Association of Hypothyroidism and Mortality in the Elderly Population: A Systematic Review and Meta-Analysis

被引:17
作者
Tsai, Tou-Yuan [1 ]
Tu, Yu-Kang [2 ,3 ,4 ,5 ]
Munir, Kashif M. [6 ]
Lin, Shu-Man [7 ]
Chang, Rachel Huai-En [8 ]
Kao, Sheng-Lun [9 ,10 ]
Loh, Ching-Hui [10 ,11 ]
Peng, Carol Chiung-Hui [12 ]
Huang, Huei-Kai [9 ,10 ]
机构
[1] Buddhist Tzu Chi Med Fdn, Dalin Tzu Chi Hosp, Emergency Dept, Chiayi 62247, Taiwan
[2] Natl Taiwan Univ, Coll Publ Hlth, Inst Epidemiol & Prevent Med, Taipei 100, Taiwan
[3] Natl Taiwan Univ, Natl Taiwan Univ Hosp, Dept Med Res, Taipei 100, Taiwan
[4] Natl Taiwan Univ, Natl Taiwan Univ Hosp, Dept Dent, Taipei 100, Taiwan
[5] Natl Taiwan Univ, Sch Dent, Taipei 100, Taiwan
[6] Univ Maryland, Div Endocrinol Diabet & Nutr, Sch Med, Baltimore, MD 21201 USA
[7] Buddhist Tzu Chi Med Fdn, Hualien Tzu Chi Hosp, Dept Phys Med & Rehabil, Hualien 97002, Taiwan
[8] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD 21205 USA
[9] Buddhist Tzu Chi Med Fdn, Hualien Tzu Chi Hosp, Dept Family Med, 707,Sec 3,Chung Yang Rd, Hualien 97002, Taiwan
[10] Tzu Chi Univ, Sch Med, Hualien 97004, Taiwan
[11] Buddhist Tzu Chi Med Fdn, Hualien Tzu Chi Hosp, Ctr Aging & Hlth, Hualien 97002, Taiwan
[12] Univ Maryland, Dept Internal Med, Med Ctr, Midtown Campus,827 Linden Ave, Baltimore, MD 21201 USA
关键词
hypothyroidism; elderly; mortality; cardiovascular mortality; overt hypothyroidism; subclinical hypothyroidism; ALL-CAUSE MORTALITY; THYROID FUNCTIONAL DISEASE; UNITED-STATES POPULATION; SUBCLINICAL HYPOTHYROIDISM; IODINE INTAKE; HEART-FAILURE; CARDIOVASCULAR MORTALITY; COGNITIVE FUNCTION; NATIONAL COHORT; SERUM TSH;
D O I
10.1210/clinem/dgz186
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: The evidence of whether hypothyroidism increases mortality in the elderly population is currently inconsistent and conflicting. Objective: The objective of this meta-analysis is to determine the impact of hypothyroidism on mortality in the elderly population. Data Sources: PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched from inception until May 10, 2019. Study Selection: Studies evaluating the association between hypothyroidism and all-cause and/or cardiovascular mortality in the elderly population (ages >= 60 years) were eligible. Data Extraction: Two reviewers independently extracted data and assessed the quality of the studies. Relative risk (RR) was retrieved for synthesis. A random-effects model for meta-analyses was used. Data Synthesis: A total of 27 cohort studies with 1 114 638 participants met the inclusion criteria. Overall, patients with hypothyroidism experienced a higher risk of all-cause mortality than those with euthyroidism (pooled RR = 1.26, 95% CI: 1.15-1.37); meanwhile, no significant difference in cardiovascular mortality was found between patients with hypothyroidism and those with euthyroidism (pooled RR = 1.10, 95% CI: 0.84-1.43). Subgroup analyses revealed that overt hypothyroidism (pooled RR = 1.10, 95% CI: 1.01-1.20) rather than subclinical hypothyroidism (pooled RR = 1.14, 95% CI: 0.92-1.41) was associated with increased all-cause mortality. The heterogeneity primarily originated from different study designs (prospective and retrospective) and geographic locations (Europe, North America, Asia, and Oceania). Conclusions: Based on the current evidence, hypothyroidism is significantly associated with increased all-cause mortality instead of cardiovascular mortality among the elderly. We observed considerable heterogeneity, so caution is needed when interpreting the results. Further prospective, large-scale, high-quality studies are warranted to confirm these findings.
引用
收藏
页码:2068 / 2080
页数:13
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