{"title":"挪威妇女与癌症（NOWAC）研究中自评健康状况与死亡率之间的关系","authors":"Ida Løken Killie, Tonje Braaten, Geir Fagerjord Lorem, Kristin Benjaminsen Borch","doi":"10.2147/clep.s433965","DOIUrl":null,"url":null,"abstract":"<strong>Purpose:</strong> We investigated the association between self-rated health (SRH) and cancer incidence and SRH and all-cause mortality among Norwegian women.<br/><strong>Population and Methods:</strong> We used data from 110,104 women in the Norwegian Women and Cancer (NOWAC) cohort aged 41– 70 years at baseline. We used flexible parametric survival analysis with restricted cubic splines to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and mortality in the entire cohort. We employed the same method in a multistate design to assess associations between baseline SRH and 1) cancer incidence, and 2) all-cause mortality in subgroups of women who did and did not receive a cancer diagnosis during follow-up.<br/><strong>Results:</strong> With very good SRH as reference category for all associations and median age at end of follow-up, lower SRH was associated with increased mortality (HR<sub>good SRH</sub> 1.19, 95% CI 1.12– 1.26) and HR<sub>poor SRH</sub> 1.81, 95% CI 1.66– 1.97). Lower SRH at baseline was associated with cancer incidence (HR<sub>good SRH</sub> 1.14, 95% CI 1.08– 1.20 and HR<sub>poor SRH</sub> 1.44, 95% CI: 1.32– 1.58). Poor baseline SRH was associated with increased mortality for women who received a cancer diagnosis (HR<sub>poor SRH</sub> 1.20, 95% CI 1.04– 1.39), and SRH showed a strong association with increased mortality for women who stayed cancer free (HR<sub>good SRH</sub> 1.59, 95% CI 1.44– 1.77 and HR<sub>poor SRH</sub> 3.34, 95% CI 2.91– 3.84).<br/><strong>Conclusion:</strong> Lower SRH at baseline predicted increased cancer risk and all-cause mortality in middle-aged to older women. Poor SRH at baseline predicted all-cause mortality in women who later received a cancer diagnosis. Both good and poor SRH at baseline predicted all-cause mortality in women who stayed cancer-free, and the association was stronger for these women compared to both the entire cohort and to women who were subsequently diagnosed with cancer.<br/><br/><strong>Keywords:</strong> self-rated health, cohort study, multistate, cancer, mortality, women<br/>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Associations Between Self-Rated Health and Mortality in the Norwegian Women and Cancer (NOWAC) Study\",\"authors\":\"Ida Løken Killie, Tonje Braaten, Geir Fagerjord Lorem, Kristin Benjaminsen Borch\",\"doi\":\"10.2147/clep.s433965\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<strong>Purpose:</strong> We investigated the association between self-rated health (SRH) and cancer incidence and SRH and all-cause mortality among Norwegian women.<br/><strong>Population and Methods:</strong> We used data from 110,104 women in the Norwegian Women and Cancer (NOWAC) cohort aged 41– 70 years at baseline. We used flexible parametric survival analysis with restricted cubic splines to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and mortality in the entire cohort. We employed the same method in a multistate design to assess associations between baseline SRH and 1) cancer incidence, and 2) all-cause mortality in subgroups of women who did and did not receive a cancer diagnosis during follow-up.<br/><strong>Results:</strong> With very good SRH as reference category for all associations and median age at end of follow-up, lower SRH was associated with increased mortality (HR<sub>good SRH</sub> 1.19, 95% CI 1.12– 1.26) and HR<sub>poor SRH</sub> 1.81, 95% CI 1.66– 1.97). Lower SRH at baseline was associated with cancer incidence (HR<sub>good SRH</sub> 1.14, 95% CI 1.08– 1.20 and HR<sub>poor SRH</sub> 1.44, 95% CI: 1.32– 1.58). Poor baseline SRH was associated with increased mortality for women who received a cancer diagnosis (HR<sub>poor SRH</sub> 1.20, 95% CI 1.04– 1.39), and SRH showed a strong association with increased mortality for women who stayed cancer free (HR<sub>good SRH</sub> 1.59, 95% CI 1.44– 1.77 and HR<sub>poor SRH</sub> 3.34, 95% CI 2.91– 3.84).<br/><strong>Conclusion:</strong> Lower SRH at baseline predicted increased cancer risk and all-cause mortality in middle-aged to older women. Poor SRH at baseline predicted all-cause mortality in women who later received a cancer diagnosis. Both good and poor SRH at baseline predicted all-cause mortality in women who stayed cancer-free, and the association was stronger for these women compared to both the entire cohort and to women who were subsequently diagnosed with cancer.<br/><br/><strong>Keywords:</strong> self-rated health, cohort study, multistate, cancer, mortality, women<br/>\",\"PeriodicalId\":10362,\"journal\":{\"name\":\"Clinical Epidemiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-02-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/clep.s433965\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/clep.s433965","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Associations Between Self-Rated Health and Mortality in the Norwegian Women and Cancer (NOWAC) Study
Purpose: We investigated the association between self-rated health (SRH) and cancer incidence and SRH and all-cause mortality among Norwegian women. Population and Methods: We used data from 110,104 women in the Norwegian Women and Cancer (NOWAC) cohort aged 41– 70 years at baseline. We used flexible parametric survival analysis with restricted cubic splines to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and mortality in the entire cohort. We employed the same method in a multistate design to assess associations between baseline SRH and 1) cancer incidence, and 2) all-cause mortality in subgroups of women who did and did not receive a cancer diagnosis during follow-up. Results: With very good SRH as reference category for all associations and median age at end of follow-up, lower SRH was associated with increased mortality (HRgood SRH 1.19, 95% CI 1.12– 1.26) and HRpoor SRH 1.81, 95% CI 1.66– 1.97). Lower SRH at baseline was associated with cancer incidence (HRgood SRH 1.14, 95% CI 1.08– 1.20 and HRpoor SRH 1.44, 95% CI: 1.32– 1.58). Poor baseline SRH was associated with increased mortality for women who received a cancer diagnosis (HRpoor SRH 1.20, 95% CI 1.04– 1.39), and SRH showed a strong association with increased mortality for women who stayed cancer free (HRgood SRH 1.59, 95% CI 1.44– 1.77 and HRpoor SRH 3.34, 95% CI 2.91– 3.84). Conclusion: Lower SRH at baseline predicted increased cancer risk and all-cause mortality in middle-aged to older women. Poor SRH at baseline predicted all-cause mortality in women who later received a cancer diagnosis. Both good and poor SRH at baseline predicted all-cause mortality in women who stayed cancer-free, and the association was stronger for these women compared to both the entire cohort and to women who were subsequently diagnosed with cancer.
Keywords: self-rated health, cohort study, multistate, cancer, mortality, women
期刊介绍：
Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment.
Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews.
Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews.
When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes.
The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.
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