Predicting All-Cause and Cause-Specific Mortality by Static and Dynamic Measurements of Allostatic Load: A 10-Year Population-Based Cohort Study in Taiwan

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• 作者：An-Chun Hwang ; MD^a ; ^b ; ^c ; Li-Ning Peng ; MD ; MSc^a ; ^b ; ^c ; Yu-Wen Wen ; PhD^d ; Yi-Wen Tsai ; PhD^a ; ^e ; Li-Chuan Chang ; MS^e ; Shu-Ti Chiou ; MD ; PhD^b ; ^f ; Liang-Kung Chen ; MD ; PhD^a ; ^d ; ^{lkchen2@vghtpe.gov.tw" class="auth_mail}
• 关键词：Allostatic load ; homeostasis ; mortality ; elderly ; geriatrics
• 刊名：Journal of the American Medical Directors Association
• 出版年：July 2014
• 年：2014
• 卷：15
• 期：7
• 页码：490-496
• 全文大小：783 K

文摘

To evaluate the role of allostatic load (AL), either static or dynamic measurements, in predicting all-cause and cause-specific mortality of older people in Taiwan.

Design

A prospective cohort study.

Setting

Population-based community study.

Participants

One thousand twenty-three community-dwelling older people.

Measurements

Allostatic load (calculated by systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glycosylated hemoglobin, fasting glucose, waist-to-hip ratio, body mass index, dehydroepiandrosterone sulfate, insulin-like growth factor-1, 12-hour urine cortisol, 12-hour urine epinephrine, 12-hour urine norepinephrine, 12-hour urine dopamine, white blood cell count, neutrophils, interleukin-6, albumin, creatinine) and all-cause and cause-specific mortality from national death registry.

Intervention

None.

Results

Adjusted for age and sex, each 1-point increase in AL score was associated with 20% incremental risk of mortality [hazard ratio 1.20, 95% confidence interval (CI) 1.09–1.31]. This association can be extended to cause-specific mortality in both sexes in general. In addition, the higher AL score quintile was significantly associated with higher risk of 10-year all-cause mortality (P < .0001). This association was consistent across different cause-specific mortality (ie, malignant neoplasm (P = .008), cardiometabolic diseases (P < .0001), infectious diseases (P < .0001), respiratory diseases (P < .0001), and others (P = .0002), respectively. Compared with AL score decliners, adjusted for age, sex, and baseline AL score in 2000, participants with fast increase had significantly higher mortality (HR 2.68, 95% CI 1.23–5.84, P = .01). The effect was stronger in men (HR 2.83, 95% CI 1.1–7.29, P = .03 in slow increase; HR 4.06, 95% CI 1.56–10.6, P = .001 in fast increase group), but it was insignificant in female participants.

Conclusions

Higher AL score or rapid increase of AL score significantly increased subsequent mortality risk in older adults, either measured statically or dynamically. AL is predictive of 10-year mortality regardless of cause of death, and rapid increase in AL score is associated with higher subsequent mortality.