Schlösser Felix J V, Vaartjes Ilonca, van der Heijden Geert J M G, Moll Frans L, Verhagen Hence J M, Muhs Bart E, de Borst Gert J, Tiel Groenestege Andreas T, Kardaun Jan W P F, Reitsma Johannes B, van der Graaf Yolanda, Bots Michiel L
Section of Vascular Surgery, Yale University School of Medicine, Yale University, New Haven, CT, USA.
Ann Vasc Surg. 2010 Nov;24(8):1125-32. doi: 10.1016/j.avsg.2010.07.010.
The purpose of this study is to quantify age- and gender-specific mortality risks for patients hospitalized for ruptured abdominal aortic aneurysm (rAAA).
The mortality risks for 28-day, 1-year, and 5-year were derived from a retrospective nation-wide cohort study of patients who were first hospitalized for rAAA in 1997 or 2000, formed through linkage of the Hospital Discharge Register with the Dutch population register. The Hospital Discharge Register contains a record for each hospital admission, giving information about patient demographics and diagnosis. The population register contains information on patient demographics and the mortality status of all registered persons in The Netherlands. Relations between gender and mortality within specific age groups were assessed with chi-square tests. Associations between age, gender, comorbidities, and mortality were studied in multivariate analysis with Cox regression.
A total of 1,463 patients hospitalized for rAAA were identified (86% males). Mean age was higher in women than in men (79 vs. 72 years; 95% CI of difference: 5.0-7.4). Mortality risks at 28-day, 1-year, and 5-year increased significantly with age (28-day: from 36 to 91% in men and 59 to 92% in women; 5-year: from 51 to 97% in men and 79 to 96% in women). In patients aged <80 years, mortality risks were significantly higher in women than in men. Age (HR: 1.04; 95% CI: 1.03-1.05), previous hospitalization for congestive heart failure (HR: 1.55; 95% CI: 1.06-2.26), and cerebrovascular disease (HR: 1.60; 95% CI: 1.16-2.21) were significant predictors of short- and long-term mortality.
Mortality risks after hospitalization for rAAA clearly increase by age and are higher in women than in men in patients aged <80 years. Because of the major effect of age and gender, future studies should consider reporting absolute mortality risks stratified by age and gender, instead of simply presenting overall mortality risks.
本研究的目的是量化因腹主动脉瘤破裂（rAAA）住院患者的年龄和性别特异性死亡风险。
28天、1年和5年的死亡风险来自一项全国性回顾性队列研究，该研究对象为1997年或2000年首次因rAAA住院的患者，通过将医院出院登记册与荷兰人口登记册相链接形成。医院出院登记册包含每次住院记录，提供患者人口统计学和诊断信息。人口登记册包含荷兰所有登记人员的人口统计学和死亡状态信息。使用卡方检验评估特定年龄组内性别与死亡率之间的关系。在多变量分析中，采用Cox回归研究年龄、性别、合并症与死亡率之间的关联。
共识别出1463例因rAAA住院的患者（86%为男性）。女性的平均年龄高于男性（79岁对72岁；差异的95%置信区间：5.0 - 7.4）。28天、1年和5年的死亡风险随年龄显著增加（28天：男性从36%增至91%，女性从59%增至92%；5年：男性从51%增至97%，女性从79%增至96%）。在年龄小于80岁的患者中，女性的死亡风险显著高于男性。年龄（风险比：1.04；95%置信区间：1.03 - 1.05）、既往因充血性心力衰竭住院（风险比：1.55；95%置信区间：1.06 - 2.26）和脑血管疾病（风险比：1.60；95%置信区间：1.16 - 2.21）是短期和长期死亡的显著预测因素。
rAAA住院后的死亡风险随年龄明显增加，且在年龄小于80岁的患者中女性高于男性。由于年龄和性别的主要影响，未来研究应考虑报告按年龄和性别分层的绝对死亡风险，而非仅呈现总体死亡风险。
