| Objective: Retired military cadres are one of the key subjects for the health care service in Chinese army. Up to now, few systematic epidemiological research reports about all cause mortality, stroke and their determinants have been found, which has baffled us to promote health service further in the special population. The study will address those health issues in a cohort of military retired veterans in Xi'an, China.Methods: An epidemiological survey, from June 30th, 2005 to June 30th, 2006, was carried out in a cohort, which was set up in 1987 and included 1268 Chinese retired military veterans from 22 health centers, Xi'an. Four epidemiological methods were used respectively, including cross sectional survey, case-control study, nested case-control study, and cohort study. The data for epidemiological analysis were entered (double entry) computer and organized by Epidata3.0. Multivariate Cox proportional hazard regression model was used to compute hazard ratio(HR) and 95% confidence interval (CI), and non conditional logistic regression model was for odd ratio(OR) and 95%CI, with the statistic analysis worked out by SAS8.2 and SPSS13.0.Results:1. The health determinants and prevalence in the military retired cadre cohort:①Up to June 30th, 2005, out of total 1268 individuals, 748 were alive, 491 had died, and 29 had been transferred away with unknown vital status.②The average age of 694 responders in the survey of 2005 was 79.78±4.40 and age varied from 69.71 to 100.38.③Prevalence of coronary heart disease (CHD), hypertension, stroke, cerebral arteriosclerosis (CAS), hyperlipoidemia (HL), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and cancers were 69.7%, 53.6%, 24.9%, 5.3%, 26.5%, 20.3%, 29.8% and 7.9%, respectively.④Smoking rate and drinking rate were 67.6% and 63.83%. 88.47% of responders did exercise regularly. According to Chinese body mass index (BMI) standard, overweight rate was 41.5% and obesity rate was 11.6%. 55.8% of retired military veterans controlled blood fat intentionally.⑤Compared with the baseline data, the levels of TG, exercise rate and drinking rate increased significantly (P<0.05), the level of diastolic blood pressure (DBP) decreased significantly. Prevalence of all kinds of diseases increased significantly with aging (P<0.05).2. All-cause mortality and its determinants in the cohort:①Up to June 30th, 2005, the five leading causes of death were malignant tumor (39.71%), COPD (16.90%), CHD (16.90%), stroke (11.20%) and DM (4.68%). Adjusted mortality rates were 1039, 442, 421, 293 and 123 per 100,000 person years, respectively. ②Adjusted total mortality was 2, 616 per 100,000 person years. The average age of death was 74.08±6.63.③The three leading death causes of cancers were lung cancer (30.77%), stomach cancer (21.54%) and liver cancer (12.82%).④The cohort study showed that age, smoking, systolic blood pressure(SBP), triglycerides(TG), family history of hypertension, stroke and cancer, existing diseases of stroke, DM and cancer, BMI and age of starting smoking were associated with all-cause mortality, HRs(95%CIs) were 1.083(1.062-1.104), 1.026(1.013-1.039), 1.009 (1.003-1.015), 1.002(1.001-1.003), 1.330(1.005- 1.759), 1.330(1.005-1.759), 1.444(1.103-1.890), 2.237(1.244-4.022), 1.462 (1.042-2.051), 2.079(1.051-4.115), 0.963(0.931-0.996) and 0.988(0.978-0.999) respectively.⑤Compared with never-smokers, current smokers had increased risks of total mortality [HR1.369 (1.083-1.731)], CHD [HR1.805 (1.022-3.188)], and lung cancer [HR2.939 (1.311- 6.585)].⑥The nested case-control study showed that age, SBP, TG, smoking, age of starting smoking, family history of hypertension and cancer were associated with all-cause mortality and their ORs (95%CIs) were 1.109(1.077-1.143), 1.012(1.003-1.020), 1.002(1.001-1.005), 2.175(1.335-3.543), 0.982 (0.964-0.999), 1.561(1.033-2.359), 1.791(1.228-2.610) respectively.⑦A cluster analysis of death risk factor showed some risk factors could have a synergic role.3. The stroke and its determinants in the cohort:①Up to June 30th, 2005, 186 new cases of stroke had appeared. Adjusted morbidity was 984.43 per 100,000 person years. Among them, 157 were cerebral infarction and 29 were cerebral hemorrhage.②Up to June 30th, 2006, 69 cases of stroke had died, and its adjusted mortality was 357.02 per 100,000 person years. Among them, 26 were cerebral infarction and 43 were cerebral hemorrhage.③A case control study showed that SBP, TC, waist-to-hip ratio (WHR), exercise, alcohol intake, and green tea intake were associated with stroke. Their ORs (95%CIs) were 1.013 (1.001-1.027), 1.115 (1.006-1.236), 2.514 (1.726-3.664), 0.230 (0.136- 0.389), 1.868 (1.196-2.917) and 0.595(0.375-0.944) respectively. Blood type, TBIL, income per capita, personality, adaptability, daily life function, life content, family structure, communication, psychological health, physical condition, acenterine intake and salt hobby were also associated with stroke to some extent.④A cluster analysis showed those risk factors could have a synergic role.⑤A cohort study showed that age, SBP, DBP, diseases history of CAS, hypertension and stroke were associated with new cases of stroke, their HRs(95%CIs) were 1.037 (1.002-1.072), 1.087(1.012-1.169), 1.186(1.050- 1.340), 1.515(1.006-2.281) and 1.571(1.052-2.347) respectively.⑥Age, DBP, diseases history of CAS and hypertension were associated with cerebral infarction. Their HRs (95%CIs) were 1.043(1.005-1.081), 1.179(1.039-1.335), 1.615(1.030-2.530) and 1.767 (1.152-2.71). DBP and diseases history of hypertension were associated with cerebral hemorrhage. HRs(95%CIs) were 1.451(1.117-1.884) and 2.701 (1.029-7.086).⑦Age, SBP, smoking, family history of hypertension and stroke, BMI, diseases history of stroke, HL and hypertension were associated with stroke death. Their HRs(95%CIs) were 1.072(1.017-1.131), 4.283(1.706-10.753), 2.180(1.019-4.665), 2.069(1.066 -4.014), 2.069(1.066-4.014), 0.858(0.779-0.946), 10.034(3.366-29.912), 3.351 (1.194-9.406) and 2.366(1.247-4.491) respectively.⑧Age, DBP, family history of hypertension and stroke, diseases history of stroke were associated with death of cerebral infarction. Their HRs (95%CIs) were 1.153(1.059-1.254), 1.401 (1.006-1.952), 4.682(1.711-12.816), 4.682 (1.711-12.816) and 14.460 (2.675- 78.162) respectively. BMI, diseases history of stroke, hypertension and HL were associated with death of cerebral hemorrhage. Their HRs (95%CIs) were 0.827 (0.731-0.936), 7.575(1.663-34.509), 4.060 (1.847-8.927), 4.179 (1.073-16.274) respectively. Conclusions:1. All-cause mortality in the cohort was lower than the national level. In the five leading death causes, the mortality of cancers, CHD and diabetes were higher than the national level, but the mortality of COPD was lower. Proportional mortality rate of five leading causes of death differed from that of the general urban male population and was also various in different age groups. These results suggest health service in retired military male veterans should pay more attention to the control, treatment and recovery of cancer, CHD and diabetes.2. Rates of smoking, drinking alcohol, and overweight were higher than the national levels in the cohort, which suggested health education was necessary. Quitting smoking, keeping suitable levels of SBP, TG and weight, to prevent stroke, DM and cancers could reduce the death risk. At the same time, it should be kept an eye on the dynamic changes of TG with aging.3. In the study, most of new stroke cases were cerebral infarction and nearly all the death cases with stroke were cerebral hemorrhage in the cohort. Compared with national level, morbidity and mortality of stroke were in a low level. To reduce the risk of stroke, some measurements, such as controlling blood pressure, TC, TBIL and weight, quitting smoking, restricting alcohol intake, preventing CAS, HL and hypertension should be advocated.
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