美国养老院老年居民慢性共病模式：性别与年龄跨度差异
Patterns of chronic co-morbid medical conditions in older residents of U.S. nursing homes: differences between the sexes and across the agespan.
作者信息
Moore K L, Boscardin W J, Steinman M A, Schwartz J B
机构信息
J.B. Schwartz, MD, Research Department, 302 Silver Avenue, San Francisco, CA 94112; (415) 406-1573, fax (415) 406-1577;
出版信息
J Nutr Health Aging. 2014 Apr;18(4):429-36. doi: 10.1007/s12603-014-0001-y.
OBJECTIVE
There are limited data on combinations of co-morbid conditions to guide efforts to improve therapeutic strategies in patients with multiple co-morbid conditions. To some extent, this may be due to limited data on combinations of co-morbid conditions in patient groups. Our goal was to determine the most common co-morbid medical conditions in older residents of U.S. nursing homes and identify sex differences in prevalences and changes across the agespan of nursing residents.
DESIGN
Cross sectional analysis of National Nursing Home Survey (NNHS)--a nationally representative sample with comprehensive medical data on nursing home residents.
SETTING
1174 Nursing homes.
PARTICIPANTS
Long term stay residents of U.S. Nursing Homes aged 65 years and older (11,734 :8745 women, 2989 men).
MEASUREMENTS
Determination of the prevalences of the most frequent two and three disease combinations identified using Clinical Classifications Software (CCS) for ICD-9-CM and a composite vascular disease diagnosis (atherosclerosis and/or coronary artery disease, and/or peripheral arterial disease, and/or cerebrovascular disease or stroke) from the most recent and only NNHS survey with comprehensive medical diagnosis information.
RESULTS
Frequent 2-disease combinations were: hypertension (HTN) + dementia (DEM) in 27%, HTN + any Vascular (Vasc) disease (26%), HTN + depression(DEP) 21%, HTN + arthritis(ARTH) 20%, DEM + Vasc (21%), DEM+Depression 19%, Arthritis + DEM 17%, DEP + Vasc (16%), ARTH + Vasc (15%), followed by HTN + GERD (14%) and ARTH + DEP (14%). Frequent 3-disease combinations: HTN +VASC+ DEP in 13%, HTN +DEM +DEP (11%), and HTN+Arthritis+DEM (10%). HTN was in 80% of the top 3-disease combinations, Vasc in 50%, HTN+VASC in 35%, DEM or DEP in 40%, ARTH in 25% and GERD in 20%. Combinations with anemia, arthritis, dementia, heart failure, osteroporosis, thyroid disease were higher in women, COPD combinations higher in men. As age increased, dementia, depression, arthritis, and anemia with hypertension were common co-morbid combinations, diabetes and heart failure were not.
CONCLUSIONS
Hypertension, vascular disease, dementia, arthritis, depression, and gastro-esophageal reflux disease were part of the most prevalent co-morbid conditions. Multimorbidity patterns can be identified in nursing home residents and vary with age and by sex.
目的
关于合并症组合的数据有限，难以指导改善患有多种合并症患者的治疗策略。在某种程度上，这可能是由于患者群体中合并症组合的数据有限。我们的目标是确定美国养老院老年居民中最常见的合并内科疾病，并确定患病率的性别差异以及养老院居民各年龄段的变化情况。
设计
对国家养老院调查（NNHS）进行横断面分析——这是一个具有全国代表性的样本，包含养老院居民的全面医疗数据。
地点
1174家养老院。
参与者
美国养老院65岁及以上的长期居住居民（11734人：8745名女性，2989名男性）。
测量
使用针对ICD - 9 - CM的临床分类软件（CCS）确定最常见的两种和三种疾病组合的患病率，以及从最近且唯一一次具有全面医疗诊断信息的NNHS调查中得出的复合血管疾病诊断（动脉粥样硬化和/或冠状动脉疾病，和/或外周动脉疾病，和/或脑血管疾病或中风）。
结果
常见的两种疾病组合为：高血压（HTN）+痴呆（DEM）占27%，HTN +任何血管（Vasc）疾病（26%），HTN +抑郁症（DEP）21%，HTN +关节炎（ARTH）20%，DEM + Vasc（21%），DEM +抑郁症19%，关节炎+ DEM 17%，DEP + Vasc（16%），ARTH + Vasc（15%），其次是HTN +胃食管反流病（GERD）（14%）和ARTH + DEP（14%）。常见的三种疾病组合：HTN + VASC + DEP占13%，HTN + DEM + DEP（11%），以及HTN +关节炎+ DEM（10%）。HTN出现在80%的最常见三种疾病组合中，Vasc占50%，HTN + VASC占35%，DEM或DEP占40%，ARTH占25%，GERD占20%。女性中贫血、关节炎、痴呆、心力衰竭、骨质疏松症、甲状腺疾病的组合较高，男性中慢性阻塞性肺疾病（COPD）组合较高。随着年龄增长，痴呆、抑郁症、关节炎以及高血压合并贫血是常见的合并症组合，糖尿病和心力衰竭则不然。
结论
高血压、血管疾病、痴呆、关节炎、抑郁症和胃食管反流病是最常见的合并症。养老院居民中可识别出多种合并症模式，且随年龄和性别而有所不同。
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