背景:大多数流行病学研究的重点是死亡率或临床事件,与基本日常功能相关的活动限制及其后果的信息较少。来自世界不同地区不同经济水平的多个国家关于活动限制及其与临床结果的关联的标准化数据很少。我们旨在量化25个国家(按不同经济水平分组)的活动限制和辅助设备使用的普遍性以及限制与不良结果的关联。
方法:在此分析中,我们从25个高收入人群中获得了数据,中等收入,和低收入国家的前瞻性城市农村流行病学(PURE)研究(175660名参与者)。在PURE研究中,我们邀请年龄在35~70岁,打算继续在目前的家庭居住4年的个体完成一份关于活动限制的问卷.参与者计划每3年通过电话或亲自进行一次随访。活动限制屏幕包括关于自我报告的行走困难的问题,抓,弯曲,近距离观察,看得很远,说话,听力,和辅助设备的使用(步态,愿景,和助听器)。我们估计了自我报告的活动限制和辅助设备使用的粗略患病率,以及按年龄和性别标准化的患病率。我们使用逻辑回归来调整教育和社会经济因素的患病率,并按年龄估计活动限制和辅助设备的可能性,性别,国家收入。我们使用Cox衰弱模型来评估每种活动限制与死亡率和临床事件(心血管疾病,心力衰竭,肺炎,falls,和癌症)。PURE研究已在ClinicalTrials.gov注册,NCT03225586。
结果:在2001年1月12日至2019年5月6日之间,175584人完成了活动限制问卷中的至少一个问题(平均年龄50·6岁[SD9·8];103625[59%]女性)。在完成所有问题的人中,平均随访10·7年(SD4·4)。最常见的自我报告活动限制是弯曲困难(175515名参与者中有23921名[13·6%]),近距离观察(167801名参与者中的22532[13·4%]),和步行(175554名参与者中的22805[13·0%]);限制的患病率随着年龄的增长和女性的增加而增加。按年龄和性别标准化的所有限制的普遍性,除了听证,在低收入国家和中等收入国家最高,在调整了社会经济因素后,这仍然是一致的。步态的使用,视觉,低收入国家和中等收入国家的助听器最低,尤其是在女性中。在低收入国家,近距离视距的患病率高四倍(37926名参与者中的6257[16·5%]与18039名参与者中的717[4·0%]),远距离视距的患病率高五倍(37923名参与者中的4003[10·6%]与18038名参与者中的391[2·2%]),但低收入国家的眼镜使用率是高收入国家的一半。行走受限与死亡率相关性最强(校正风险比1·32[95%CI1·25-1·39]),与其他临床事件相关性最强。观察到远处的局限性和死亡率之间的其他显著关联,掌握限制和心血管疾病,弯曲限制和下降,在说话限制和中风之间。
结论:全球妇女活动受限率明显高于男性,低收入国家和中等收入国家与高收入国家相比,再加上步态的使用要低得多,视觉,和助听器。需要采取战略来防止和减轻全球活动限制,特别是低收入国家和妇女。
背景:本文末尾列出了资金来源。
BACKGROUND: The focus of most epidemiological studies has been mortality or clinical events, with less information on activity limitations related to basic daily functions and their consequences. Standardised data from multiple countries at different economic levels in different regions of the world on activity limitations and their associations with clinical outcomes are sparse. We aimed to quantify the prevalence of activity limitations and use of assistive devices and the association of limitations with adverse outcomes in 25 countries grouped by different economic levels.
METHODS: In this analysis, we obtained data from individuals in 25 high-income, middle-income, and low-income countries from the Prospective Urban Rural Epidemiological (PURE) study (175 660 participants). In the PURE study, individuals aged 35-70 years who intended to continue living in their current home for a further 4 years were invited to complete a questionnaire on activity limitations. Participant follow-up was planned once every 3 years either by telephone or in person. The activity limitation screen consisted of questions on self-reported difficulty with walking, grasping, bending, seeing close, seeing far, speaking, hearing, and use of assistive devices (gait, vision, and hearing aids). We estimated crude prevalence of self-reported activity limitations and use of assistive devices, and prevalence standardised by age and sex. We used logistic regression to additionally adjust prevalence for education and socioeconomic factors and to estimate the probability of activity limitations and assistive devices by age, sex, and country income. We used Cox frailty models to evaluate the association between each activity limitation with mortality and clinical events (cardiovascular disease, heart failure, pneumonia, falls, and cancer). The PURE study is registered with ClinicalTrials.gov, NCT03225586.
RESULTS: Between Jan 12, 2001, and May 6, 2019, 175 584 individuals completed at least one question on the activity limitation questionnaire (mean age 50·6 years [SD 9·8]; 103 625 [59%] women). Of the individuals who completed all questions, mean follow-up was 10·7 years (SD 4·4). The most common self-reported activity limitations were difficulty with bending (23 921 [13·6%] of 175 515 participants), seeing close (22 532 [13·4%] of 167 801 participants), and walking (22 805 [13·0%] of 175 554 participants); prevalence of limitations was higher with older age and among women. The prevalence of all limitations standardised by age and sex, with the exception of hearing, was highest in low-income countries and middle-income countries, and this remained consistent after adjustment for socioeconomic factors. The use of gait, visual, and hearing aids was lowest in low-income countries and middle-income countries, particularly among women. The prevalence of seeing close limitation was four times higher (6257 [16·5%] of 37 926 participants vs 717 [4·0%] of 18 039 participants) and the prevalence of seeing far limitation was five times higher (4003 [10·6%] of 37 923 participants vs 391 [2·2%] of 18 038 participants) in low-income countries than in high-income countries, but the prevalence of glasses use in low-income countries was half that in high-income countries. Walking limitation was most strongly associated with mortality (adjusted hazard ratio 1·32 [95% CI 1·25-1·39]) and most consistently associated with other clinical events, with other notable associations observed between seeing far limitation and mortality, grasping limitation and cardiovascular disease, bending limitation and falls, and between speaking limitation and stroke.
CONCLUSIONS: The global prevalence of activity limitations is substantially higher in women than men and in low-income countries and middle-income countries compared with high-income countries, coupled with a much lower use of gait, visual, and hearing aids. Strategies are needed to prevent and mitigate activity limitations globally, with particular emphasis on low-income countries and women.
BACKGROUND: Funding sources are listed at the end of the Article.