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Association of coincident self-reported mental health problems and alcohol intake with all-cause and cardiovascular disease mortality: A Norwegian pooled population analysis.
PLOS Medicine ( IF 15.8 ) Pub Date : 2020-02-03 , DOI: 10.1371/journal.pmed.1003030
Eirik Degerud 1 , Gudrun Høiseth 2, 3, 4 , Jørg Mørland 1, 4 , Inger Ariansen 1 , Sidsel Graff-Iversen 1 , Eivind Ystrom 1, 5, 6 , Luisa Zuccolo 7 , Øyvind Næss 1, 8
Affiliation  

BACKGROUND The disease burden attributable to mental health problems and to excess or harmful alcohol use is considerable. Despite a strong relationship between these 2 important factors in population health, there are few studies quantifying the mortality risk associated with their co-occurrence in the general population. The aim of this study was therefore to investigate cardiovascular disease (CVD) and all-cause mortality according to self-reported mental health problems and alcohol intake in the general population. METHODS AND FINDINGS We followed 243,372 participants in Norwegian health surveys (1994-2002) through 2014 for all-cause and CVD mortality by data linkage to national registries. The mean (SD) age at the time of participation in the survey was 43.9 (10.6) years, and 47.8% were men. During a mean (SD) follow-up period of 16.7 (3.2) years, 6,587 participants died from CVD, and 21,376 died from all causes. Cox models estimated hazard ratios (HRs) with 95% CIs according to a mental health index (low, 1.00-1.50; high, 2.01-4.00; low score is favourable) based on the General Health Questionnaire and the Hopkins Symptom Checklist, and according to self-reported alcohol intake (low, <2; light, 2-11.99; moderate, 12-23.99; high, ≥24 grams/day). HRs were adjusted for age, sex, educational level, marital status, and CVD risk factors. Compared to a reference group with low mental health index score and low alcohol intake, HRs (95% CIs) for all-cause mortality were 0.93 (0.89, 0.97; p = 0.001), 1.00 (0.92, 1.09; p = 0.926), and 1.14 (0.96, 1.35; p = 0.119) for low index score combined with light, moderate, and high alcohol intake, respectively. HRs (95% CIs) were 1.22 (1.14, 1.31; p < 0.001), 1.24 (1.15, 1.33; p < 0.001), 1.43 (1.23, 1.66; p < 0.001), and 2.29 (1.87, 2.80; p < 0.001) for high index score combined with low, light, moderate, and high alcohol intake, respectively. For CVD mortality, HRs (95% CIs) were 0.93 (0.86, 1.00; p = 0.058), 0.90 (0.76, 1.07; p = 0.225), and 0.95 (0.67, 1.33; p = 0.760) for a low index score combined with light, moderate, and high alcohol intake, respectively, and 1.11 (0.98, 1.25; p = 0.102), 0.97 (0.83, 1.13; p = 0.689), 1.01 (0.71, 1.44; p = 0.956), and 1.78 (1.14, 2.78; p = 0.011) for high index score combined with low, light, moderate, and high alcohol intake, respectively. HRs for the combination of a high index score and high alcohol intake (HRs: 2.29 for all-cause and 1.78 for CVD mortality) were 64% (95% CI 53%, 74%; p < 0.001) and 69% (95% CI 42%, 97%; p < 0.001) higher than expected for all-cause mortality and CVD mortality, respectively, under the assumption of a multiplicative interaction structure. A limitation of our study is that the findings were based on average reported intake of alcohol without accounting for the drinking pattern. CONCLUSIONS In the general population, the mortality rates associated with more mental health problems and a high alcohol intake were increased when the risk factors occurred together.

中文翻译:

自我报告的心理健康问题和饮酒的巧合与全因和心血管疾病死亡率的关联:挪威人群汇总分析。

背景技术归因于精神健康问题以及过量或有害饮酒的疾病负担是相当大的。尽管这两个重要因素与人群健康之间有着很强的关系,但是很少有研究量化与它们在普通人群中同时发生相关的死亡风险。因此,本研究的目的是根据自我报告的心理健康问题和一般人群的饮酒量,调查心血管疾病(CVD)和全因死亡率。方法和结果我们通过与国家注册机构的数据链接,追踪了243,372名挪威健康调查(1994-2002年)至2014年的参与者的全因和CVD死亡率。参与调查时的平均(SD)年龄为43.9(10.6)岁,男性为47.8%。在平均(SD)随访期间为16.7(3。2)年,有6587名参与者死于CVD,而21376名参与者死于各种原因。根据一般健康问卷和霍普金斯症状清单,Cox模型根据心理健康指数(低,1.00-1.50;高,2.01-4.00;低分是有利的)估算具有95%CI的危险比(HR)。自我报告的酒精摄入量(低,<2;轻,2-1.99;中度,12-23.99;高,≥24克/天)。根据年龄,性别,教育程度,婚姻状况和CVD危险因素对HR进行了调整。与心理健康指数得分低和饮酒量低的参考组相比,全因死亡率的HR(95%CI)为0.93(0.89,0.97; p = 0.001),1.00(0.92,1.09; p = 0.926),指数得分低,轻度,中度和高酒精摄入量分别为1.14(0.96,1.35; p = 0.119)。HR(95%CI)为1.22(1.14,1.31; 高指数得分与低,轻,中度,高,低,高,低,低,和高酒精摄入量。对于CVD死亡率,低指数评分合并的HRs(95%CIs)为0.93(0.86,1.00; p = 0.058),0.90(0.76,1.07; p = 0.225)和0.95(0.67,1.33; p = 0.760)分别摄入少量,中度和高度酒精,分别为1.11(0.98,1.25; p = 0.102),0.97(0.83,1.13; p = 0.689),1.01(0.71,1.44; p = 0.956)和1.78(1.14) ,2.78; p = 0.011),分别是高,低,轻,中和高酒精摄入量的高分。高指数评分和高酒精摄入相结合的HR(HR:全因2.29,CVD死亡率1.78)分别为64%(95%CI 53%,74%; p <0.001)和69%(95%) CI 42%,97%; p <0。001)在乘法相互作用结构的假设下分别高于全因死亡率和CVD死亡率的预期值。我们研究的局限性在于,这些发现是基于报告的平均酒精摄入量而未考虑饮酒方式。结论在一般人群中,当危险因素同时发生时,与更多精神健康问题和高酒精摄入量相关的死亡率增加。
更新日期:2020-02-04
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