慢性病和身体损伤与老年人残疾的关系：十年的变化？
Association of chronic diseases and impairments with disability in older adults: a decade of change?
机构信息
Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
出版信息
Med Care. 2012 Jun;50(6):501-7. doi: 10.1097/MLR.0b013e318245a0e0.
BACKGROUND
Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.
OBJECTIVE
To examine how the associations of chronic disease and impairment with specific disability have changed over time.
RESEARCH DESIGN
Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.
SUBJECTS
The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.
MEASUREMENTS
: Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.
RESULTS
Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99% confidence interval (CI), 1.06-1.46; OR = 1.07; 99% CI, 0.90-1.27; OR = 1.00; 99% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99% CI, 1.13-1.54; OR=0.97; 99% CI, 0.82-1.14; OR = 0.99; 99% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99% CI, 1.01-1.46; OR = 1.37; 99% CI, 1.15-1.64; OR = 1.52; 99% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99% CI, 1.33-2.03; OR = 1.63; 99% CI, 1.32-2.01; OR = 2.11; 99% CI, 1.73-2.57).
CONCLUSIONS
Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.
背景
关于慢性疾病、功能障碍和残疾之间的关系在老年人中随时间如何变化，人们知之甚少。
目的
研究慢性疾病和功能障碍与特定残疾之间的关联随时间如何变化。
研究设计
对健康与退休研究的最近 3 个波次进行重复的横截面分析，然后使用时间交互变量对汇总样本进行检查。
研究对象
1998 年、2004 年和 2008 年，年龄在 65 岁及以上的 10390、10621 和 10557 名居住在社区的成年人。
测量方法
基于调查的慢性疾病史，包括高血压、心脏病、心力衰竭、中风、糖尿病、癌症、慢性肺部疾病和关节炎；功能障碍，包括认知、视力和听力；以及残疾，包括移动、复杂日常生活活动（ADL）和自我护理 ADL。
结果
随着时间的推移，慢性疾病和功能障碍与残疾之间的关系基本保持不变；然而，高血压与复杂 ADL 残疾之间的关联从 1998 年到 2004 年和 2008 年逐渐减弱（比值比[OR] = 1.24；99%置信区间[CI]，1.06-1.46；OR = 1.07；99% CI，0.90-1.27；OR = 1.00；99% CI，0.83-1.19），高血压与自我护理 ADL 残疾之间的关联也是如此（OR = 1.32；99% CI，1.13-1.54；OR = 0.97；99% CI，0.82-1.14；OR = 0.99；99% CI，0.83-1.17）。糖尿病与自我护理 ADL 残疾之间的关联从 1998 年到 2004 年和 2008 年逐渐增强（OR = 1.21；99% CI，1.01-1.46；OR = 1.37；99% CI，1.15-1.64；OR = 1.52；99% CI，1.29-1.79），肺部疾病与自我护理 ADL 残疾之间的关联也是如此（OR = 1.64；99% CI，1.33-2.03；OR = 1.63；99% CI，1.32-2.01；OR = 2.11；99% CI，1.73-2.57）。
结论
尽管疾病、功能障碍和残疾之间的关系基本保持不变，但残疾与高血压的关联性降低，而与糖尿病和肺部疾病的关联性增高。
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