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Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study.

ABSTRACT: OBJECTIVE:To examine the associations of blood pressure with all cause mortality and cause specific mortality at three years among oldest old people in China. DESIGN:Community based, longitudinal prospective study. SETTING:2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, conducted in 22 Chinese provinces. PARTICIPANTS:4658 oldest old individuals (mean age 92.1 years). MAIN OUTCOME MEASURES:All cause mortality and cause specific mortality assessed at three year follow-up. RESULTS:1997 deaths were recorded at three year follow-up. U shaped associations of mortality with systolic blood pressure, mean arterial pressure, and pulse pressure were identified; values of 143.5 mm Hg, 101 mm Hg, and 66 mm Hg conferred the minimum mortality risk, respectively. After adjustment for covariates, the U shaped association remained only for systolic blood pressure (minimum mortality risk at 129 mm Hg). Compared with a systolic blood pressure value of 129 mm Hg, risk of all cause mortality decreased for values lower than 107 mm Hg (from 1.47 (95% confidence interval 1.01 to 2.17) to 1.08 (1.01 to 1.17)), and increased for values greater than 154 mm Hg (from 1.08 (1.01 to 1.17) to 1.27 (1.02 to 1.58)). In the cause specific analysis, compared with a middle range of systolic blood pressure (107-154 mm Hg), higher values (>154 mm Hg) were associated with a higher risk of cardiovascular mortality (adjusted hazard ratio 1.51 (95% confidence interval 1.12 to 2.02)); lower values (<107 mm Hg) were associated with a higher risk of non-cardiovascular mortality (1.58 (1.26 to 1.98)). The U shaped associations remained in sensitivity and subgroup analyses. CONCLUSIONS:This study indicates a U shaped association between systolic blood pressure and all cause mortality at three years among oldest old people in China. This association could be explained by the finding that higher systolic blood pressure predicted a higher risk of death from cardiovascular disease, and that lower systolic blood pressure predicted a higher risk of death from non-cardiovascular causes. These results emphasise the importance of revisiting blood pressure management or establishing specific guidelines for management among oldest old individuals.

SUBMITTER: Lv YB

PROVIDER: S-EPMC5987177 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study.

Lv Yue-Bin YB Gao Xiang X Yin Zhao-Xue ZX Chen Hua-Shuai HS Luo Jie-Si JS Brasher Melanie Sereny MS Kraus Virginia Byers VB Li Tian-Tian TT Zeng Yi Y Shi Xiao-Ming XM

BMJ (Clinical research ed.) 20180605

<h4>Objective</h4>To examine the associations of blood pressure with all cause mortality and cause specific mortality at three years among oldest old people in China.<h4>Design</h4>Community based, longitudinal prospective study.<h4>Setting</h4>2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, conducted in 22 Chinese provinces.<h4>Participants</h4>4658 oldest old individuals (mean age 92.1 years).<h4>Main outcome measures</h4>All cause mortality and cause specific mortali ...[more]

PMID: 29871897

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Project description:BackgroundExposure to natural vegetation, or greenness, might affect health through several pathways, including increased physical activity and social engagement, improved mental health, and reductions in exposure to air pollution, extreme temperatures, and noise. Few studies of the effects of greenness have focused on Asia, and, to the best of our knowledge, no study has assessed the effect on vulnerable oldest-old populations. We assessed the association between residential greenness and mortality in an older cohort in China.MethodsWe used five waves (February, 2000-October, 2014) of the China Longitudinal Healthy Longevity Survey (CLHLS), a prospective cohort representative of the general older population in China. We assessed exposure to greenness through satellite-derived Normalised Difference Vegetation Index (NDVI) values in the 250 m and 1250 m radius around the residential address for each individual included in the study. We calculated contemporaneous NDVI values, cumulative NDVI values, and changes in NDVI from the start of the study over time. The health outcome of the study was all-cause mortality, excluding accidental deaths. Mortality rate ratios were estimated with Cox proportional hazards models, adjusted for age, sex, ethnicity, marital status, geographical region, childhood and adult socioeconomic status, social and leisure activity, smoking status, alcohol consumption, and physical activity.FindingsAmong 23 754 individuals (mean age at baseline 93 years [SD 7·5]) totaling 80 001 person-years, we observed 18 948 deaths during 14 years of follow-up, between June, 2000, and December, 2014. Individuals in the highest quartile of contemporaneous NDVI values had 27% lower mortality than those in the lowest quartile for the 250 m radius (hazard ratio [HR] 0·73, 95% CI 0·70-0·76), and 30% lower mortality for the 1250 m radius (0·70, 0·67-0·74). No clear association was observed for cumulative NDVI measurements and mortality. We did not detect an association between area-level changes in NDVI and mortality.InterpretationOur research suggests that proximity to more green space is associated with increased longevity, which has policy implications for the national blueprint of ecological civilisation and preparation for an ageing society in China.FundingBill & Melinda Gates Foundation, US National Institute on Aging, US National Institute of Health, Natural Science Foundation of China, UN Population Fund, China Social Sciences Foundation, and Hong Kong Research Grants Council.

Project description:ObjectivesThis study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China.DesignRepeated, cross-sectional study.SettingThis study derived nationally representative data from the 2005-2018 Chinese Longitudinal Health Longevity Survey.ParticipantsA final analytical sample of 38 032 oldest-old individuals.Primary outcome measuresAvailability of CHVS was defined as having home visiting services in one's neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics.ResultsOf 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018.ConclusionsDespite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.

Dataset Information

Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study.

Publications

Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study.

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