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Article(id=1241676524819116442, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202407204, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1720800000000, receivedDateStr=2024-07-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773968352751, onlineDateStr=2026-03-20, pubDate=1731168000000, pubDateStr=2024-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773968352751, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773968352751, creator=13701087609, updateTime=1773968352751, updator=13701087609, issue=Issue{id=1241676522256388920, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773968352140, creator=13701087609, updateTime=1773968629818, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241677686985249701, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241677686985249702, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3894, endPage=3898, ext={EN=ArticleExt(id=1241676526052241823, articleId=1241676524819116442, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of breastfeeding on life expectancy and healthy life expectancy of rural women, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the impact of breastfeeding on life expectancy (LE) and healthy life expectancy (HLE) among rural women.

Methods

A cohort study was conducted involving women aged 40 and above from rural Henan. Data on demographic characteristics, personal medical history, and breastfeeding history were collected through questionnaires. The European five-dimensional health scale (EQ-5D-5L) was used to assess the quality-of-life utility index and visual analog scale (VAS) scores. Multi-state life table method was employed to calculate LE and HLE from three dimensions: common chronic diseases, health status utility index, and VAS scores.

Results

Women with breastfeeding history had a lower prevalence of common chronic diseases (21.85% vs 23.46%). The average health status utility index and VAS scores were 0.94±0.12 and 76.85±15.26 for those with a breastfeeding history, compared to 0.93±0.15 and 76.09±17.97 for those without. In terms of common chronic diseases, women with breastfeeding history had HLE and LE at age 40 of 24.10 years and 44.36 years, respectively, which were 3.48 years and 3.23 years longer than those without breastfeeding history. In the utility index dimension, women with breastfeeding history had HLE and LE at age 40 of 35.96 years and 44.58 years, respectively, which were 4.08 years and 4.40 years longer than those without. In the VAS score dimension, HLE and LE at age 40 for women with breastfeeding history were 32.31 years and 46.36 years, respectively, which were 3.39 years and 3.75 years longer than those without. Among the three dimensions, in the utility index dimension, the highest HLE at age 40 was observed based on cumulative breastfeeding duration: ≤36 months (35.34 years), 37-60 months (35.87 years), and ≥61 months (36.34 years).

Conclusion

Breastfeeding is associated with longer HLE and LE among rural women, with those having a breastfeeding history enjoying greater HLE and LE. Increased cumulativebreastfeeding duration correlates with longer LE.

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目的

分析母乳喂养对农村女性预期寿命（life expectancy）和健康预期寿命（healthy life expectancy, HLE）的影响。

方法

以河南农村队列中40岁及以上女性为研究对象，通过问卷获得人口学特征、个人疾病史、哺乳史等，采用欧洲五维健康量表（EQ-5D-5L）评价研究对象生命质量效用指数和视觉模拟尺度（VAS）评分，利用多状态寿命表法从常见慢性病、健康状况效用指数和VAS评分三个维度计算研究对象预期寿命和HLE。

结果

有哺乳史女性常见慢性病患病率较低（21.85% vs. 23.46%），健康状况平均效用指数和VAS评分分别为（0.94±0.12）和（76.85±15.26）分，而无哺乳史女性分别为（0.93±0.15）和（76.09±17.97）分。在常见慢性病维度，有哺乳史女性40岁时HLE和预期寿命分别为24.10和44.36年，较无哺乳史女性分别增加3.48和3.23年；在效用指数维度，有哺乳史女性40岁时HLE和预期寿命分别为35.96和44.58年，较无哺乳史女性分别增加4.08和4.40年；在VAS评分维度，有哺乳史女性40岁时HLE和预期寿命分别为32.31和46.36年，较无哺乳史女性分别增加3.39和3.75年。三个维度中在效用指数维度，女性40岁时根据累积哺乳时长≤36月、37～60月、≥61月测得的HLE最高，分别为35.34、35.87和36.34年。

结论

母乳喂养与农村女性的HLE和预期寿命相关，有哺乳史女性具有更长的HLE和预期寿命。随累积哺乳时长的增加，女性具有更长的预期寿命。

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赵冰，E-mail: ；
王重建，E-mail: ；
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=tFNVKXNcYihHBmX3cgLi0Q==, magXml=/lfjSwU9vXUCHa1ElR7xHA==, pdfUrl=null, pdf=Vvn9AxIXUYVGxjSZFHkeRg==, pdfFileSize=895600, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=UooTFLV7IRs1QddhmqO6mA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=a6Fg4R1zrWe6hCXXTAX2hg==, mapNumber=null, authorCompany=null, fund=null, authors=

赵冰与王重建为共同通信作者

李润鑫（2001—），女，硕士在读，研究方向：生命质量、预期寿命和健康预期寿命

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李润鑫（2001—），女，硕士在读，研究方向：生命质量、预期寿命和健康预期寿命

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李润鑫（2001—），女，硕士在读，研究方向：生命质量、预期寿命和健康预期寿命

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Modern Preventive Medicine, 2024, 51(1): 71-75.(In Chinese), articleTitle=Analysis of self-rated health status of the elderly and influencing factors of in rural areas of China, refAbstract=null)], funds=[Fund(id=1241821866864743402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, awardId=2016YFC0900803, language=CN, fundingSource=国家重点研发计划“精准医学研究”国家重点专项(2016YFC0900803), fundOrder=null, country=null), Fund(id=1241821867019932660, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, awardId=2020BSH018, language=CN, fundingSource=河南省哲学社会科学规划项目(2020BSH018), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241821852713161156, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, xref=1., ext=[AuthorCompanyExt(id=1241821852721549765, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, companyId=1241821852713161156, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Social Medicine and Health Services Management, School of Public Health, Zhengzhou University, Zhengzhou,Henan 450001, China), AuthorCompanyExt(id=1241821852729938374, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, companyId=1241821852713161156, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.郑州大学公共卫生学院社会医学与卫生事业管理学系，河南 郑州450001)]), AuthorCompany(id=1241821852830601674, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, xref=2., ext=[AuthorCompanyExt(id=1241821852834795979, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, companyId=1241821852830601674, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.郑州大学公共卫生学院流行病与卫生统计学系，河南 郑州450001)]), AuthorCompany(id=1241821852956430801, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, xref=3., ext=[AuthorCompanyExt(id=1241821852964819410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, companyId=1241821852956430801, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.郑州大学第三附属医院保健科，河南 郑州450052)])], figs=[ArticleFig(id=1241821864574653357, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, language=EN, label=Figure 1, caption=Life expectancy and healthy life expectancy of rural women under different lactation conditions, figureFileSmall=aWjVKORVCtCBiKi8enBriA==, figureFileBig=/nTQFfqVLE4xrGIe5Cmn3A==, tableContent=null), ArticleFig(id=1241821866009105332, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, language=CN, label=图1, caption=不同哺乳情况农村女性各年龄段的预期寿命和HLE

注：调整变量年龄、婚姻状况、受教育程度、家庭人均月收入、体质指数、胎次。

, figureFileSmall=aWjVKORVCtCBiKi8enBriA==, figureFileBig=/nTQFfqVLE4xrGIe5Cmn3A==, tableContent=null), ArticleFig(id=1241821866185266111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, language=EN, label=Table 1, caption=

General demographic characteristics of the survey subjects ［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量常见慢性病维度（n=18 301）EQ-5D量表维度（n=7 746）
无哺乳史（n=405）有哺乳史（n=17 896）P值无哺乳史（n=174）有哺乳史（n=7 572）P值
年龄（岁）55.77±9.8657.60±9.27<0.00156.40±9.9958.37±9.23<0.05
婚姻状况0.347<0.05
已婚/同居358 (88.40)16 075 (89.82)147 (84.48)6 812 (89.96)
未婚/离婚/分居/丧偶47 (11.60)1 821 (10.18)27 (15.52)760 (10.04)
受教育程度0.8090.803
未上学91 (22.47)4 270 (23.86)45 (25.86)1 854 (24.49)
小学134 (33.09)5 834 (32.60)58 (33.33)2 440 (32.22)
初中及以上180 (44.44)7 792 (43.54)71 (40.81)3 278 (43.29)
家庭人均月收入（元）<0.050.437
<500174 (42.96)6 604 (36.90)79 (45.40)3 093 (40.85)
500～1 000117 (28.89)5 990 (33.47)49 (28.16)2 417 (31.92)
≥1 000114 (28.15)5 302 (29.63)46 (26.44)2 062 (27.23)
体质指数0.5500.243
低体重9 (2.22)337 (1.88)2 (1.15)132 (1.74)
正常157 (38.77)6 500 (36.32)73 (41.95)2 642 (34.89)
超重157 (38.77)7 557 (42.23)64 (36.78)3 230 (42.66)
肥胖82 (20.24)3 502 (19.57)35 (20.12)1 568 (20.71)
), ArticleFig(id=1241821866311095240, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, language=CN, label=表1, caption=

研究对象一般人口学特征［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量常见慢性病维度（n=18 301）EQ-5D量表维度（n=7 746）
无哺乳史（n=405）有哺乳史（n=17 896）P值无哺乳史（n=174）有哺乳史（n=7 572）P值
年龄（岁）55.77±9.8657.60±9.27<0.00156.40±9.9958.37±9.23<0.05
婚姻状况0.347<0.05
已婚/同居358 (88.40)16 075 (89.82)147 (84.48)6 812 (89.96)
未婚/离婚/分居/丧偶47 (11.60)1 821 (10.18)27 (15.52)760 (10.04)
受教育程度0.8090.803
未上学91 (22.47)4 270 (23.86)45 (25.86)1 854 (24.49)
小学134 (33.09)5 834 (32.60)58 (33.33)2 440 (32.22)
初中及以上180 (44.44)7 792 (43.54)71 (40.81)3 278 (43.29)
家庭人均月收入（元）<0.050.437
<500174 (42.96)6 604 (36.90)79 (45.40)3 093 (40.85)
500～1 000117 (28.89)5 990 (33.47)49 (28.16)2 417 (31.92)
≥1 000114 (28.15)5 302 (29.63)46 (26.44)2 062 (27.23)
体质指数0.5500.243
低体重9 (2.22)337 (1.88)2 (1.15)132 (1.74)
正常157 (38.77)6 500 (36.32)73 (41.95)2 642 (34.89)
超重157 (38.77)7 557 (42.23)64 (36.78)3 230 (42.66)
肥胖82 (20.24)3 502 (19.57)35 (20.12)1 568 (20.71)
), ArticleFig(id=1241821866445312976, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, language=EN, label=Table 2, caption=

Life expectancy at 40 years for women with different lactation conditions (years)

, figureFileSmall=null, figureFileBig=null, tableContent=
不同维度类别HLEHLE差值a预期寿命预期寿命差值bHLE/预期寿命（%）
常见慢性病维度
无哺乳史20.62—41.13—50.13
有哺乳史24.103.4844.363.2354.33
累积哺乳时长（月）
≤3623.943.3243.322.1955.26
37～6023.312.6943.502.3753.59
≥6122.692.0743.702.5751.92
效用指数维度
无哺乳史31.88—40.18—79.34
有哺乳史35.964.0844.584.4080.66
累积哺乳时长（月）
≤3635.343.4642.842.6682.50
37～6035.873.9944.143.9681.26
≥6136.344.4645.445.2679.97
VAS评分维度
无哺乳史28.92—42.61—67.87
有哺乳史32.313.3946.363.7569.69
累积哺乳时长（月）
≤3630.431.5142.45-0.1671.68
37～6030.631.7143.110.5071.05
≥6130.671.7543.390.7870.68
), ArticleFig(id=1241821866562753499, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676524819116442, language=CN, label=表2, caption=

不同哺乳情况女性人群40岁预期寿命（年）

, figureFileSmall=null, figureFileBig=null, tableContent=
不同维度类别HLEHLE差值a预期寿命预期寿命差值bHLE/预期寿命（%）
常见慢性病维度
无哺乳史20.62—41.13—50.13
有哺乳史24.103.4844.363.2354.33
累积哺乳时长（月）
≤3623.943.3243.322.1955.26
37～6023.312.6943.502.3753.59
≥6122.692.0743.702.5751.92
效用指数维度
无哺乳史31.88—40.18—79.34
有哺乳史35.964.0844.584.4080.66
累积哺乳时长（月）
≤3635.343.4642.842.6682.50
37～6035.873.9944.143.9681.26
≥6136.344.4645.445.2679.97
VAS评分维度
无哺乳史28.92—42.61—67.87
有哺乳史32.313.3946.363.7569.69
累积哺乳时长（月）
≤3630.431.5142.45-0.1671.68
37～6030.631.7143.110.5071.05
≥6130.671.7543.390.7870.68
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母乳喂养对农村女性预期寿命和健康预期寿命的影响
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李润鑫 1 , 张洪剑 1 , 刘晓田 2 , 张换想 2 , 江凤 2 , 岳秋红 2 , 吕伊兰 2 , 鲁倩惠 2 , 李子旭 2 , 屈慧敏 3 , 赵冰 3 , 王重建 2
现代预防医学 | 儿少卫生与妇幼保健 2024,51(21): 3894-3898
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(21): 3894-3898
母乳喂养对农村女性预期寿命和健康预期寿命的影响
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李润鑫1, 张洪剑1, 刘晓田2, 张换想2, 江凤2, 岳秋红2, 吕伊兰2, 鲁倩惠2, 李子旭2, 屈慧敏3, 赵冰3 , 王重建2
作者信息
  • 1.郑州大学公共卫生学院社会医学与卫生事业管理学系，河南 郑州450001
  • 2.郑州大学公共卫生学院流行病与卫生统计学系，河南 郑州450001
  • 3.郑州大学第三附属医院保健科，河南 郑州450052

    • 李润鑫（2001—），女，硕士在读，研究方向：生命质量、预期寿命和健康预期寿命

通讯作者:

赵冰，E-mail: ；
王重建，E-mail: ；
The impact of breastfeeding on life expectancy and healthy life expectancy of rural women
Run-xin LI1, Hong-jian ZHANG1, Xiao-tian LIU2, Huan-xiang ZHANG2, Feng JIANG2, Qiu-hong YUE2, Yi-lan LV2, Qian-hui LU2, Zi-xu LI2, Hui-min QU3, Bing ZHAO3 , Chong-jian WANG2
Affiliations
  • Department of Social Medicine and Health Services Management, School of Public Health, Zhengzhou University, Zhengzhou,Henan 450001, China
出版时间: 2024-11-10 doi: 10.20043/j.cnki.MPM.202407204
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摘要
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目的

分析母乳喂养对农村女性预期寿命（life expectancy）和健康预期寿命（healthy life expectancy, HLE）的影响。

方法

以河南农村队列中40岁及以上女性为研究对象，通过问卷获得人口学特征、个人疾病史、哺乳史等，采用欧洲五维健康量表（EQ-5D-5L）评价研究对象生命质量效用指数和视觉模拟尺度（VAS）评分，利用多状态寿命表法从常见慢性病、健康状况效用指数和VAS评分三个维度计算研究对象预期寿命和HLE。

结果

有哺乳史女性常见慢性病患病率较低（21.85% vs. 23.46%），健康状况平均效用指数和VAS评分分别为（0.94±0.12）和（76.85±15.26）分，而无哺乳史女性分别为（0.93±0.15）和（76.09±17.97）分。在常见慢性病维度，有哺乳史女性40岁时HLE和预期寿命分别为24.10和44.36年，较无哺乳史女性分别增加3.48和3.23年；在效用指数维度，有哺乳史女性40岁时HLE和预期寿命分别为35.96和44.58年，较无哺乳史女性分别增加4.08和4.40年；在VAS评分维度，有哺乳史女性40岁时HLE和预期寿命分别为32.31和46.36年，较无哺乳史女性分别增加3.39和3.75年。三个维度中在效用指数维度，女性40岁时根据累积哺乳时长≤36月、37～60月、≥61月测得的HLE最高，分别为35.34、35.87和36.34年。

结论

母乳喂养与农村女性的HLE和预期寿命相关，有哺乳史女性具有更长的HLE和预期寿命。随累积哺乳时长的增加，女性具有更长的预期寿命。

健康预期寿命  /  多状态寿命表  /  哺乳史  /  生命质量  /  农村女性
Objective

To analyze the impact of breastfeeding on life expectancy (LE) and healthy life expectancy (HLE) among rural women.

Methods

A cohort study was conducted involving women aged 40 and above from rural Henan. Data on demographic characteristics, personal medical history, and breastfeeding history were collected through questionnaires. The European five-dimensional health scale (EQ-5D-5L) was used to assess the quality-of-life utility index and visual analog scale (VAS) scores. Multi-state life table method was employed to calculate LE and HLE from three dimensions: common chronic diseases, health status utility index, and VAS scores.

Results

Women with breastfeeding history had a lower prevalence of common chronic diseases (21.85% vs 23.46%). The average health status utility index and VAS scores were 0.94±0.12 and 76.85±15.26 for those with a breastfeeding history, compared to 0.93±0.15 and 76.09±17.97 for those without. In terms of common chronic diseases, women with breastfeeding history had HLE and LE at age 40 of 24.10 years and 44.36 years, respectively, which were 3.48 years and 3.23 years longer than those without breastfeeding history. In the utility index dimension, women with breastfeeding history had HLE and LE at age 40 of 35.96 years and 44.58 years, respectively, which were 4.08 years and 4.40 years longer than those without. In the VAS score dimension, HLE and LE at age 40 for women with breastfeeding history were 32.31 years and 46.36 years, respectively, which were 3.39 years and 3.75 years longer than those without. Among the three dimensions, in the utility index dimension, the highest HLE at age 40 was observed based on cumulative breastfeeding duration: ≤36 months (35.34 years), 37-60 months (35.87 years), and ≥61 months (36.34 years).

Conclusion

Breastfeeding is associated with longer HLE and LE among rural women, with those having a breastfeeding history enjoying greater HLE and LE. Increased cumulativebreastfeeding duration correlates with longer LE.

Healthy life expectancy  /  Multi-state life table  /  Breastfeeding history  /  Quality of life  /  Rural women
李润鑫, 张洪剑, 刘晓田, 张换想, 江凤, 岳秋红, 吕伊兰, 鲁倩惠, 李子旭, 屈慧敏, 赵冰, 王重建. 母乳喂养对农村女性预期寿命和健康预期寿命的影响. 现代预防医学, 2024 , 51 (21) : 3894 -3898 . DOI: 10.20043/j.cnki.MPM.202407204
Run-xin LI, Hong-jian ZHANG, Xiao-tian LIU, Huan-xiang ZHANG, Feng JIANG, Qiu-hong YUE, Yi-lan LV, Qian-hui LU, Zi-xu LI, Hui-min QU, Bing ZHAO, Chong-jian WANG. The impact of breastfeeding on life expectancy and healthy life expectancy of rural women[J]. Modern Preventive Medicine, 2024 , 51 (21) : 3894 -3898 . DOI: 10.20043/j.cnki.MPM.202407204
正文
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母乳喂养可以减少婴幼儿感染性和过敏性疾病的发生，促进神经发育，减少儿童期甚至成年期的糖尿病、超重和肥胖、高脂血症、癫痫等疾病的发生[1-3]，然而，关于母乳喂养对母亲健康影响的研究较少，尤其是关于其对母亲预期寿命（life expectancy）的影响的研究尚未见相关报道。预期寿命是指在特定死亡水平下，某一年龄段人群平均还能生存的年数[4]；健康预期寿命（healthy life expectancy, HLE）[5]是能够综合反映现有人口死亡水平和健康水平的指标。本研究为探究哺乳史对农村女性健康预期寿命及预期寿命的影响，以河南农村队列基线和前瞻性随访调查女性人群为研究对象进行分析，为母乳喂养相关健康教育及健康促进工作提供数据支撑。
1　资料与方法
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1.1　研究对象
数据来源于河南农村队列[6]（注册号ChiCTR-OOC-15006699）。采用多阶段分层整群抽样方法，于2015年7月—2017年9月选取河南省禹州市、驻马店市、新乡市、开封市、义马市5个农村地区18～79岁39 259名常住人口进行基线调查。于2018年7月—2022年9月开展前瞻性随访调查，平均随访时间3.83年，随访人数为35 995人，其中死亡1 006人，随访率为91.69%。在慢性病维度：河南农村队列随访的35 995人中，排除基线及随访慢性病数据缺失者（n=1 692）、男性（n=13 570）、基线年龄小于40岁者（n=2 367）和哺乳史数据缺失者（n=65），最终纳入18 301名研究对象。在欧洲五维健康量表（EQ-5D-5L）维度：河南农村队列随访的35 995人中，排除基线及随访EQ-5D-5L数据缺失者（n=21 909）、男性（n=5 505）、基线年龄小于40岁者（n=800）和哺乳史数据缺失者（n=35），最终纳入7 746名研究对象。本研究已通过郑州大学生命科学伦理委员会审查，所有研究对象均签署了知情同意书。
1.2　相关定义及标准
本研究由通过培训的调查员使用标准化调查问卷对研究对象进行面对面调查。问卷内容主要包括：基本人口学信息（如年龄、性别、出生日期、婚姻状况、受教育程度、收入水平等）、体格检查（身高、体重等）、常见慢性病（脑卒中、冠心病、糖尿病，癌症等），同时采用欧洲五维健康量表（EQ-5D-5L）对研究对象生命质量进行评价。EQ-5D由生命质量效用指数和视觉模拟尺度（VAS）评分组成，EQ-5D-5L生命质量效用指数包含：行动能力（mobility）、自我照顾（self-care）、日常活动（usual activity）、疼痛/不适（pain/discomfort）和焦虑/抑郁（anxiety/depression）五个维度，每个维度由五个层次组成（没有问题、有轻微问题、有中度问题、有严重问题和有极度严重的问题）[7]；EQ-5D视觉模拟尺度（VAS）评分：由研究对象自己选择最近健康状况的分数。范围为0～100分，100分代表“能想象的最好的健康状况”，0分代表“能想象的最差的健康状况”。通过国家死因登记报告信息系统和入户随访调查获得研究对象死亡数据。
本研究对哺乳史的定义为：有哺乳经历且累积哺乳时长大于等于1个月。有哺乳史女性根据累积哺乳时长三分位数划分为≤36个月，37～60个月以及≥61个月三类。本研究从三个维度定义研究对象健康状况：在常见慢性病维度，将不患脑卒中、冠心病、糖尿病和癌症定义为健康，患其中任意一种疾病及以上定义为不健康；在效用指数维度，根据EQ-5D-5L生命质量效用指数进行计算，具体计算公式如下：Utility=1-MO×Ln-SC×Ln-UA×Ln-PD×Ln- AD×Ln (n=1, 2, 3, 4, 5)，将指数为1定义为健康，低于1定义为不健康；在VAS评分维度，将得分大于或等于80分定义为健康，小于80分定义为不健康。
1.3　质量控制
工作人员参加统一培训，问卷调查完成后，由非同一人完成两次核查。数据采用双录入，之后再进行审核，较为可靠。
1.4　统计学分析
连续变量以（均数±标准差）表示，组间比较采用独立样本t检验。分类变量以频数（百分比）表示，组间比较采用χ2检验。采用SPSS 21.0版进行统计分析。以α=0.05（双侧检验）为检验水准。HLE和预期寿命的计算基于动态纵向追踪数据的多状态寿命表法，将研究对象的健康状况分为健康、不健康以及死亡。结合基线数据与随访数据，通过两次调查时研究对象的健康状态变化，基于马尔科夫链基本模型计算不同健康状态之间的转换概率，从而测算出不同健康状态下的预期寿命[8]。采用R 4.3.1的ELECT包构建寿命表。
2　结果
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2.1　人口学特征
基于常见慢性病维度，本研究共纳入18 301名研究对象，其中有无哺乳史研究对象分别为17 896（97.79%）和405（2.21%）人，常见慢性病的患病率分别为21.85%和23.46%。基于EQ-5D维度，共纳入7 746名研究对象，其中有无哺乳史研究对象分别为7 572（97.75%）和174（2.25%）人,平均效用指数分别为（0.94±0.12）和（0.93±0.15），平均VAS评分分别为（76.85±15.26）和（76.09±17.97）分。研究对象人口学特征见表1。
2.2　不同哺乳情况女性人群40岁预期寿命
在常见慢性病维度，有无哺乳史女性40岁时HLE和预期寿命分别为24.10年、20.62年和44.36年、41.13年。有哺乳史女性根据累积哺乳时长划分为≤36个月，37～60个月以及≥61个月三类，40岁时HLE分别为23.94、23.31和22.69年，预期寿命分别为43.32、43.50和43.70年，均高于无哺乳史；在效用指数维度，40岁时有无哺乳史HLE和预期寿命分别为35.96年、31.88年和44.58年、40.18年。有哺乳史女性根据累积哺乳时长≤36个月，37～60个月以及≥61个月测得的HLE分别为35.34、35.87和36.34年，预期寿命分别为42.84、44.14和45.44年，均高于无哺乳史；在VAS评分维度，40岁时有无哺乳史HLE和预期寿命分别为32.31年、28.92年和46.36年、42.61年。有哺乳史女性根据累积哺乳时长≤36个月，37～60个月以及≥61个月测得的HLE分别为30.43、30.63和30.67年，预期寿命分别为42.45、43.11和43.39年。与无哺乳史40岁女性相比，有哺乳史的女性在三个维度当中HLE/预期寿命的比值即HLE的余寿占比均有所增加。不同哺乳时长的HLE/预期寿命也均高于无哺乳史的女性。见表2。
2.3　不同哺乳情况女性各年龄段的预期寿命
图1展示了从常见慢性病、效用指数和VAS评分三种维度，有无哺乳史以及不同累积哺乳时长女性各年龄段的HLE和预期寿命。该图表明有无哺乳史以及不同累积哺乳时长女性的HLE和预期寿命均随着年龄的上升呈下降趋势。横向比较，相同年龄有哺乳经历的女性HLE和预期寿命均高于无哺乳史的女性。在有哺乳经历女性人群当中，三个维度女性的预期寿命均随累积哺乳时长的增加而增加。在效用指数和VAS评分维度，HLE同样随累积哺乳时长的增加而增加。
3　讨论
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本研究基于常见慢性病、健康状况效用指数和VAS评分三个不同维度分析母乳喂养对农村女性HLE和预期寿命的影响发现，母乳喂养中有无哺乳经历与女性HLE和预期寿命有关。同一年龄有哺乳史的女性HLE和预期寿命均高于无哺乳史者。
母乳喂养不仅促进婴儿生长发育，还能预防女性相关疾病的发生，对婴儿、产妇、家庭、社会具有重大意义。母乳喂养使母体激素发生变化进而对骨骼具有保护作用[9]，可降低绝经后髋部骨折的风险[10]，降低乳腺组织对雌激素等致癌因素的敏感性[11]，降低女性的血清胰岛素浓度和转化因子-β的表达[12]，通过调节激素、受体、刺激乳腺细胞分化、清除DNA损伤细胞等方式降低乳腺癌[13]和卵巢癌[14-15]的发病率。同时，母乳喂养有助于降低母体的焦虑、抑郁情绪，增强其自我效能、成就感、满足感和赋权感[16-17]。综合来看，母乳喂养可提升全民健康水平，减少医疗支出和社会成本，促进社会和谐与家庭稳定。
当前，中国常见慢性病患者数量在老龄化进程加快的背景下迅速增加，与赵新月[18]的慢性病会对身体和心理造成长期的、持续的不利影响的观点一致，慢性病是影响人群健康状况和寿命的主要因素之一，母乳喂养已被大量研究证明能显著降低多种慢性疾病的风险，慢性病数据可用于HLE的计算[19]。通过EQ-5D量表开展的健康状况效用指数和VAS评分两个维度的研究，不仅能反映个体健康状况，还能了解社会心理因素对个体身体健康的影响[20]。在本研究的三个维度中，研究对象的HLE和预期寿命均随哺乳经历的存在而增加。然而，常见慢性病维度的HLE/预期寿命在50%左右，而效用指数维度的HLE/预期寿命可达到80%。这可能是由于效用指数维度所代表的自评健康与实际心理健康以及躯体健康之间存在平行关系[21-22]，自评健康能够较好地反映研究对象的健康状况[23-24]。总体而言，这三个维度的研究均表明，哺乳经历对女性HLE和预期寿命具有积极影响。
虽然本研究采用前瞻性设计，样本量较大，并从不同的维度探讨了不同哺乳情况对女性HLE和预期寿命的影响，但仍存在一定的局限性。首先，研究对象在回答问卷中哺乳史和常见慢性病相关问题时可能存在回忆偏倚。其次，本研究根据女性累积哺乳时长测算了HLE和预期寿命，但并未调查每胎哺乳时长，不能精准测算每胎哺乳时长对女性HLE和预期寿命的影响。最后，研究对象来自河南农村队列，将结果应用到其他人群时应当谨慎。
综上所述，哺乳史对女性的HLE和预期寿命有一定的提升作用。尽管各维度之间存在一定的差异，但可为女性母乳喂养的健康教育工作提供数据参考。
基金
收起
  • 国家重点研发计划“精准医学研究”国家重点专项(2016YFC0900803)
  • 河南省哲学社会科学规划项目(2020BSH018)
文献
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2024年第51卷第21期
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doi: 10.20043/j.cnki.MPM.202407204
  • 接收时间：2024-07-13
  • 首发时间：2026-03-20
  • 出版时间：2024-11-10
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  • 收稿日期：2024-07-13
基金
国家重点研发计划“精准医学研究”国家重点专项(2016YFC0900803)
河南省哲学社会科学规划项目(2020BSH018)
作者信息
    1.郑州大学公共卫生学院社会医学与卫生事业管理学系，河南 郑州450001
    2.郑州大学公共卫生学院流行病与卫生统计学系，河南 郑州450001
    3.郑州大学第三附属医院保健科，河南 郑州450052

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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