前瞻性队列研究:50 万中国男性和女性中与婚姻状况相关的发病率和死亡率风险的广泛分布情况

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Meng Xiao , Aolin Li , Yueqing Wang , Canqing Yu , Yuanjie Pang , Pei Pei , Ling Yang , Yiping Chen , Huaidong Du , Dan Schmidt , Daniel Avery , Qiang Sun , Junshi Chen , Zhengming Chen , Liming Li , Jun Lv , Dianjianyi Sun
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引用次数: 0

摘要

方法利用中国嘉道理生物库(CKB)的基线(2004-2008年)和随访信息(截至2017年12月31日的ICD10编码事件)对婚姻状况(与配偶同居与无配偶同居)进行了性别分层表观范围关联分析(PheWAS)。我们估算了调整后的危险比(aHRs),以评估婚姻状况与2017年记录的中国全表重大疾病或性别特异性前10位死亡原因的发病风险之间的关联。此外,还评估了基线患有主要慢性病的参与者的婚姻状况与死亡风险之间的关联。研究结果在长达11.1年的中位随访期间,在210202名男性和302521名女性(年龄在30-79岁之间)中记录了1946380起健康事件。结果发现,婚姻状况分别与男性的 13 种疾病(p < 9.92 × 10-5)和女性的 9 种疾病(p < 9.33 × 10-5)有显著的全表关联。在最终模型中对所有疾病特异性协变量进行调整后,与无配偶者相比,无配偶者患精神分裂症、精神分裂症和妄想症的风险更高(男性的 aHR [95% CI]:2.55,[1.83-3.56];女性的 aHR [95%CI]:1.49,[1.13-1.97])。只有在无配偶的男性中才观察到总体精神和行为障碍(1.31,1.13-1.53)、心血管疾病(1.07,1.04-1.10)和癌症(1.06,1.00-1.12)的额外较高风险,而无配偶生活的女性患泌尿生殖系统疾病(0.89,0.85-0.93)和受伤及中毒(0.93,0.88-0.97)的风险较低。在基线时患有主要慢性疾病的 282 810 名参与者中,有 39 166 人死亡。在男性患者的 21 种疾病中,有 12 种疾病会增加无配偶者的死亡风险;在女性患者的 23 种疾病中,有 1 种疾病会增加无配偶者的死亡风险。对于基线时自我报告患有任何疾病的患者,与有配偶者相比,男性和女性无配偶者的死亡风险aHRs(95% CIs)分别为1.29(1.24-1.34)和1.04(1.00-1.07)(pinteraction<0.0001)。经费来源:国家自然科学基金委员会、嘉道理慈善基金会、国家重点研发计划、中国科技部和英国威康信托基金会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A wide landscape of morbidity and mortality risk associated with marital status in 0.5 million Chinese men and women: a prospective cohort study

Background

A comprehensive depiction of long-term health impacts of marital status is lacking.

Methods

Sex-stratified phenome-wide association analyses (PheWAS) of marital status (living with vs. without a spouse) were performed using baseline (2004–2008) and follow-up information (ICD10-coded events till Dec 31, 2017) from the China Kadoorie Biobank (CKB). We estimated adjusted hazard ratios (aHRs) to evaluate the associations of marital status with morbidity risks of phenome-wide significant diseases or sex-specific top-10 death causes in China documented in 2017. Additionally, the association between marital status and mortality risks among participants with major chronic diseases at baseline was assessed.

Findings

During up to 11.1 years of the median follow-up period, 1,946,380 incident health events were recorded among 210,202 men and 302,521 women aged 30–79. Marital status was found to have phenome-wide significant associations with thirteen diseases among men (p < 9.92 × 10−5) and nine diseases among women (p < 9.33 × 10−5), respectively. After adjusting for all disease-specific covariates in the final model, participants living without a spouse showed increased risks of schizophrenia, schizotypal and delusional disorders (aHR [95% CI]: 2.55, [1.83–3.56] for men; 1.49, [1.13–1.97] for women) compared with their counterparts. Additional higher risks in overall mental and behavioural disorder (1.31, 1.13–1.53), cardiovascular disease (1.07, 1.04–1.10) and cancer (1.06, 1.00–1.12) were only observed among men without a spouse, whereas women living without a spouse were at lower risks of developing genitourinary diseases (0.89, 0.85–0.93) and injury & poisoning (0.93, 0.88–0.97). Among 282,810 participants with major chronic diseases at baseline, 39,166 deaths were recorded. Increased mortality risks for those without a spouse were observed in 12 of 21 diseases among male patients and one of 23 among female patients. For patients with any self-reported disease at baseline, compared with those living with a spouse, the aHRs (95% CIs) of mortality risk were 1.29 (1.24–1.34) and 1.04 (1.00–1.07) among men and women without a spouse (pinteraction<0.0001), respectively.

Interpretation

Long-term associations of marital status with morbidity and mortality risks are diverse among middle-aged Chinese adults, and the adverse impacts due to living without a spouse are more profound among men. Marital status may be an influential factor for health needs.

Funding

The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology, and the UK Wellcome Trust.

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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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