Social, Demographic and Behavioral Factors and Their Impact on 5-year Survival in Subjects Aged Over 75 Years in Moscow Population

Objective: to study the impact of social, demographic and behavioral factors on 5-year survival rate in persons older than 75 years living in Moscow and the Moscow region. Materials and methods. We included in this prospective observational study 283 patients (25% men, age 75-98, mean 86.8±4.3 years) after stay at the Russian gerontological clinical research center. To study social and behavioral factors we recorded anthropometric parameters and used questionnaires. Duration of follow-up was 5 years. Endpoint was death from any cause. Results. One hundred five patients (37.1%) died during the follow-up (median 3.8 years). Survival analysis using the Kaplan-Meier method revealed a number of parameters that affected 5-year survival: age, deficient and excessive body weight, consumption of less than 1 liter of water per day, start of the night sleep after midnight, nighttime sleep duration >10 h, level of physical activity and history of blood donation. At multivariate analysis adjusted for age and sex the following factors were independently associated with death during follow-up: weight deficiency (hazard ratio [HR] 7.36, 95% confidence interval [CI] 2.15-25.26, p=0.001), second degree obesity (HR 0.47, 95% CI 0.25-0.87, p=0.016), start of night sleep after midnight (HR 2.53, 95% CI 1.32-4.85, p=0.005), nighttime sleep duration ≥10 h (HR 3.89, 95% CI 1.77-8.59, p=0.001), and history of blood donation (HR 0.24, 95% CI 0.09-0.62, p=0.003). Conclusion. In people older than 75 years late sleep initiation and long duration of night sleep, and weight loss increase the risk of death in the next 5 by years, 2.5, 3.9 and 7.4 times, respectively, while overweight and history of blood donation are associated with 53% and 76% reduction of the risk of death.

пожилой и старческий возраст, выживаемость, смертность, предикторы, социально-демографические факторы, elderly, survival, mortality, predictors, social factors, demographic factors

1. Федеральная служба государственной статистики Российской Федерации. http:// www.gks.ru/wps/wcm/connect/rosstat_main/rosstat/ru/statis-tics /population / demography /

2. Серова Л. Д., Серова Н. Д., Терешина Е. В. и др. Медико-социальные характеристики долгожителей Москвы и ветеранов Великой Отечественной войны. Успехи геронтологии 2011;3:505-510

3. Болотнова Т. В., Логинова Н. В. Опыт изучения феномена долгожительства в г. Тюмени. Состояние здоровья долгожителей: влияние наследственных, эколого-климатических, социальных факторов на продолжительность жизни. Успехи геронтологии 2001;8:82-88

4. Пушкова Э. С., Ленская Л. В. Долгожительство в Санкт-Петербурге. Успехи геронтологии 1999;3:22-26

5. Данилов А. Н., Шульдяков В. А., Малинова Л. И. и др. Старение и долгожительство населения Поволжского региона. Саратовский научно-медицинский журнал 2012;8 (2):242-247

6. Александров Е. В. Медико-социальный и эколого-биогеохимический анализ феномена долгожительства в Чувашии. Вестник Чувашского университета 2013;3:336-340

7. Fonarow G. C., Srikanthan P., Costanzo M. R. et al. An obesity paradox in acute heart failure: analysis of body mass index and in hospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J. 2007;153:74-81.

8. Kenchaiah S., Pocock S.J., Wang D. Body mass index and prognosis in patients with chronic heart failure: insights from the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program. Circulation 2007;116:627-636.

9. Flegal K. M., Kit B. K., Orpana H., Graubard B. I. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013;309:71-82.

10. Tamakoshi A., Yatsuya H., Lin Y. et al. BMI and all-cause mortality among Japanese older adults: findings from the Japan collaborative cohort study. Obesity (Silver Spring) 2010;18:362-369.

11. Weiss A., Beloosesky Y., Boaz M. et al. Body mass index is inversely related to mortality in elderly subjects. J. Gen Intern Med 2008;23:19-24.

12. Chandra R. K. Nutrition the immune system: an introduction. Am J. Clin Nutr 1997;66:460S - 463S.

13. Kim N. H., Lee J., Kim T.J. et al. Body Mass Index and Mortality in the General Population and in Subjects with Chronic Disease in Korea: A Nationwide Cohort Study (2002-2010). PLoS One 2015;10 (10):e0139924. DOI: 10.1371/journal. pone. 0139924.

14. Lin G. M., Li Y. H., Lai C. P. et al. The obesity-mortality paradox in elderly patients with angiographic coronary artery disease: a report from the ET-CHD registry. Acta Cardiol 2015;70 (4):479-486.

15. Wu C. Y., Chou Y. C., Huang N. et al. Association of body mass index with all-cause and cardiovascular disease mortality in the elderly. PLoS One 2014;9 (7):e102589. DOI: 10.1371/journal. pone. 0102589.

16. Negoro H., Sugino Y., Nishizawa K. et al. Underweight body mass index is a risk factor of mortality in outpatients with nocturia in Japan. BMC Res Notes 2015;8:490. DOI: 10.1186/s13104-015-1456-6.

17. Veronese N., Cereda E., Solmi M. et al. Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects. Obes Rev 2015;16 (11):1001-1015. DOI: 10.1111/obr. 12309.

18. Jiang J., Hu X., Chen J. et al. Predicting long-term mortality in hospitalized elderly patients using the new ESPEN definition. Sci Rep 2017;7 (1):4067. DOI: 10.1038/s41598-017-04483-1.

19. Lee J. S., Auyeung T. W., Leung J. et al. Long sleep duration is associated with higher mortality in older people independent of frailty: a 5-year cohort study. J. Am Med Dir Assoc 2014;15 (9):649-654. DOI: 10.1016/j. jamda. 2014.05.006.

20. da Silva A. A., de Mello R. G., Schaan C. W. et al. Sleep duration and mortality in the elderly: a systematic review with metaanalysis. BMJ Open 2016;6 (2):e008119. DOI: 10.1136/bmjo-pen-2015-008119

21. Wu C. Y., Hu H. Y., Chou Y. C. et al. The association of physical activity with all-cause, cardiovascular, and cancer mortalities among older adults. Prev Med 2015;72:23-29. DOI: 10.1016/ j.ypmed. 2014.12.023.

22. Fortes C., Mastroeni S., Sperati A. et al. Walking four times weekly for at least 15 min is associated with longevity in a cohort of very elderly people. Maturitas 2013;74 (3):246-251. DOI: 10.1016/ j.maturitas. 2012.12.001.

23. Ullum H., Rostgaard K., Kamper-Jorgensen M. et al. Blood donation and blood donor mortality after adjustment for a healthy donor effect. Transfusion 2015;55 (10):2479-2485. DOI: 10.1111/trf. 13205.