不同年龄段生活方式对脑卒中影响的差异研究

王静茹; 姜永根; 吴毅凌; 苏旭燕; 谢旖婧; 张彭燕; 夏丁; 赵琦; 徐珂琳; 张铁军; 陈兴栋; 赵根明; 蒋艳峰; 索晨

doi:10.16462/j.cnki.zhjbkz.2024.01.001

不同年龄段生活方式对脑卒中影响的差异研究

doi: 10.16462/j.cnki.zhjbkz.2024.01.001

王静茹¹,
姜永根²,
吴毅凌²,
苏旭燕²,
谢旖婧¹,
张彭燕¹,
夏丁¹,
赵琦³,
徐珂琳⁴,
张铁军^{1, 5, 6},
陈兴栋^{5, 6, 7},
赵根明¹,
蒋艳峰⁸,
索晨^{1, 6, 9, ,}

1.
复旦大学公共卫生学院流行病学教研室-教育部公共卫生安全重点实验室，上海 200032
2.
上海市松江区疾病预防与控制中心慢性病防治科，上海 201620
3.
复旦大学公共卫生学院社会医学教研室，上海 200032
4.
复旦大学公共卫生学院生物统计学教研室，上海 200032
5.
复旦大学义乌研究院，义乌 322000
6.
复旦大学泰州健康科学研究院，泰州 225316
7.
复旦大学遗传工程国家重点实验室-人类表型组研究院-张江复旦国际创新中心-华山医院国家老年疾病临床医学研究中心，上海 200438
8.
复旦大学遗传工程国家重点实验室-人类表型组研究院-生命科学学院，上海 200438
9.
上海市重大传染病与生物安全研究院，上海 200032

基金项目:

国家重点研发计划项目 2021YFC2500104

江苏省重点研发计划项目 BE2021696

国家重点研发计划“精准医学研究”重点专项 2017YFC0907000

详细信息

通讯作者:
索晨，E-mail：suochen@fudan.edu.cn

中图分类号: R181.3
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出版历程
- 收稿日期: 2023-06-07
- 修回日期: 2023-09-26
- 网络出版日期: 2024-02-05
- 刊出日期: 2024-01-10

Age-related differences in the role of lifestyle for stroke

WANG Jingru¹,
JIANG Yonggen²,
WU Yiling²,
SU Xuyan²,
XIE Yijing¹,
ZHANG Pengyan¹,
XIA Ding¹,
ZHAO Qi³,
XU Kelin⁴,
ZHNAG Tiejun^{1, 5, 6},
CHEN Xingdong^{5, 6, 7},
ZHAO Genming¹,
JIANG Yanfeng⁸,
SUO Chen^{1, 6, 9
, ,}

1.
Department of Epidemiology & Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai 200032, China
2.
Department of Chronic Disease Prevention and Control, Songjiang District Center for Disease Control and Prevention, Shanghai 201620, China
3.
Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
4.
Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China
5.
Yiwu Research Institute, Fudan University, Yiwu 322000, China
6.
Fudan University Taizhou Institute of Health Sciences, Taizhou 225316, China
7.
State Key Laboratory of Genetic Engineering, Human Phenome Institute, Zhangjiang Fudan International Innovation Center, and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200438, China
8.
State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai 200438, China
9.
Shanghai Institute of Infectious Disease and Biosecurity, Shanghai 200032, China

Funds:

National Key Research and Development Program of China 2021YFC2500104

Key Research and Development Plans of Jiangsu Province, China BE2021696

"Precision Medicine Research" Key Project, National Key Research and Development Program of China 2017YFC0907000

More Information

Corresponding author: SUO Chen, E-mail: suochen@fudan.edu.cn

摘要

摘要: 目的探讨上海市松江区居民生活方式对脑卒中风险的影响在不同年龄段中是否存在差异。方法选取上海郊区自然人群队列和生物样本库中松江区的31 771名研究对象，计算其健康生活方式评分(包括不吸烟、积极体育锻炼、均衡膳食和正常体重)，并随访至2021年12月31日。分别采用Cox比例风险回归和泊松回归评估不同基线年龄组和暴露年龄组中不同的生活方式或健康生活方式评分与新发脑卒中的HR值(95% CI)和RR值(95% CI)。基线年龄分层：年轻组(20~＜62岁)、中年组(62~＜68岁)以及老年组(≥68岁)。暴露年龄分层：年轻组(20~＜65岁)、中年组(65~＜70岁)以及老年组(≥70岁)。结果在5.0年的中位随访时间内共新发488例脑卒中事件。控制混杂变量后，两种方法都未发现不吸烟、积极体育锻炼、均衡膳食和正常体重与脑卒中发病风险的关联在不同的年龄组有显著差异。与基线生活方式评分≤1分组相比，年轻组、中年组及老年组中评分≥3分组的新发脑卒中风险较低(HR=0.67, 95% CI: 0.43~1.03, P=0.072; HR=0.59, 95% CI: 0.39~0.91, P=0.015; HR=0.64, 95% CI: 0.42~1.00, P=0.043和RR=0.63, 95% CI: 0.42~0.96, P=0.028; RR =0.61, 95% CI: 0.40~0.94, P=0.023; RR=0.63, 95% CI: 0.40~0.99, P=0.045)。结论在上海市松江区居民中没有发现不同的生活方式与脑卒中的关联存在年龄差异。提示在任何年龄阶段都应重视健康的生活方式。当整体的生活方式比较健康时可大幅度降低脑卒中发病风险。
- 脑卒中 /
- 生活方式 /
- 年龄差异 /
- 队列研究
Abstract: Objective To investigate whether there are differences in the influence of lifestyle on stroke risk in different age groups in Songjiang district of Shanghai. Methods A total of 31 771 study participants from the Songjiang District in the Shanghai Suburban Adult Cohort and Biobank were selected to calculate their healthy lifestyle scores (including non-smoking, active physical activity, balanced diet, and normal body weight) and were followed until December 31, 2021. Cox proportional risk regression and Poisson regression were used to determine the HR (95% CI) and RR (95% CI) of different lifestyle or healthy lifestyle scores associated with stroke in various baseline age groups and exposed age groups, respectively. Baseline age was stratified by young (20- < 62 years), middle (62- < 68 years), and old (≥68 years) groups. Exposure age was stratified by young (20- < 65 years), middle (65- < 70 years), and old (≥70 years) groups. Results Over a median follow-up of 5.0 years, 488 participants developed stroke. After adjusting confounding factors, the associations between non-smoking, active physical activity, balanced diet, or normal body weight and the risk of stroke were not significantly different across age groups, regardless of the method used. The risk of stroke was lower in the group with a score of ≥3 in the young, middle, and old stratum compared with the group with a baseline lifestyle score ≤1 (HR=0.67, 95% CI: 0.43-1.03, P=0.072; HR=0.59, 95% CI: 0.39-0.91, P=0.015; HR=0.64, 95% CI: 0.42-1.00, P=0.043; RR=0.63, 95% CI: 0.42-0.96, P=0.028; RR=0.61, 95% CI: 0.40-0.94, P=0.023; RR=0.63, 95% CI: 0.40-0.99, P=0.045). Conclusions No age-related differences in the association of different lifestyles with stroke are found among residents of Songjiang District, Shanghai. It implies that a healthy lifestyle should be emphasized regardless of age. In addition, a healthy lifestyle can substantially reduce the risk of stroke.
- Stroke /
- Lifestyle /
- Age difference /
- Cohort study

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图 1 不同年龄段中不同健康生活方式与脑卒中风险的关联

Cox比例风险回归和泊松回归分别评估了各年龄组(年轻组：Y，中年组：M，老年组：O)中的不同健康生活方式与脑卒中的HR及RR值。模型1调整了年龄和性别(绿色表示)。模型2调整年龄、性别、受教育年限、婚姻状况、脑卒中家族史、是否有高血压、糖尿病或高脂血症病史(红色表示)。黑色实线为在整个年龄阶段中通过多变量调整的HR或RR值，阴影部分为95% CI。

Figure 1. The association of various healthy lifestyles with the risk of stroke in different age groups

Cox proportional risk regression and Poisson regression were used to assess the HR and RR for stroke by different healthy lifestyles in each age group (young: Y, middle: M, and old: O), respectively. Model 1 adjusts for age and sex (indicated in green). Model 2 adjusts for age, sex, years of education, marital status, family history of stroke, and whether there is a history of hypertension, diabetes or hyperlipidemia (indicated in red). The solid black line is the HR or RR adjusted by multivariate adjustment throughout the age range, and the shaded area is the 95% CI.

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表 1 基线研究对象中有无发生脑卒中的人口学基本特征

Table 1. Characteristics of study participants according to stroke at baseline

特征Feature	总人群^① Total ^① (n=31 771)	发生脑卒中^① Stroke ^① (n=488)	未发生脑卒中^① Non-stroke ^① (n=31 283)	P值value
年龄/岁Age/years	55.48±11.28	62.92±7.64	55.36±11.29	< 0.001
女性Female	18 882(59.43)	203(41.59)	18 679(59.71)	< 0.001
受教育年限/年Years of education/years				< 0.001
≤6	14 221(44.76)	307(62.91)	13 914(44.48)
7~＜12	15 310(48.19)	174(35.66)	15 136(48.38)
≥12	2 240(7.05)	7(1.43)	2 233(7.14)
未婚Unmarried	2 199(6.92)	35(7.17)	2 164(6.92)	0.897
健康生活方式Healthy lifestyle
不吸烟Non-smoking	25 259(79.50)	326(66.80)	24 933(79.70)	< 0.001
积极体育锻炼Active physical activity	7 795(24.53)	119(24.39)	7 676(24.54)	0.980
均衡膳食Balanced diet	27 013(85.02)	371(76.02)	26 642(85.16)	< 0.001
正常体重Normal body weight	14 377(45.25)	177(36.27)	14 200(45.39)	< 0.001
健康生活方式评分/分Healthy lifestyle score/score				< 0.001
≤1	4 854(15.28)	131(26.84)	4 723(15.10)
2	12 641(39.79)	209(42.83)	12 432(39.74)
≥3	14 276(44.93)	148(30.33)	14 128(45.16)
高血压Hypertention	16 051(50.52)	359(73.57)	15 692(50.16)	< 0.001
糖尿病Diabetes	4 281(13.47)	150(30.74)	4 131(13.21)	< 0.001
高脂血症Hyperlipidaemia	10 077(31.72)	203(41.60)	9 874(31.56)	< 0.001
脑卒中家族史Family history of stroke	2 182(6.87)	31(6.35)	2 151(6.88)	0.716
注：①以人数(占比/%)或x±s表示。 Note: ① Number of people(proportion/%) or x±s

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表 2 每个年龄层的患病人数、暴露年数、脑卒中事件数量和粗脑卒中发生率的描述

Table 2. Description of the number of patients, years of exposure, number of stroke events, and crude stroke rates within each age stratum

特征Feature	基线年龄分析/岁Analysis relative to age at baseline/years			暴露年龄分析/岁Analysis relative to age at exposure/years
特征Feature	20~＜62	62~＜68	≥68	20~＜65	65~＜70	≥70
总人群Total	20 837	6 679	4 255
随访中位时间/年Median follow-up/years	5.1	4.6	4.6
脑卒中Strokes
人数Number of people	170	170	148
占比/% Proportion/% (95% CI)	0.82 (0.71~0.95)	2.55 (2.20~2.96)	3.48 (2.97~4.07)
随访人年Person-years of follow-up				120 757	52 147	27 424
脑卒中事件数Stroke events				188	165	135
脑卒中发病率/10万人年Incidence of stroke per 100 000 person-years (95% CI)				155.69 (134.95~179.61)	316.41 (271.64~368.57)	492.26 (415.85~582.72)
注：每个人在每个年龄层内对风险年数的贡献被计算为参与者在不同年龄层内的潜在年龄。 Notes: Each person′s contribution to years at risk within each age stratum was calculate as the participant potentially ages between age strata.

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表 3 健康生活方式评分与脑卒中的风险比及相对风险

Table 3. Hazard ratio and relative risk for stroke by healthy lifestyle score

年龄组Age group	健康生活方式评分Healthy lifestyle score HR值value (95% CI)				健康生活方式评分Healthy lifestyle score RR值value(95% CI)
年龄组Age group	≤1	2	≥3	P_趋势 P_trend	≤1	2	≥3	P_趋势 P_trend
Y
模型1 Model 1	1.00	0.70(0.47~1.03)	0.56(0.37~0.87)	0.011	1.00	0.73(0.51~1.06)	0.54(0.35~0.81)	0.003
模型2 Model 2	1.00	0.74(0.50~1.08)	0.67(0.43~1.03)	0.080	1.00	0.77(0.54~1.12)	0.63(0.42~0.96)	0.033
M
模型1 Model 1	1.00	0.74(0.51~1.08)	0.57(0.37~0.87)	0.009	1.00	0.77(0.52~1.13)	0.59(0.39~0.91)	0.017
模型2 Model 2	1.00	0.76(0.52~1.10)	0.59(0.39~0.91)	0.016	1.00	0.77(0.53~1.14)	0.61(0.40~0.94)	0.027
O
模型1 Model 1	1.00	0.74(0.50~1.11)	0.63(0.41~0.98)	0.047	1.00	0.67(0.44~1.03)	0.62(0.39~0.97)	0.046
模型2 Model 2	1.00	0.76(0.51~1.14)	0.64(0.42~1.00)	0.050	1.00	0.69(0.45~1.05)	0.63(0.40~0.99)	0.050
注：1. Cox比例风险回归和泊松回归分别评估了各年龄组(年轻组：Y，中年组：M，老年组：O)中的健康生活方式评分与脑卒中的HR及RR值。 2. 模型1调整了年龄和性别; 模型2调整年龄、性别、受教育年限、婚姻状况、脑卒中家族史、是否有高血压、糖尿病或高脂血症病史。 Notes：1. Cox proportional risk regression and Poisson regression were used to assess the HR and RR for stroke by healthy lifestyles score in each age group (young: Y, middle: M, and old: O), respectively. 2. Model 1 adjusts for age and sex. Model 2 adjusts for age, sex, years of education, marital status, family history of stroke, and whether there is a history of hypertension, diabetes or hyperlipidemia.

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