Center for Research in Epidemiology and Population Health UMR 1018, INSERM, Paris-Sud University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France.
Department of Epidemiology and Public Health, Paris Sud University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
PLoS One. 2018 Mar 13;13(3):e0193729. doi: 10.1371/journal.pone.0193729. eCollection 2018.
The number of adolescents with a severe chronic disease has increased in high-income countries due to improvements in the prognosis of childhood-onset chronic conditions. The transition from childhood to adulthood is a critical period that may be associated with increased mortality and morbidity. We aimed to estimate the prevalence of adolescents with a long-term disease (LTD) in France and assess their mortality and hospitalization risks relative to the general population.
We extracted a population-based cohort from the French national health insurance database that included 61,119 subjects who reached 14 years of age between 2005 and 2014. LTDs are diagnosed by patients' physicians and then confirmed and registered by a physician of the national health insurance system. We assessed mortality and hospitalizations using data of patients who were between 14 and 21 years-old.
Among 14-year-old adolescents, 3.30% (95% confidence interval: 3.16-3.44) had a LTD. Their mortality rate between the ages of 14 and 21 years was 20.9/10,000 person-years (13.7-32.1) versus 1.9 (1.5-2.5) for adolescents without a LTD. Mortality was higher in males than females in youths without a LTD, but not in those with a LTD. We found a similar pattern for the risk of hospitalization for an external cause. The five-year probability of hospitalization was 61.8% among youths with a LTD versus 42.7% for those without. The rate of planned hospitalizations sharply fell at 19 years-of-age among youths with a LTD, whereas the rate of unplanned hospitalizations remained stable.
The 3% of youths with a LTD have ten-fold higher mortality than those without and a high risk of hospitalization. The decrease in the rate of planned hospitalizations at age 19 among youths with a LTD may indicate differences in medical practice after transfer to adult care or a break in medical care.
由于儿童期发病的慢性疾病预后改善，高收入国家青少年中患有严重慢性疾病的人数有所增加。从儿童期到成年期的过渡是一个关键时期，可能与死亡率和发病率增加有关。我们旨在估计法国患有长期疾病（LTD）的青少年的患病率，并评估他们与普通人群相比的死亡率和住院风险。
我们从法国国家健康保险数据库中提取了一个基于人群的队列，其中包括 61119 名在 2005 年至 2014 年期间年满 14 岁的受试者。LTD 由患者的医生诊断，然后由国家健康保险系统的医生确认和登记。我们使用 14 至 21 岁患者的数据评估死亡率和住院率。
在 14 岁的青少年中，3.30%（95%置信区间：3.16-3.44）患有 LTD。他们在 14 至 21 岁之间的死亡率为 20.9/10000 人年（13.7-32.1），而没有 LTD 的青少年为 1.9（1.5-2.5）。在没有 LTD 的青少年中，男性的死亡率高于女性，但在患有 LTD 的青少年中则不然。对于外部原因导致的住院风险，我们发现了类似的模式。患有 LTD 的青少年五年住院概率为 61.8%，而没有 LTD 的青少年为 42.7%。患有 LTD 的青少年的计划住院率在 19 岁时急剧下降，而未计划住院率则保持稳定。
3%患有 LTD 的青少年的死亡率比没有 LTD 的青少年高十倍，住院风险也很高。患有 LTD 的青少年在 19 岁时计划住院率下降可能表明在转入成人护理或中断医疗保健后医疗实践存在差异。
