成人哮喘的高死亡率：一项随访15年的人群队列研究
2018/05/03
摘要
背景：前期研究显示哮喘患者的全因死亡率较高。哮喘患儿的多重致敏发病率较高，哮喘成人过敏性鼻炎和/或过敏性结膜炎（AR/AC）患病率较高。有关AR/AC和其他因素对成人哮喘患者死亡率的影响所知甚少。我们的目的是研究成人有无哮喘时的死亡率及其危险因素。
方法：我们从国家登记处随机抽取1648名年龄超过30岁的哮喘患者，并将哮喘患者与1到2个对照进行匹配。基线信息是在1997年通过问卷获得的，研究人群与1997-2013年芬兰统计局的死亡证明信息相关联。在几个修正后的模型中比较了各组之间的总体和特定原因生存率。
结果：在平均15.6年的随访期间，我们观察到1052例哮喘患者中221例死亡，1889例非哮喘患者中335例死亡。心血管疾病是两组人员的主要死因。哮喘与全因死亡率（校正HR 1.25; 95％CI 1.05-1.49，P = 0.011）以及慢性阻塞性肺病（HR 12.0,4.18-34.2，P <0.001）和呼吸器官恶性肿瘤（HR 2.33,1.25-4.42，P = 0.008）的死亡率增加相关。在哮喘患者中，吸烟与全因死亡率增加有关，自我报告的AR / AC与死亡率降低相关。在非哮喘患者中，吸烟和肥胖与全因死亡率增加相关，而女性死亡风险降低。
结论：成人哮喘患者合并COPD、恶性呼吸道肿瘤和心血管疾病致死亡率增加。 戒烟对降低哮喘和非哮喘成年人的总死亡率来说非常重要。 仅在哮喘患者中AR / AC与降低的死亡率呈现相关性。 因此，未来需要在更大规模的其他人群中进行研究，以进一步探讨这种关联的性质。
Higher mortality of adults with asthma: a 15 year follow-up of a populationbased cohort.
Riikka E. Lemmetyinen, et al.
Abstract
BACKGROUND：Higher all-cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic conjunctivitis (AR/AC) is associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults
with and without asthma.
METHODS：We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause-specific survival between the groups was compared in several adjusted models.
RESULTS：During a mean follow-up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 non-asthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all-cause mortality (adjusted HR 1.25; 95% CI 1.05-1.49, P=0.011); as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18–34.2, P<0.001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25–4.42, P=0.008). Among asthmatics, smoking was associated with increased all-cause mortality and self-reported AR/AC was associated with decreased mortality. Among non-asthmatics, smoking and obesity were associated with increased all-cause mortality, whereas female gender showed an association with a decreased risk.
CONCLUTIONS：Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms and cardiovascular diseases. Smoking cessation is important for reduction of total mortality in both asthmatic and non-asthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association.
背景：前期研究显示哮喘患者的全因死亡率较高。哮喘患儿的多重致敏发病率较高，哮喘成人过敏性鼻炎和/或过敏性结膜炎（AR/AC）患病率较高。有关AR/AC和其他因素对成人哮喘患者死亡率的影响所知甚少。我们的目的是研究成人有无哮喘时的死亡率及其危险因素。
方法：我们从国家登记处随机抽取1648名年龄超过30岁的哮喘患者，并将哮喘患者与1到2个对照进行匹配。基线信息是在1997年通过问卷获得的，研究人群与1997-2013年芬兰统计局的死亡证明信息相关联。在几个修正后的模型中比较了各组之间的总体和特定原因生存率。
结果：在平均15.6年的随访期间，我们观察到1052例哮喘患者中221例死亡，1889例非哮喘患者中335例死亡。心血管疾病是两组人员的主要死因。哮喘与全因死亡率（校正HR 1.25; 95％CI 1.05-1.49，P = 0.011）以及慢性阻塞性肺病（HR 12.0,4.18-34.2，P <0.001）和呼吸器官恶性肿瘤（HR 2.33,1.25-4.42，P = 0.008）的死亡率增加相关。在哮喘患者中，吸烟与全因死亡率增加有关，自我报告的AR / AC与死亡率降低相关。在非哮喘患者中，吸烟和肥胖与全因死亡率增加相关，而女性死亡风险降低。
结论：成人哮喘患者合并COPD、恶性呼吸道肿瘤和心血管疾病致死亡率增加。 戒烟对降低哮喘和非哮喘成年人的总死亡率来说非常重要。 仅在哮喘患者中AR / AC与降低的死亡率呈现相关性。 因此，未来需要在更大规模的其他人群中进行研究，以进一步探讨这种关联的性质。
（复旦大学附属中山医院呼吸内科 罗锦龙 摘译 杨冬 审校）
（Allergy. 2018 Feb 20）
（Allergy. 2018 Feb 20）
Higher mortality of adults with asthma: a 15 year follow-up of a populationbased cohort.
Riikka E. Lemmetyinen, et al.
Abstract
BACKGROUND：Higher all-cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic conjunctivitis (AR/AC) is associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults
with and without asthma.
METHODS：We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause-specific survival between the groups was compared in several adjusted models.
RESULTS：During a mean follow-up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 non-asthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all-cause mortality (adjusted HR 1.25; 95% CI 1.05-1.49, P=0.011); as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18–34.2, P<0.001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25–4.42, P=0.008). Among asthmatics, smoking was associated with increased all-cause mortality and self-reported AR/AC was associated with decreased mortality. Among non-asthmatics, smoking and obesity were associated with increased all-cause mortality, whereas female gender showed an association with a decreased risk.
CONCLUTIONS：Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms and cardiovascular diseases. Smoking cessation is important for reduction of total mortality in both asthmatic and non-asthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association.
