Ageing-related functional and cognitive impairments and cold mortality risk: a longitudinal cohort study in China.

IF 21.6 1区 医学 Q1 ENVIRONMENTAL SCIENCES
Di Xi, Linxin Liu, Jialu Song, Min Zhang, Yi Zeng, John S Ji
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引用次数: 0

Abstract

Background: Cold-related mortality is the leading contributor to the disease burden from non-optimal temperatures in China. In this study, we aimed to explore ageing-related risk factors, advance our understanding of temperature-related mortality, and enhance the accuracy of relative risk measures.

Methods: We assessed daily cold spell exposure individually for 13 527 participants with a median age of 89 years (IQR 78-96) and 4659 winter mortalities during follow-up from 2008 to 2018 in the Chinese Longitudinal Healthy Longevity Survey. We used a time-varying Cox proportional hazards model to capture daily variations in cold spell exposure, adjusting for individual-level demographics, multidimensional measures of functional status, and socioeconomic factors. We also examined effect modification by demographics, functional status measures, comorbidities, and socioeconomic factors. The primary outcome is all-cause mortality recorded from 2008 to 2018.

Findings: Cold spell days were associated with a near-doubling of mortality risk (hazard ratio [HR] 1·87-2·08). Individuals with impaired physical functional status, particularly those dependent on activities of daily living (eg, bathing, dressing, eating, toileting, cooking, carrying weights of 5 kg, doing laundry, and taking public transportation), exhibited significantly higher vulnerability (HR 2·23-3·74). Cognitive impairments, notably in attention and calculation, orientation, and short-term memory, also increased risk (HR 2·23-2·41). Women faced greater mortality risk than men (HR 2·17-2·27 vs 1·50-1·89). Self-reported chronic disease comorbidities did not significantly modify these associations.

Interpretation: Beyond age as a general risk factor, to reduce cold-related mortality in China, interventions should prioritise older adults with impaired activities of daily living (eg, bathing or dressing) and cognitive deficits (eg, attention and calculation or short-term memory), particularly women. Community-based programmes, such as subsidised heating and real-time cold alert systems, combined with targeted caregiver support for functionally dependent individuals, could mitigate risks.

Funding: Data collection was jointly supported by the National Key R&D Program of China (number 2018YFC2000400), the National Natural Science Foundation of China (number 72061137004), the US National Institute of Aging, National Institutes of Health (number P01AG031719), and Beijing TaiKang YiCai Public Welfare Foundation. The study was supported by the National Natural Science Foundation of China (number 82422064, 82250610230), the Natural Science Foundation of Beijing (number IS23105), and the Tsinghua University Vanke School of Public Health Research Fund (number 2021PY001).

中国与年龄相关的功能和认知障碍与感冒死亡风险:一项纵向队列研究
背景:在中国,与寒冷相关的死亡率是由非最佳温度引起的疾病负担的主要原因。在本研究中,我们旨在探讨衰老相关的危险因素,提高我们对温度相关死亡率的认识,并提高相对风险措施的准确性。方法:我们在2008年至2018年的中国纵向健康寿命调查中,对13 527名中位年龄为89岁(IQR 78-96)的参与者和4659名冬季死亡的参与者进行了每日寒潮暴露的单独评估。我们使用时变Cox比例风险模型来捕捉寒潮暴露的每日变化,调整了个人层面的人口统计学、多维功能状态测量和社会经济因素。我们还检查了人口统计学、功能状态测量、合并症和社会经济因素对效果的影响。主要结果是2008年至2018年记录的全因死亡率。结果:寒潮天数与死亡风险增加近一倍相关(危险比[HR] 1.87 - 2.08)。身体功能受损的个体,特别是那些依赖日常生活活动的个体(如洗澡、穿衣、吃饭、如厕、做饭、负重5公斤、洗衣服和乘坐公共交通工具),表现出明显更高的脆弱性(HR 2.23 - 3.74)。认知障碍,特别是在注意和计算、定向和短期记忆方面,也增加了风险(HR 2.23 - 2.41)。女性面临的死亡风险高于男性(HR 2.17 - 2.27 vs 1.50 - 1.89)。自我报告的慢性病合并症并没有显著改变这些关联。解释:除了将年龄作为一般风险因素外,为了降低中国与感冒相关的死亡率,干预措施应优先考虑日常生活活动受损(如洗澡或穿衣)和认知缺陷(如注意力、计算能力或短期记忆)的老年人,尤其是女性。以社区为基础的规划,如补贴供暖和实时冷警报系统,加上有针对性的照顾者对功能依赖的个人的支持,可以减轻风险。资助:数据收集由国家重点研发计划项目(no . 2018YFC2000400)、国家自然科学基金项目(no . 72061137004)、美国国家老龄研究所、美国国立卫生研究院(no . P01AG031719)、北京泰康一财公益基金会共同支持。本研究得到国家自然科学基金(no . 82422064, 82250610230)、北京市自然科学基金(no . IS23105)和清华大学万科公共卫生学院科研基金(no . 2021PY001)的资助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
28.40
自引率
2.30%
发文量
272
审稿时长
8 weeks
期刊介绍: The Lancet Planetary Health is a gold Open Access journal dedicated to investigating and addressing the multifaceted determinants of healthy human civilizations and their impact on natural systems. Positioned as a key player in sustainable development, the journal covers a broad, interdisciplinary scope, encompassing areas such as poverty, nutrition, gender equity, water and sanitation, energy, economic growth, industrialization, inequality, urbanization, human consumption and production, climate change, ocean health, land use, peace, and justice. With a commitment to publishing high-quality research, comment, and correspondence, it aims to be the leading journal for sustainable development in the face of unprecedented dangers and threats.
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