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    昼夜节律综合征与中老年人多种慢性病及多病共存发病风险的关联研究

    Association of circadian syndrome with the risks of incident multiple chronic diseases and multimorbidity in middle-aged and older adults

      摘要
    • 摘要:
      目的 探讨昼夜节律综合征（circadian syndrome，CircS）与10种慢性病及多病共存（≥2种疾病）发病风险的关联。
      方法 基于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）2011年基线数据，纳入8 093例参与者（CircS组3 091例，非CircS组5 002例），采用Cox比例风险模型评估CircS与慢性病及多病共存发病风险的关联，并进行剂量—反应分析、随访时长分层分析（≤4年vs＞4年）及CircS动态变化分析。
      结果 CircS显著增加卒中（HR=2.07）、记忆相关疾病（HR=1.62）、肝脏疾病（HR=1.38）、心脏疾病（HR=1.27）、肾脏疾病（HR=1.28）及消化系统疾病（HR=1.23）的发病风险。剂量—反应分析显示，CircS评分≥6分者卒中发病风险升高170%（HR=2.70，95% CI：2.12~3.44），心脏疾病发病风险升高66%（HR =1.66，95% CI：1.35~2.04）。短期随访（≤4年）内卒中风险显著升高，而肾脏、消化系统及肝脏疾病的发病风险主要在长期随访（＞4年）后显现。多病共存方面，CircS人群发生≥2种疾病（HR=1.30）、≥3种疾病（HR=1.42）、≥4种疾病（HR=1.53）及≥5种疾病（HR=1.49）的发病风险均显著升高，CircS评分≥6分者多病共存（≥5种）风险最突出（HR=2.74）。CircS动态变化分析表明，持续性CircS的疾病发病风险最高（卒中HR=3.04），即便缓解后，卒中、心脏疾病及肝脏疾病的残余风险仍存在。
      结论 CircS与多种慢性病及多病共存的发病风险显著关联，其关联呈现剂量—反应梯度及时间动态特征，疾病发病风险在CircS缓解后仍持续存在，提示CircS可作为潜在的慢性病风险评估指标。

       

      Abstract:
      Objective To investigate the association of circadian syndrome (CircS) with the risks of 10 incident chronic diseases and multimorbidity (≥2 diseases).
      Methods Based on the baseline data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), 8, 093 participants were enrolled (CircS group: n=3, 091; non-CircS group: n=5, 002). Cox proportional hazards models were used to assess the association of CircS with the risks of incident chronic diseases and multimorbidity. Additionally, dose-response analyses, stratified analyses by follow-up duration (≤4 years vs > 4 years), and analyses of dynamic changes in CircS status were performed.
      Results CircS was significantly associated with the increased risks of incident stroke (HR=2.07), memory-related diseases (HR=1.62), liver diseases (HR=1.38), heart diseases (HR=1.27), kidney diseases (HR=1.28) and digestive system diseases (HR=1.23). Dose-response analyses revealed that the participants with CircS scores ≥6 points had a 170% increase in the risk of incident stroke (HR=2.70, 95% CI: 2.12–3.44), and a 66% increase in the risk of incident heart diseases (HR=1.66, 95% CI: 1.35–2.04). The risk of incident stroke was significantly increased during the short-term follow-up (≤4 years), whereas the risks of incident kidney diseases, digestive system diseases, and liver diseases emerged predominantly after the long-term follow-up (> 4 years). Regarding multimorbidity, CircS was significantly associated with higher risks of developing ≥2 (HR=1.30), ≥3 (HR=1.42), ≥4 (HR=1.53) and ≥5 (HR=1.49) diseases in the participants, and the risks of incident multimorbidity (≥5 diseases) were most pronounced in those with CircS scores ≥6 points (HR=2.74). The analyses of dynamic changes in CircS status revealed that persistent CircS conferred the highest risk of incident diseases (stroke: HR=3.04). Notably, residual risks of incident stroke, heart diseases and liver diseases remained even after CircS remission.
      Conclusion CircS is significantly associated with the risks of incident multiple chronic diseases and multimorbidity. This association exhibits dose-response gradients and time-varying patterns. The risks of incident diseases remain even after CircS remission, suggesting that CircS may serve as a potential indicator for the risk assessment of chronic diseases.

       

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