老年人心肌梗死后入住养老院：一项全国性队列研究。
Nursing home admission after myocardial infarction in the elderly: A nationwide cohort study.
机构信息
Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark.
Aalborg University Hospital, Department of Clinical Epidemiology and Biostatistics, Aalborg, Denmark.
出版信息
PLoS One. 2018 Aug 15;13(8):e0202177. doi: 10.1371/journal.pone.0202177. eCollection 2018.
BACKGROUND
Data on nursing home admission after myocardial infarction (MI) in the elderly are scarce. We investigated nursing home admission within 6 months and 2 years after MI including predictors for nursing home admission in a nationwide cohort of elderly patients.
METHODS
Using Danish nationwide registries, we identified all subjects 65 years or older residing at home who were discharged following first-time MI in the period 2008-2015. We determined sex- and age-stratified incidence rates per 1000 person years (IRs) and incidence rate ratios (IRRs) of nursing home admissions using Poisson regression models compared to the Danish population 65 years or older with no prior MI. Poisson regression models were also applied to identify predictors of nursing home admission.
RESULTS
The 26,539 patients who were discharged after MI had a median age of 76 (quartile 1-quartile 3: 70-83) years. The IRs of nursing home admission after MI increased with increasing age and for 80-84-year-old women IRs after 6 months and 2 years were 113.9 and 62.9, respectively, compared to 29.4 for women of the same age with no prior MI. The IRs for 80-84-year-old men after MI were 56.0 and 36.2, respectively, compared to 24.3 for men of the same age with no prior MI. In adjusted analyses the 6 months and 2 years IRRs for 80-84-year-old subjects were 2.56 (95% CI 2.11-3.10) and 1.41 (95% CI 1.22-1.65) for women and 1.74 (95% CI 1.34-2.25) and 1.05 (95% CI 0.88-1.26) for men, respectively. Predictors were advanced age, dementia, home care, Parkinson's disease, cerebrovascular disease, living alone, depression, and arrhythmia.
CONCLUSION
In elderly patients discharged following first-time MI, the risk of subsequent nursing home admission within 6 months was 2-fold higher compared to an age-stratified population with no prior MI. After 2 years this risk remained higher in women.
背景
关于老年人心肌梗死（MI）后入住养老院的数据很少。我们研究了在全国老年人队列中，MI 后 6 个月和 2 年内入住养老院的情况，包括入住养老院的预测因素。
方法
利用丹麦全国登记处，我们确定了所有在 2008-2015 年期间首次 MI 出院并居住在家中的 65 岁或以上的患者。我们使用泊松回归模型确定了每 1000 人年的性别和年龄分层发病率（IRs）和与无既往 MI 的年龄在 65 岁或以上的丹麦人群相比的发病率比（IRRs）。泊松回归模型也被用于识别入住养老院的预测因素。
结果
26539 名 MI 后出院的患者的中位年龄为 76 岁（四分位距 1-3 分位距：70-83 岁）。MI 后入住养老院的 IR 随着年龄的增加而增加，80-84 岁女性 6 个月和 2 年后的 IR 分别为 113.9 和 62.9，而同期无既往 MI 的同年龄女性的 IR 为 29.4。MI 后 80-84 岁男性的 IR 分别为 56.0 和 36.2，而同期无既往 MI 的同年龄男性的 IR 为 24.3。在调整后的分析中，80-84 岁患者的 6 个月和 2 年 IRR 分别为女性的 2.56（95%CI 2.11-3.10）和 1.41（95%CI 1.22-1.65），男性为 1.74（95%CI 1.34-2.25）和 1.05（95%CI 0.88-1.26）。预测因素为高龄、痴呆、家庭护理、帕金森病、脑血管病、独居、抑郁和心律失常。
结论
在首次 MI 后出院的老年患者中，与年龄分层无既往 MI 的人群相比，6 个月内再次入住养老院的风险增加了 2 倍。2 年后，女性的这一风险仍然较高。
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