上海市社区居民静坐时间与全因死亡风险关系的队列研究

张妍; 段春梅; 金亚清; 龚刚; 赵琦; 赵根明; 彭谦; 于宏杰

doi:10.16462/j.cnki.zhjbkz.2024.06.009

上海市社区居民静坐时间与全因死亡风险关系的队列研究

doi: 10.16462/j.cnki.zhjbkz.2024.06.009

张妍¹,
段春梅¹,
金亚清¹,
龚刚¹,
赵琦²,
赵根明²,
彭谦¹,
于宏杰^1, ,

1.
上海市嘉定区疾病预防控制中心综合办，上海 201899
2.
复旦大学公共卫生学院，上海 200032

基金项目:

国家重点研发计划精准医学重点专项 2017YFC0907000

上海市加强公共卫生体系建设三年行动计划优青项目 GWIV-11.2-YQ18

上海市疾病预防控制青年骨干人才培养项目 21QNGG22

详细信息

通讯作者:
于宏杰，E-mail：jiecky2002@163.com

中图分类号: R161.1
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出版历程
- 收稿日期: 2024-03-11
- 修回日期: 2024-05-27
- 网络出版日期: 2024-07-13
- 刊出日期: 2024-06-10

A cohort study on the relationship between sedentary time and all-cause mortality in community residents in Shanghai

1.
General Office, Jiading District Center for Disease Control and Prevention, Shanghai 201899, China
2.
School of Public Health, Fudan University, Shanghai 200032, China

Funds:

National Key Research and Development Plan Precision Medicine Key Project 2017YFC0907000

Talent Youth Project, Three-year (2023-2025) Action Plan of Shanghai Public Health System Development GWIV-11.2-YQ18

Key Young Talents Training Program for Shanghai Disease Control and Prevention 21QNGG22

More Information

Corresponding author: YU Hongjie, E-mail: jiecky2002@163.com

摘要

摘要: 目的探索上海市嘉定区20~74岁社区居民静坐时间与全因死亡风险的关系，为静坐行为指导提供科学依据。方法基于上海市高峰人群队列在嘉定区的项目点数据，排除静坐时间缺失的个体后，最终纳入10 038人。个体的静坐时间通过基线调查问卷获得，个体的死亡信息通过链接死亡监测系统和主动的定向监测获取。采用Cox比例风险回归模型评估死亡风险。结果 2017年7月1日―2022年12月31日，研究对象平均随访(5.4±0.4)年(共观察53 985.7人年)，随访期间发生205例死亡事件。静坐时间0~＜4 h/d、4~＜6 h/d、6~＜8 h/d、≥8 h/d组的死亡率分别为1.8%(89/5 040)、2.0%(54/2 654)、2.8%(26/945)、2.6%(36/1 399)。Kaplan-Meier生存曲线显示，4组的全因死亡风险随着随访时间增加而上升，组间差异无统计学意义(Log-Rank $\chi^2$=6.230，P=0.101)。Cox比例风险回归模型显示，调整混杂后，与静坐时间0~＜4 h/d组相比，6~＜8 h/d、≥8 h/d组的全因死亡发生风险均增加(HR_{6~＜8 h/d组}=1.602, 95% CI：1.007~2.548, P=0.047; HR_{≥8 h/d组}=1.670, 95% CI：1.100~2.538, P=0.016)。结论静坐时间是全因死亡发生风险的独立危险因素，每天静坐时间≥6 h后死亡风险增加。未来仍需针对不同人群采取个性化的干预措施，避免长时间静坐。
- 静坐时间 /
- 社区居民 /
- 死亡风险 /
- 队列研究
Abstract: Objective To explore the relationship between sedentary time and mortality of the community residents aged 20-74 in Jiading District, Shanghai, in order to provide a scientific basis for the guidance of sedentary behavior. Methods Based on the project site data of Shanghai Peak Cohort in Jiading District, a total of 10 038 individuals without missing sedentary time were used as baseline data. Sedentary time was obtained through baseline questionnaires, and individual death information was obtained from the death surveillance system and active surveillance. The Cox proportional risk model was used to assess the risk of death. Results As of December 31, 2022, the mean follow-up was (5.4±0.4) years (53 985.7 person-years). During the follow-up period, 205 deaths occurred. The mortality rates in the groups 0-<4 h/d, 4-<6 h/d, 6-<8 h/d and ≥8 h/d were 1.8% (89/5 040), 2.0% (54/2 654), 2.8% (26/945) and 2.6% (36/1 399), respectively. Kaplan-Meier curve showed that the risk of all-cause death increased with the increase of follow-up time in the four groups, but there was no statistically significant difference between groups (Log-Rank $\chi^2$=6.230, P=0.101). Compared to the community residents with sedentary time 0-<4 h/d, those with sedentary time 6-<8 h/d and ≥8 h/d had an increased risk of all-cause death (HR_{6-<8 h/d group}=1.602, 95% CI: 1.007-2.548, P=0.047; HR_{≥8 h/d group}=1.670, 95% CI: 1.100-2.538, P=0.016). Conclusions Sedentary time is an independent risk factor for all-cause mortality in the community residents, and those with sedentary time ≥6 h/d have an increased risk of all-cause death. In the future, we need to take personalized intervention to avoid high levels of sedentary behavior.
- Sedentary time /
- Community residents /
- Mortality risk /
- Cohort study

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图 1 静坐时间与全因死亡关系的生存函数图

Figure 1. Survival function graph of the relationship between sedentary time and all-cause death

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表 1 调查人群的基线特征描述

Table 1. Description of baseline characteristics in the survey population

变量 Variable	合计 ^① Total ^① (n=10 038)	通常1 d静坐时间 Typical sedentary time in 1 day				$\chi^2$/F/H值 value	P值 value
变量 Variable	合计 ^① Total ^① (n=10 038)	0~＜4/(h·d^-1) ^①(n=5 040)	4~＜6/(h·d^-1) ^①(n=2 654)	6~＜8/(h·d^-1) ^①(n=945)	≥8/(h·d^-1) ^①(n=1 399)	$\chi^2$/F/H值 value	P值 value
年龄/岁 Age/years	57.5±10.4	58.8±8.8	58.2±10.2	56.0±11.8	52.6±13.3	148.875	＜0.001
性别 Gender						74.366	＜0.001
男性 Male	4 013(40.0)	1 838(36.5)	1 074(40.5)	436(46.1)	665(47.5)
女性 Female	6 025(60.0)	3 202(63.5)	1 580(59.5)	509(53.9)	734(52.5)
文化程度 Education level						416.760	＜0.001
小学及以下 Elementary school or below	540(5.4)	270(5.4)	164(6.2)	46(4.9)	60(4.3)
初中 Middle school	2 240(22.3)	1 210(24.0)	592(22.3)	199(21.0)	239(17.1)
高中/中专 High/technical secondary school	6 205(61.8)	3 260(64.7)	1 637(61.7)	535(56.6)	773(55.2)
大专及以上 College or above	1 053(10.5)	300(5.9)	261(9.8)	165(17.5)	327(23.4)
婚姻状况 Marital status						9.861	0.020
在婚 Married	9 257(92.2)	4 682(92.9)	2 442(92.0)	868(91.9)	1 265(90.4)
非在婚 Single	781(7.8)	358(7.1)	212(8.0)	77(8.1)	134(9.6)
BMI/(kg·m^-2) ^②						22.928	0.006
低体重 Underweight	369(4.0)	163(3.5)	95(3.9)	40(4.6)	71(5.6)
正常 Standard	4 599(50.1)	2 362(51.3)	1 153(47.5)	432(49.7)	652(51.1)
超重 Overweight	3 253(35.5)	1 613(35.2)	906(37.4)	313(35.9)	421(33.0)
肥胖 Obesity	951(10.4)	464(10.1)	271(11.2)	85(9.8)	131(10.3)
吸烟 Smoking						56.969	＜0.001
是 Yes	2 687(26.8)	1 197(23.8)	742(28.0)	301(31.9)	447(32.0)
否 No	7 351(73.2)	3 843(76.2)	1 912(72.0)	644(68.1)	952(68.0)
饮酒 Drinking						4.406	0.221
是 Yes	1 312(13.1)	626(12.4)	365(13.8)	123(13.0)	198(14.2)
否 No	8 726(86.9)	4 414(87.6)	2 289(86.2)	822(87.0)	1 201(85.8)
体力活动 Physical activity						358.109	＜0.001
高水平 High level	4 425(44.1)	2 490(49.4)	1 215(45.8)	351(37.1)	369(26.4)
中等水平 Moderate level	3 855(38.4)	1 866(37.0)	1 025(38.6)	377(39.9)	587(41.9)
低水平 Low level	1 758(17.5)	684(13.6)	414(15.6)	217(23.0)	443(31.7)
睡眠时间/(h·d^-1) Sleep duration/(h·d^-1)						16.844	0.010
0~＜7	1 193(11.8)	599(11.9)	313(11.8)	114(12.0)	167(11.9)
7~＜10	8 467(84.4)	4 283(85.0)	2 240(84.4)	786(83.3)	1 158(82.8)
≥10	377(3.8)	158(3.1)	101(3.8)	44(4.7)	74(5.3)
高血压 Hypertension						45.746	＜0.001
有 Yes	3 798(37.8)	1 968(39.0)	1 074(40.5)	327(34.6)	429(30.7)
无 No	6 240(62.2)	3 072(61.0)	1 580(59.5)	618(65.4)	970(69.3)
糖尿病 Diabetes						5.680	0.128
有 Yes	867(8.6)	423(8.4)	243(9.2)	95(10.1)	106(7.6)
无 No	9 171(91.4)	4 617(91.6)	2 411(90.8)	850(89.9)	1 293(92.4)
冠心病 Coronary heart disease						24.126	＜0.001
有 Yes	558(5.6)	245(4.9)	190(7.2)	63(6.7)	60(4.3)
无 No	9 480(94.4)	4 795(95.1)	2 464(92.8)	882(93.3)	1 339(95.7)
脑卒中 Stroke						6.669	0.083
有 Yes	549(5.5)	256(5.1)	171(6.4)	49(5.2)	73(5.2)
无 No	9 489(94.5)	4 784(94.9)	2 483(93.6)	896(94.8)	1 326(94.8)
恶性肿瘤 Malignant tumor						2.995	0.539
有 Yes	169(1.7)	91(1.8)	45(1.7)	17(1.8)	16(1.1)
无 No	9 869(98.3)	4 949(98.2)	2 609(98.3)	928(98.2)	1 383(98.9)
注：①以人数(占比/%)或(x±s)表示；②缺失866例。 Note：①Number of people (proportion/%) or (x±s); ② 866 cases were missing.

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表 2 嘉定区社区居民全因死亡的多因素Cox比例风险回归模型分析

Table 2. Multivariate Cox regression analysis of all-cause deaths in Jiading District

自变量 Independent variable	参照组 Reference	β值 value	s_x	Wald $\chi^2$值 value	P值 value	HR值 value(95% CI)
年龄/岁 Age/years		0.095	0.012	63.545	＜0.001	1.100 (1.075~1.126)
性别 Gender
女性 Female	男性 Male	-0.579	0.218	7.025	0.008	0.561 (0.366~0.860)
文化程度 Education level
小学及以下 Elementary school or below	大专及以上 College or above	0.367	0.473	0.603	0.438	1.444 (0.571~3.650)
初中 Middle school		0.173	0.409	0.180	0.671	1.189 (0.534~2.650)
高中/中专 High/technical secondary school		0.138	0.394	0.123	0.725	1.148 (0.530~2.487)
婚姻状况 Marital status
非在婚 Single	在婚 Married	-0.117	0.283	0.170	0.680	0.890 (0.511~1.549)
BMI
低体重 Underweight	正常 Standard	0.712	0.300	5.625	0.018	2.038 (1.132~3.671)
超重 Overweight		-0.328	0.176	3.498	0.061	0.720 (0.510~1.016)
肥胖 Obesity		0.142	0.226	0.392	0.531	1.152 (0.739~1.796)
吸烟 Smoking
是 Yes	否 No	0.157	0.209	0.568	0.451	1.170 (0.777~1.762)
饮酒 Drinking
是 Yes	否 No	-0.254	0.216	1.393	0.238	0.775 (0.508~1.183)
体力活动 Physical activity
高水平 High level	低水平 Low level	-0.299	0.211	2.008	0.156	0.742 (0.491~1.121)
中等水平 Moderate level		-0.245	0.199	1.516	0.218	0.783 (0.530~1.156)
睡眠时间/(h·d^-1) Sleep duration/(h·d^-1)
7~＜10	0~＜7	0.024	0.234	0.010	0.919	1.024 (0.647~1.620)
≥10		0.419	0.339	1.520	0.218	1.520 (0.781~2.956)
高血压 Hypertension
有 Yes	无 No	0.082	0.161	0.258	0.611	1.085 (0.791~1.489)
糖尿病 Diabetes
有 Yes	无 No	0.263	0.210	1.563	0.211	1.300 (0.861~1.963)
冠心病 Coronary heart disease
有 Yes	无 No	0.284	0.238	1.426	0.232	1.328 (0.833~2.117)
脑卒中 Stroke
有 Yes	无 No	0.462	0.219	4.469	0.035	1.587 (1.034~2.436)
恶性肿瘤 Malignant tumor
有 Yes	无 No	0.673	0.366	3.388	0.066	1.961 (0.957~4.017)
静坐时间/(h·d^-1) Sedentary time/(h·d^-1)
4~＜6	0~＜4	0.103	0.183	0.316	0.574	1.108 (0.774~1.587)
6~＜8		0.471	0.237	3.963	0.047	1.602 (1.007~2.548)
≥8		0.513	0.213	5.783	0.016	1.670 (1.100~2.538)

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