Jakoi Ande M, Pannu Gurpal, D'Oro Anthony, Buser Zorica, Pham Martin H, Patel Neil N, Hsieh Patrick C, Liu John C, Acosta Frank L, Hah Raymond, Wang Jeffrey C
Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.
Department of Orthopaedic Surgery, Drexel University, Philadelphia, PA, USA.
Asian Spine J. 2017 Jun;11(3):337-347. doi: 10.4184/asj.2017.11.3.337. Epub 2017 Jun 15.
Retrospective analysis of a nationwide private insurance database. Chi-square analysis and linear regression models were utilized for outcome measures.
The purpose of this study was to investigate any relationship between lumbar degenerative disc disease, diabetes, obesity and smoking tobacco.
Diabetes, obesity, and smoking tobacco are comorbid conditions known to individually have effect on degenerative disc disease. Most studies have only been on a small populous scale. No study has yet to investigate the combination of these conditions within a large patient cohort nor have they reviewed the combination of these conditions on degenerative disc disease.
A retrospective analysis of insurance billing codes within the nationwide Humana insurance database was performed, using PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA), to identify trends among patients diagnosed with lumbar disc degenerative disease with and without the associated comorbidities of obesity, diabetes, and/or smoking tobacco. Patients billed for a comorbidity diagnosis on the same patient record as the lumbar disc degenerative disease diagnosis were compared over time to patients billed for lumbar disc degenerative disease without a comorbidity. There were no sources of funding for this manuscript and no conflicts of interest.
The total number and prevalence of patients (per 10,000) within the database diagnosed with lumbar disc degenerative disease increased by 241.4% and 130.3%, respectively. The subsets of patients within this population who were concurrently diagnosed with either obesity, diabetes, tobacco use, or a combination thereof, was significantly higher than patients diagnosed with lumbar disc degenerative disease alone ( <0.05 for all). The number of patients diagnosed with lumbar disc degenerative disease and smoking rose significantly more than patients diagnosed with lumbar disc degenerative disease and either diabetes or obesity ( <0.05). The number of patients diagnosed with lumbar disc degenerative disease, smoking and obesity rose significantly more than the number of patients diagnosed with lumbar disc degenerative disease and any other comorbidity alone or combination of comorbidities ( <0.05).
Diabetes, obesity and cigarette smoking each are significantly associated with an increased diagnosis of lumbar degenerative disc disease. The combination of smoking and obesity had a synergistic effect on increased rates of lumbar degenerative disc disease. Patient education and preventative care is a vital goal in prevention of degenerative disc disease within the general population.
对全国性私人保险数据库进行回顾性分析。采用卡方分析和线性回归模型作为结果测量方法。
本研究旨在调查腰椎退行性椎间盘疾病、糖尿病、肥胖症与吸烟之间的关系。
糖尿病、肥胖症和吸烟是已知各自会对退行性椎间盘疾病产生影响的共病情况。大多数研究规模较小。尚无研究在大型患者队列中调查这些情况的组合，也未评估这些情况的组合对退行性椎间盘疾病的影响。
使用PearlDiver软件（PearlDiver公司，美国印第安纳州韦恩堡）对全国性Humana保险数据库中的保险计费代码进行回顾性分析，以确定诊断为腰椎间盘退行性疾病的患者中，伴有或不伴有肥胖症、糖尿病和/或吸烟等相关共病情况的患者趋势。将在同一患者记录中因共病诊断而计费的患者与因腰椎间盘退行性疾病但无共病而计费的患者进行长期比较。本手稿无资金来源且无利益冲突。
数据库中诊断为腰椎间盘退行性疾病的患者总数和患病率（每10,000人）分别增加了241.4%和130.3%。该人群中同时诊断为肥胖症、糖尿病、吸烟或其组合的患者子集显著高于仅诊断为腰椎间盘退行性疾病的患者（所有情况均P<0.05）。诊断为腰椎间盘退行性疾病且吸烟的患者数量增长显著高于诊断为腰椎间盘退行性疾病且患有糖尿病或肥胖症的患者（P<0.05）。诊断为腰椎间盘退行性疾病、吸烟且肥胖的患者数量增长显著高于诊断为腰椎间盘退行性疾病且单独患有任何其他共病或共病组合的患者数量（P<0.05）。
糖尿病、肥胖症和吸烟均与腰椎退行性椎间盘疾病诊断增加显著相关。吸烟和肥胖的组合对腰椎退行性椎间盘疾病发病率增加具有协同作用。患者教育和预防保健是普通人群预防退行性椎间盘疾病的重要目标。
