huotcz

作者：Brande Nicole Martin  
出處：WebMD醫學新聞

　　February 26, 2010 — 根據一項斷面性研究結果，相較於加拿大，在美國，肥胖與缺乏運動，特別是女性，可能造成關節炎高盛行率與關節炎相關的活動限制（AAL）。
　　
　　這項由多倫多西方研究機構以及加拿大安大略大學Elena Badley哲學博士所領導的研究，發表在3月號的關節炎照護與研究。
　　
　　這是第一項直接比較兩個不同國家關節炎與AAL盛行率及危險因子有關健康差異的研究。這項研究也評估肥胖與休閒時間缺乏運動是如何影響關節炎和AAL的。
　　
　　Badley博士與來自多倫多西方研究機構的Hina Ansari理學碩士寫到，這項研究主要的優勢在於比較兩個國家之間研究方法學的比較性。
　　
　　這項研究使用2002年到2003年聯合加拿大/美國健康普查結果數據。這是一次性、隨機、電腦協助電話語音普查，針對18歲以上、居住在美國50州與加拿大10個省份非缺乏自理能力居民進行普查。
　　
　　整體而言，3,505位加拿大民眾（65%）與5,138位美國居民（50.2%）回覆聯合加拿大/美國健康普查問答。
　　
　　【評估研究變項】
　　普查參與者被問到一連串有關關節炎診斷、當進行不同活動時的困難程度、社會流行病學數據、生活型態因子、以及接受健康照護管道。主要試驗變項是關節炎盛行率、AAL、身體質量指數、以及缺乏運動。超過95%的受試者回應有關這些變項的問題。
　　
　　在美國，關節炎盛行率較高（18.7%；95%信賴區間[CI]為17.6-19.8），相較於加拿大（16.8%；95% CI為15.5-18.2）。對AAL而言，美國（9.6%；95% CI為15.5-18.2）的估計盛行率同樣高於加拿大（7.7%；95% CI為6.8-8.6）。
　　
　　除此之外，研究作者們發現，相較於加拿大女性（19.6%；95% CI為17.7-21.5），美國女性（23.3%；95% CI為21.7-25.0）的關節炎盛行率較高。AAL的盛行率，美國女性是13.0%（95% CI為11.7-14.3），加拿大女性則是9.2%（95% CI為7.9-10.6）。
　　
　　這兩個國家的男性，發生關節炎與AAL的盛行率相似（分別是約14%與6%）。除此之外，整體而言，罹患關節炎的女性與男性也有AAL的問題（美國民眾為44.7%，加拿大民眾為39.3%）。在這兩個國家，缺乏運動的人比較可能有關節炎與AAL的問題。
　　
　　這項研究有許多與使用次級資料庫有關的常見限制。其他限制包括兩個國家之間通報的數據差異、排除種族變項、以及保險相關資料、不同定義以及區分關節炎種類的方法，還有身體質量指數組別的分級、僅納入休閒時間的活動（工作時或是居家相關活動並不需要納入）。
　　
　　【關節炎是公共衛生的訊息之一】
　　Badley博士在一項新聞稿中表示，我們的研究結果顯示，在美國，關節炎與AAL的高盛行率可能是這個國家人民肥胖與缺乏運動的結果，特別是女性。
　　
　　Badley博士強調，公共衛生提倡的「促進健康體重與運動」應該將關節炎納入健康預防訊息中，以潛在地降低關節炎與AAL發生率。
　　
　　這項研究由安大略衛生與長期照護部門，透過其健康系統連結研究單位計畫經費贊助。研究作者們表示已無相關資金上的往來。


Obesity, Physical Inactivity Linked to Arthritis Risk in Women

By Brande Nicole Martin
Medscape Medical News

February 26, 2010 — Obesity and physical inactivity, particularly in women, may account for the high prevalence of arthritis and arthritis-attributable activity limitations (AAL) in the United States compared with Canada, according to a cross-sectional study.

The study, led by Elena Badley, DPhil, from Toronto Western Research Institute and University of Ontario, Canada, is published in the March issue of Arthritis Care Research.

This is the first study to directly compare health disparities associated with the prevalence and risk factors for arthritis and AAL between the 2 countries. The study also evaluated how obesity and leisure-time physical inactivity affected arthritis and AAL.

"The major strength of the study was the comparability in the methodology of the study between the two countries," write Dr. Badley and coauthor Hina Ansari, MSc, from Toronto Western Research Institute.

The study used data from the 2002 to 2003 Joint Canada/United States Survey of Health. It was a 1-time, random, computer-assisted telephone survey targeting adults aged 18 years or older in noninstitutionalized households in the 50 US states and all 10 Canadian provinces. Those living in healthcare institutions, nursing homes, full-time members of the US and Canadian Armed Forces, and residents of the 3 Canadian territories were excluded from the study.

Overall, 3505 Canadians (65%) and 5138 Americans (50.2%) responded to the Joint Canada/United States Survey of Health.

Study Variables Assessed

Survey participants were asked a series of questions related to diagnosis of arthritis, difficulty level when performing in various activities, sociodemographic data, lifestyle factors, and access to healthcare. The main study variables were arthritis prevalence, AAL, body mass index, and physical inactivity. More than 95% of participants responded to questions about these variables.

In the United States, the estimated prevalence of arthritis was higher (18.7%; 95% confidence interval [CI], 17.6 - 19.8) than in Canada (16.8%; 95% CI, 15.5 - 18.2). For AAL, the estimated prevalence was also higher in the United States (9.6%; 95% CI, 8.8 - 10.5) vs Canada (7.7%; 95% CI, 6.8 - 8.6).

Further, the study authors found that US women had a higher prevalence of arthritis compared with Canadian women: 23.3% (95% CI, 21.7 - 25.0) vs 19.6% (95% CI, 17.7 - 21.5), respectively. The prevalence of AAL was 13.0% (95% CI, 11.7 - 14.3) and 9.2% (95% CI, 7.9 - 10.6) for US and Canadian women, respectively.

Men in both countries had similar prevalence of arthritis and AAL (about 14% and 6%, respectively). In addition, overall, both women and men with arthritis also reported AAL (44.7% of Americans and 39.3% of Canadians). In both countries, those who were physically inactive were more likely to have arthritis and AAL.

Several of the study limitations were common to using secondary databases. Other limitations include differences in data reporting between the 2 countries, exclusion of racial variables and insurance coverage data, varying ways in defining and distinguishing between types of "arthritis" and categorizing body mass index groups, and inclusion of leisure time activities only (work- or home-related activities were not necessarily accounted for).

Arthritis as Part of Public Health Message

"Our study results suggest that higher prevalence of arthritis and AAL in the US may be a consequence of greater obesity and physical inactivity in that country, particularly in women," Dr. Badley said in a news release.

Dr. Badley stresses that public health initiatives "that promote healthy weight and physical activity" should include arthritis in the health prevention messages to potentially reduce the incidence of arthritis and AAL.

The study was supported by the Ontario Ministry of Health and Long Term Care through its Health System-Linked Research Unit grant scheme. The study authors have disclosed no relevant financial relationships.

Arthritis Care Res. 2010;62:308-315.