| 谢 丽,张焕玲,唐认桥.队列研究中多因素调整人群归因危险度的估计及其应用[J].中国肿瘤,2013,22(5):373-378. |
| 队列研究中多因素调整人群归因危险度的估计及其应用 |
| Estimation and Application of Partial Population Attributable Risk in Cohort Study |
| 投稿时间：2013-02-26 |
| DOI：10.11735/j.issn.1004-0242.2013.05.A201302063 |
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| 中文关键词: 人群归因危险度 人群归因危险度百分比 多因素调整人群归因危险度 肺癌 队列研究 |
| 英文关键词:population attributable risk population attributable risk proportion partial population attributable risk lung cancer cohort study |
| 基金项目:国家科技重大专项子项目（2008ZX10002-015，2012ZX10002008-002） |
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| 中文摘要: |
| 摘 要：［目的］ 介绍多因素调整人群归因危险度（PARP）估计方法及其在队列研究中的应用。［方法］ 利用2002～2006年建立的上海市男性健康队列（SMHS），在拟合多因素Cox风险比例模型基础上，以男性肺癌为例估计其常见危险因素的PARP。文中分别介绍了PAR在未调整和调整混杂因素情况下的估计方法，以及95%可信区间的计算。数据分析通过SAS程序来实现。［结果］ 上海市男性健康队列共61 500名对象，截止2010年12月31日，共发生肺癌507例。调整其他因素对肺癌影响后，吸烟、酗酒、慢性支气管炎史、肺癌家族史对肺癌的多因素调整人群归因危险度及其95%可信区间分别为64.31%（54.95%~72.13%）、8.46%（3.82%~12.97%）、6.43%（1.13%~11.56%）、3.43%（1.15%~5.62%），其他生活方式因素中水果摄入不足、身体消瘦分别可解释18.33%（0.93%~34.60%）和3.16%（0.42%~5.84%）的上海市区男性肺癌的发生。［结论］ 上海市区男性肺癌的发生很大程度上归因于吸烟、酗酒、身体消瘦、水果摄入不足等不良生活方式因素。多因素调整人群归因危险度是一个重要的流行病学指标，尤其对指导病因复杂的慢性疾病预防和控制的公共卫生实践非常重要，值得推广应用。 |
| 英文摘要: |
| Abstract: ［Purpose］ To introduce estimation and application of partial population attributable risk in cohort study. ［Methods］ We introduced a series of formulas for estimation of crude and partial population attributable risks. Data from the Shanghai Men’s Health Study (SMHS)，a prospective，population-based cohort study，were used as an example for estimation of crude and partial population attributable risks. Multivariate Cox proportional hazard model was used to estimate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of established risk factors for lung cancer. Partial population attributable risks (PARps) and their 95% CIs were calculated based on the confounding adjusted harzard ratios and exposures of corresponding risk factors among population in SMHS. ［Results］ Until the last follow-up date，December 31，2010，507 lung cancer cases were identified out of 61 500 participants in SMHS during a mean follow-up of 6.4 years. In SMHS，the PARps of a range of documented risk factors were estimated separately. Smoking，heavy alcohol consumption，history of chronic bronchitis，family history of lung cancer，low fruit intake and low body mass index were responsible for male lung cancer incidence by 64.31%(54.95%~72.13%)，8.46%(3.82%~12.97%)，6.43%(1.13%~11.56%)，3.43%(1.15%~5.62%)，18.33%(0.93%~34.60%) and 3.16%(0.42%~5.84%)，respectively. ［Conclusion］ Incidence of male lung cancer in urban Shanghai might be largely due to smoking，heavy alcohol consumption，history of chronic bronchitis，low body mass index and low fruit intake，those commonly known as bad lifestyle risk factors. The partial population attributable risk can be a useful tool for translating the results of analytic epidemiology to public health practice. |
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