 889(70.11%) had died(age:89.13 ± 3.78),363(28.63%) were alive(age:78.84 ± 8.34)and 16(1.26%)were lost. The five leading causes of death are carcinoma(333 cases,37.46%),coronary heart diseases(192 cases,21.6%,respiratory diseases(132 cases,14.85%),apoplexy(104 cases,11.7%) and diabetes mellitus(36 cases,4.05%),and the standardized mortality ratio are 875.39,504.73,347.00,273.40 and 94.64 per one hundred thousand person year. Compared with age standardized mortality of males in the same age group(≥55 years old),the first five death rates were lower than those of the national standard. The five leading proportion of malignant tumors was lung cancer(31.83%),gastric cancer(16.52%),intestinal cancer(11.71%),liver cancer(9.3%)and carcinoma of gallbladder(3.9%),and the standardized mortality are 278.65,144.58,102.52,81.49 and 34.17 per hundred thousand person year. The leading four death rates were lower than those of the national standard and the carcinoma of gallbladder was higher than it. The HR(95% CI) of the age of follow-up,negative life events,smoking,history disease of COPD and cancer were0.759(0.724 ～ 0.796),2.130(1.274 ～ 3.563),1.299(1.081 ～ 1.561),2.831(1.753 ～ 4.571) and 8.383(2.039 ～ 34.460).Conclusion The leading causes of death are carcinoma,coronary heart diseases,respiratory diseases,apoplexy and diabetes mellitus.Lung cancer and gastrointestinal tumor are main causes of death among carcinoma patients,screening and prevention measures for carcinoma of gallbladder should be more effective. Age of follow-up,smoking,negative life events,history disease of COPD and cancer are related with all causes of death.
引文
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[7]李鹏,王拥军,陈光勇,等.中国早期结直肠癌及癌前病变筛查与诊治共识[J].中国实用内科杂志,2015,50(3):211-227.
[8]柏愚,杨帆,马丹,等.中国早期结直肠癌筛查及内镜诊治指南(2014年,北京)[J].胃肠病学,2015,10(6):345-365.
[9]赛晓勇,闫永平.军队男性老年人脑卒中发病与死亡因素的队列研究[J].中国慢性病预防与控制,2010,2(18):4-7.
[10]赛晓勇,何耀,闰永平,等.西安市军队老年人慢性阻塞性肺疾病死亡危险因素的18年队列研究[J].中华流行病学杂志,2006,9(27):765-767.
[11]赛晓勇,何耀,闰永平,等.西安市1268名军队老年男性吸烟相关死亡18年随访研究[J].中国慢性病预防与控制,2006,12(14):392-394.
[12] Sai XY,He Y,Men K,et al. All-cause mortality and risk factors in a cohort of retired military male veterans,Xi'an,China:an18-year follow up study[J]. BMC Public Health,2007,12(7):290.
[2] Thurkaa S,Aspasia S,Simon C,et al. Global incidence and outcome of testicular cancer[J]. Clinical Epidemiology,2013,5(1):417-427.
[3] GoéréD,Allard MA,HonoréC,et al. Incidence and prognosis of synchronous colorectal carcinomatosis[J]. Future Oncology,2013,9(4):541-549.
[4] Borghesi M,Brunocilla E,Schiavina R,et al. Positive surgical margins after nephron-sparing surgery for renal cell carcinoma:incidence,clinical impact,and management[J]. Clinical Genitourinary Cancer,2013,11(1):5-9.
[5]母斌,孙光红,王德明. 810例60岁及以上老年患者死亡情况分析[D].医学信息(上旬刊),2010,12:4622-4623.
[6]朱静鸿,张宇宁,白雪梅.长春市2000-2004年老年恶性肿瘤死亡分析[J].中国卫生工程学,2008,7(1):61-62.
[7]李鹏,王拥军,陈光勇,等.中国早期结直肠癌及癌前病变筛查与诊治共识[J].中国实用内科杂志,2015,50(3):211-227.
[8]柏愚,杨帆,马丹,等.中国早期结直肠癌筛查及内镜诊治指南(2014年,北京)[J].胃肠病学,2015,10(6):345-365.
[9]赛晓勇,闫永平.军队男性老年人脑卒中发病与死亡因素的队列研究[J].中国慢性病预防与控制,2010,2(18):4-7.
[10]赛晓勇,何耀,闰永平,等.西安市军队老年人慢性阻塞性肺疾病死亡危险因素的18年队列研究[J].中华流行病学杂志,2006,9(27):765-767.
[11]赛晓勇,何耀,闰永平,等.西安市1268名军队老年男性吸烟相关死亡18年随访研究[J].中国慢性病预防与控制,2006,12(14):392-394.
[12] Sai XY,He Y,Men K,et al. All-cause mortality and risk factors in a cohort of retired military male veterans,Xi'an,China:an18-year follow up study[J]. BMC Public Health,2007,12(7):290.