Department of Epidemiology, University Hospital of Toulouse, Toulouse, France.
UMR1027 Epidemiology and Analyses in Public Health, INSERM, Toulouse, France.
Eur J Neurol. 2020 Aug;27(8):1436-1447. doi: 10.1111/ene.14256. Epub 2020 May 19.
To study the association between Alzheimer's disease and related syndromes (ADRS) and the incidence of short-stay hospitalizations from the year before (Y ) to 4 years after (Y -Y ) ADRS identification in the healthcare system.
Among all beneficiaries of the French health insurance general scheme aged 40 years or more, those with an incident ADRS in 2011, identified through long-term disease registry, hospitalization diagnoses or ADRS-specific drug delivery, were matched with beneficiaries without ADRS of the same age, gender and residence area. The annual incidence rates of all-cause hospitalizations (excluding those with a diagnosis code of ADRS) were compared between individuals with or without ADRS using incidence ratios (IRs) globally and by age, gender, deprivation index and modified Charlson score. We also studied cause-specific hospitalizations using patients' diagnoses and procedure codes.
A total of 90 871 subjects with and 90 871 subjects without ADRS were included (mean age 79.6 years, 66% females). From Y to Y , incidence rates were significantly higher in subjects with ADRS than in those without for all-cause hospitalization [IR(Y ) = 1.73; 95% confidence intervals, 1.71-1.75; IR(Y ) = 1.37; 95% confidence intervals, 1.35-1.39], hospitalizations for social reasons [IR(Y ) = 4.28; IR(Y ) = 2.70], fall [IR(Y ) = 5.36; IR(Y ) = 2.59], injury [IR(Y ) = 2.71; IR(Y ) = 2.09] and infection [IR(Y ) = 2.04; IR(Y ) = 2.07]. The inverse was observed for hospitalizations for cataract surgery [IR(Y )=0.73; IR(Y ) = 0.51] or total hip prosthesis after 2 years [IR(Y ) = 0.72].
Incident ADRS cases were associated with a higher incidence of hospitalization, but these subjects underwent some common non-emergency surgeries less frequently. Future studies need to assess the clinical impact of these differences.
本研究旨在探讨阿尔茨海默病及相关综合征（ADRS）与医疗系统中 ADRS 确诊前一年（Y 年）至确诊后 4 年（Y - Y 年）内短期住院之间的关联性。
在所有符合条件的法国全民健康保险计划的 40 岁及以上受益人群中，通过长期疾病登记、住院诊断或 ADRS 特定药物治疗来识别出新发 ADRS 病例，将其与同年龄、同性别、同居住地区且无 ADRS 的受益人群相匹配。通过发病率比值（IR）对比个体有或无 ADRS 时全因住院（不包括 ADRS 诊断编码的住院）的年度发病率，该比值在总体和按年龄、性别、剥夺指数和改良 Charlson 评分进行分层后进行比较。此外，我们还根据患者的诊断和治疗代码研究了特定病因的住院情况。
共纳入 90871 例 ADRS 患者和 90871 例无 ADRS 患者（平均年龄 79.6 岁，66%为女性）。从 Y 年到 Y - Y 年，ADRS 患者的全因住院（IR(Y )=1.73；95%置信区间，1.71-1.75；IR(Y )=1.37；95%置信区间，1.35-1.39）、社会原因住院（IR(Y )=4.28；IR(Y )=2.70）、跌倒（IR(Y )=5.36；IR(Y )=2.59）、损伤（IR(Y )=2.71；IR(Y )=2.09）和感染（IR(Y )=2.04；IR(Y )=2.07）的发病率显著高于无 ADRS 患者。而两年后全髋关节置换术（IR(Y )=0.72）或白内障手术（IR(Y )=0.73）的住院率则相反。
新发 ADRS 与更高的住院率相关，但这些患者较少接受某些常见的非紧急手术。未来的研究需要评估这些差异的临床影响。
