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美国老年慢性丙型肝炎(CH-C)患者住院死亡率及资源利用的预测因素

Predictors of Inpatient Mortality and Resource Utilization for the Elderly Patients With Chronic Hepatitis C (CH-C) in the United States.

作者信息

Golabi Pegah, Otgonsuren Munkhzul, Suen Winnie, Koenig Aaron B, Noor Bashir, Younossi Zobair M

机构信息

From the Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA (PG, MO, WS, ABK, BN, ZMY); and Center for Liver Diseases, Department of Medicine, Inova Fair Falls Church, VA (WS, ZMY).

出版信息

Medicine (Baltimore). 2016 Jan;95(3):e2482. doi: 10.1097/MD.0000000000002482.

Abstract

New incidents of chronic hepatitis C (CH-C) have stabilized yet the full impact of CH-C is not realized.Assess inpatient mortality and resource utilization for CH-C patients hospitalized in the United States.Adult CH-C patients were identified from The National Inpatient Sample (NIS) 2005 to 2009 database using the International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes (070.51, 070.54, 070.70, 070.71, 070.41, and 070.44) also used to identify comorbidities.324,823 hospitalized CH-C patients were identified. Of these, 13.63% (N = 44,288) were older than 65. The rate of hospitalization for the elderly cohort steadily increased over the study period with Medicare as the payer for the majority (86%). This cohort had higher inpatient charges, approximately a half day longer hospital stay (P < 0.001) and more moderate or severe illness. During the index hospitalization, older CH-C patients were twice more likely to die than the younger age-group (5% versus 2%, P < 0.001). In the adjusted model, older age (OR: 1.02 [95% CI, 1.02-1.03]), severity of illness (OR: 12.06 [95% CI, 10.68-13.62]), and number of diagnoses (OR: 1.10 [95% CI, 1.09-1.11]) were associated with higher in-hospital mortality; severity of illness and having private insurance were significantly associated with charge per hospital stay (P < 0.001).The number of CH-C patients 65 and older increased due to the aging of the baby boomer population. Early treatment of CH-C patients with highly effective, well-tolerated, new anti-HCV regimens may prevent this significant societal burden.

摘要

慢性丙型肝炎(CH-C)的新发病例已趋于稳定,但CH-C的全面影响尚未显现。评估美国住院的CH-C患者的住院死亡率和资源利用情况。使用国际疾病分类第九版(ICD-9)诊断代码(070.51、070.54、070.70、070.71、070.41和070.44)从2005年至2009年的全国住院患者样本(NIS)数据库中识别成年CH-C患者,这些代码也用于识别合并症。共识别出324,823例住院的CH-C患者。其中,13.63%(N = 44,288)年龄超过65岁。在研究期间,老年队列的住院率稳步上升,医疗保险是大多数患者(86%)的支付方。该队列的住院费用更高,住院时间大约长半天(P < 0.001),病情更中度或重度。在首次住院期间,老年CH-C患者死亡的可能性是年轻患者的两倍(5%对2%,P < 0.001)。在调整模型中,年龄较大(比值比:1.02 [95%置信区间,1.02 - 1.03])、病情严重程度(比值比:12.06 [95%置信区间,10.68 - 13.62])和诊断数量(比值比:1.10 [95%置信区间,1.09 - 1.11])与较高的住院死亡率相关;病情严重程度和拥有私人保险与每次住院费用显著相关(P < 0.001)。由于婴儿潮一代人口老龄化,65岁及以上的CH-C患者数量增加。采用高效、耐受性良好的新型抗丙型肝炎病毒方案对CH-C患者进行早期治疗,可能会避免这一重大的社会负担。

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