Gender Difference in Health Status Related to Mortality in Elderly People Over 65 Years Old in Taiwan
Date Issued
2007
Date
2007
Author(s)
Chen, Huang-Kuang
DOI
zh-TW
Abstract
Introduction and aim of research
There are few tools for predicting health condition of people older than 65 years old now, and we have interesting in how gender factor affects lifespan and distribution of risk factors of mortality in elderly people. We hope to realize the relationship by analyzing risk factors about psychosocial aspect, biologic measurement, physical aspect, and functional aspect.
Materials and methods
We designed a prospective cohort study. A total of 2600 subjects enrolled from a nationwide survey on health status of residents age 65 years or older in Taiwan between 1989 and 1991 were followed up until 31 December 2003 for ascertaining cause of death. The average time of follow-up year was 11 years. The health information gathered between 1989 to 1991 included age, gender, sexual activity, frequency of sexual activity, libido, widowhood status, Barthel index score, Hasegawa dementia scale, body mass index, anthropometric measures, life-style factors, preexisting disease, biochemical markers. We computed cumulative survival curve to show the effect of risk factors on all-cause death by life table estimates. Adjusted hazard ratios either by age or by all possible confounding factors were also calculated by Cox proportional hazards regression model. At least, we designed a mortality prediction model including the four aspects of risk factors to predict survival time of the elderly people.
Result
The risk factors that women had higher prevalence or value included widowhood status, body mass index, systolic blood pressure, total cholesterol, low density lipoprotein, triglyceride, diabetes mellitus history; the risk factors that men had higher prevalence and value included sexual activity, Hasegawa dementia scale, serum uric acid, creatinine, hemoglobin, alcohol drinking habit, smoking habit, and stroke history.
The life expectancy calculated by survival function was 16.17 years for all people, 17.84 years for women, and 14.68 years for men.
After controlling for age and relevant confounding factors, sexual activity may reduce mortality by 33% (adjusted hazard ratio (aHR) =0.67 (95%CI: 0.56-0.80)) for men, 16% (aHR=0.84 (95% CI: 0.65-1.09)) for women, and 28% (aHR=0.72 (95% CI: 0.62-0.84)) for both sex combined. Males reported to have libido may lead to a 19% decrease of mortality (aHR=0.81 (95% CI: 0.68-0.97)). The elevated risk for mortality attributed to widowhood status was estimated as 66% (aHR=1.66 (95% CI: 1.25-2.19)) for men, 33% (aHR=1.33 (95% CI: 1.09-1.62)) for women, and 43% (aHR=1.43 (95% CI: 1.21-1.68)) for both sex combined. Sexual activity has been found to reduce 36% (aHR=0.64 (95% CI: 0.41-1.00)) mortality from stroke.
After controlling for age and relevant confounding factors, people with impaired activity of daily life (ADL) function may increase all-cause mortality by 70% (aHR =1.70 (95%CI: 1.32-2.20)) for men, 72% (aHR =1.72 (95%CI: 1.30-2.28)) for women, and 73% ( aHR =1.73 (95%CI: 1.44-2.01)) for both sex combined. Impairment in every item of the Bathel index score will also induce high all-caused mortality. Among all items, we found people with grooming function impairment had the highest adjusted hazard ratio of all-cause mortality (aHR= 2.43 (95% CI: 1.46-4.04)), and had the lowest adjusted hazard ratio (aHR=1.57 (95% CI: 1.00-2.45)) with dressing function impairment.
People with cognitive function impairment may increase all-cause mortality by 33% (aHR=1.33 (95%CI: 1.13-1.57)) in men, 33% (aHR=1.33 (95%CI: 1.06-1.69)) in women, and 33% (aHR =1.33 (95%CI: 1.16-1.52)) for both sex combined.
The relationship between body mass index and all-cause mortality was L-shape in men, but U-shape in women. Underweight men had always highest mortality than other BMI groups, but the relationship was seen only in the third and fifth years in women. Overweight women had the lowest mortality at all stages, but the lowest mortality occurred in overweight or obesity men. Obesity women showed higher mortality than normal range group. We found BMI had no effect on mortality of elderly people if we re-analyzed after removing people died in the first five years. The effect of BMI on mortality of elderly people would reduce gradually when the time of follow-up prolonged. The relationship between body mass index and all-cause mortality on non-smoker is U-shape in women, but changed by time in men. Underweight men still had the highest mortality after the fifth years of follow-up.
Higher serum albumin level had protective effect on elderly people. The age adjusted hazard ratio of all-cause mortality of the first, second, and third quartiles of serum albumin level contrast to the lowest quartile were 0.86 (95% CI: 0.81-0.92), 0.80 (95% CI: 0.74-0.87), and 0.70 (95% CI:0.60-0.80) . The relative risk of women died from diabetes mellitus in the lowest quartile contrast to others was 2.02 (95%CI: 1.12-3.68), and the relative risk of women died from hepatocellular carcinoma was 4.10 (95% CI: 1.59-10.48).
Higher serum uric acid level had higher all-cause mortality on elderly people. The age adjusted hazard ratio of all-cause mortality of the first, second, and third quartiles of serum uric acid level contrast to the lowest quartile were 1.14 (95% CI:1.08-1.20), 1.15 (95% CI:1.06-1.25), 1.24 (95% CI:1.06-1.46) for both sex combined. The similar effect was seen in women, but the effect of serum uric acid level on all-cause mortality was U-shape in men. The highest quartile and the lowest quartile had higher mortality than other two quartiles. People in the highest quartile of serum uric acid level had higher mortality rate died form stroke than others (men: RR: 1.72, 95%CI: 1.10-2.71 ; women: RR=1,91, 95% CI: 1.12-3.27) . Otherwise, women in the highest quartile had higher risk died from kidney disease (RR=2.91, 95% CI: 1.27-6.67) and cervical cancer (RR: 4.07, 95%CI: 1.08-15.3).
According to our studying result, we designed an all-cause mortality prediction model, and the parameters of model included age, gender, sexual behavior, widowhood status, ADL function, cognitive function, body mass index, serum albumin, hemoglobin, serum uric acid, creatinine, GPT (glutamic pyruvic transaminase), triglyceride, smoking habit, coronary heart disease history, diabetes mellitus history, and stoke history.
Conclusion
Distribution of risk factors of mortality between men and women was different, but the effects of these risk factors on mortality were similar in both gender, except body mass index and serum uric acid level.
Except without sexual activity, low Hasegawa dementia scale, high average body mass index, high triglyceride level, high prevalence of diabetes mellitus, and low average hemoglobin, women had fewer risk factors than men. This can explain the reason why women had lower mortality rate than men. After adjusting all confounders, we still found women had lower mortality than men, so female gender is a very important health protection factor.
Although we had developed a mortality prediction model for elderly people, we still need find more unknown risk factors to improve the ability of predicting mortality of our model.
Subjects
老年人
死亡率
平均餘命
加速衰敗時間模式
性行為
日常生活功能
心智功能
身體質量指數
白蛋白
尿酸
Elderly
mortality
life expectancy
accelerated failure time model
sexual behavior
activity of daily life
cognitive function
body mass index
albumin
uric acid
SDGs
Type
thesis
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