Piggott Damani A, Muzaale Abimereki D, Varadhan Ravi, Mehta Shruti H, Westergaard Ryan P, Brown Todd T, Patel Kushang V, Walston Jeremy D, Leng Sean X, Kirk Gregory D
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.
J Gerontol A Biol Sci Med Sci. 2017 Mar 1;72(3):389-394. doi: 10.1093/gerona/glw142.
Hospitalization events exact a substantial toll across the age spectrum. Frailty is associated with all-cause hospitalization among HIV-uninfected adults aged 65 years and older. Limited data exist on the frailty relationship to hospitalization among HIV-infected persons or those aged less than 65 years. Comparative investigation of the frailty relationship to specific classes of hospitalizations has rarely been reported among adults of any age. This study sought to determine the frailty relationship to three distinct classes of hospitalization events among HIV-infected persons and their uninfected counterparts.
Frailty was ascertained semiannually among persons with prior injection drug use using the five Fried phenotypic domains. Hospitalization events were categorized using Agency for Healthcare Research and Quality clinical classification software into chronic, infectious, and nonchronic, noninfectious conditions. Cox proportional hazards models were used to examine the frailty relationship to time to first hospitalization event.
Among 1,303 subjects, mean age was 48 years; 32% were HIV-infected. Adjusting for sociodemographics, comorbidity, substance use, and HIV disease stage, time-updated frailty status was associated with risk for all hospitalization classes. Baseline frailty was significantly associated with all-cause (hazards ratio [HR] 1.41; 95% confidence interval [CI], 1.06, 1.87), chronic (HR 2.13; 95% CI, 1.46, 3.11), and infectious disease hospitalization (HR 2.51; 95% CI, 1.60, 3.91) but not with nonchronic, noninfectious hospitalization risk (HR 1.09; 95% CI, 0.74, 1.61).
The frailty phenotype predicts vulnerability to chronic and infectious disease-related hospitalization. Frailty-targeted interventions may mitigate the substantial burden of infectious and chronic disease-related morbidity and health care utilization in HIV-infected and uninfected populations.
住院事件在各个年龄段都会造成巨大损失。衰弱与65岁及以上未感染艾滋病毒的成年人的全因住院有关。关于衰弱与感染艾滋病毒者或年龄小于65岁者住院之间关系的数据有限。在任何年龄段的成年人中，很少有关于衰弱与特定类型住院之间关系的比较研究报告。本研究旨在确定衰弱与感染艾滋病毒者及其未感染的对应者中三种不同类型住院事件之间的关系。
使用弗里德的五个表型领域，每半年对有注射吸毒史的人进行一次衰弱评估。使用医疗保健研究与质量机构的临床分类软件将住院事件分为慢性、感染性和非慢性、非感染性疾病。使用Cox比例风险模型来检验衰弱与首次住院事件时间之间的关系。
在1303名受试者中，平均年龄为48岁；32%感染了艾滋病毒。在调整了社会人口统计学、合并症、物质使用和艾滋病毒疾病阶段后，随时间更新的衰弱状态与所有住院类型的风险相关。基线衰弱与全因（风险比[HR]1.41；95%置信区间[CI]，1.06，1.87）、慢性（HR 2.13；95%CI，1.46，3.11）和传染病住院（HR 2.51；95%CI，1.60，3.91）显著相关，但与非慢性、非感染性住院风险无关（HR 1.09；95%CI，0.74，1.61）。
衰弱表型预示着易患慢性和传染病相关住院。针对衰弱的干预措施可能会减轻感染艾滋病毒和未感染人群中传染病和慢性病相关发病及医疗保健利用的巨大负担。
