Social Vulnerability, Frailty and Mortality in Elderly People 英文参考文献.docVIP

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Social Vulnerability, Frailty and Mortality in Elderly People 英文参考文献.doc

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Social Vulnerability, Frailty and Mortality in Elderly People 英文参考文献

SocialVulnerability,FrailtyandMortalityinElderly People MelissaK.Andrew1,ArnoldB.Mitnitski2,3,KennethRockwood1* 1Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, 2Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, 3DepartmentofMathematicsandStatistics,DalhousieUniversity,Halifax,NovaScotia,Canada Abstract Background:Socialvulnerabilityisrelatedtothehealthofelderlypeople,butitsmeasurementandrelationshiptofrailty are controversial. The aims of the present study were to operationalize social vulnerability according to a deficit accumulationapproach,tocomparesocialvulnerabilityandfrailty,andtostudysocialvulnerabilityinrelationtomortality. Methods and Findings: This is a secondary analysis of community-dwelling elderly people in two cohort studies, the CanadianStudyofHealthandAging(CSHA,1996/7–2001/2;N=3707)andtheNationalPopulationHealthSurvey(NPHS, 1994–2002; N=2648). Social vulnerability index measures that used self-reported items (23 in NPHS, 40 in CSHA) were constructed.Eachmeasurerangesfrom0(novulnerability)to1(maximumvulnerability).Theprimaryoutcomemeasure wasmortalityoverfive(CHSA)oreight(NPHS)years.Associationswithage,sex,andfrailty(asmeasuredbyananalogously constructed frailty index) were also studied. All individuals had some degree of social vulnerability. Women had higher social vulnerability than men, and vulnerability increased with age. Frailty and social vulnerability were moderately correlated. Adjusting for age, sex, and frailty, each additional social ‘deficit’ was associated with an increased odds of mortality(5yearsinCSHA,oddsratio=1.05,95%confidenceinterval:1.02–1.07;8yearsintheNPHS,oddsratio=1.08,95% confidence interval: 1.03–1.14). We identified a meaningful survival gradient across quartiles of social vulnerability, and althoughwomenhadbettersurvivalthanmen,survivalforwomenwithhighsocialvulnerabilitywasequivalenttothatof menwithlowvulnerability. Conclusions: Social vulnerability is re