有和没有脑瘫的成年人的非创伤性骨折的心血管疾病负担。
The cardiovascular disease burden of non-traumatic fractures for adults with and without cerebral palsy.
机构信息
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
出版信息
Bone. 2020 Jul;136:115376. doi: 10.1016/j.bone.2020.115376. Epub 2020 Apr 23.
BACKGROUND
Individuals with cerebral palsy (CP) are vulnerable to non-trauma fracture (NTFx) and have an elevated burden of cardiovascular disease (CVD) related morbidity and mortality. However, very little is known about the contribution of NTFx to CVD risk among adults with CP. The purpose of this study was to determine if NTFx is a risk factor for CVD among adults with CP and if NTFx exacerbates CVD risk compared to adults without CP.
METHODS
Data from 2011 to 2016 Optum Clinformatics® Data Mart and a random 20% sample Medicare fee-for-service were used for this retrospective cohort study. Diagnosis codes were used to identify adults (18+ years) with and without CP, NTFx, incident CVD up to 2 years (i.e., ischemic heart disease, heart failure, cerebrovascular disease), and pre-NTFx comorbidities. Crude incidence rates per 100 person years of CVD measures were estimated. Cox regression estimated hazard ratios (HR and 95% confidence interval [CI]) for CVD measures, comparing: (1) CP and NTFx (CP + NTFx; n = 1012); (2) CP without NTFx (CP w/o NTFx; n = 8345); (3) without CP and with NTFx (w/o CP + NTFx; n = 257,355); and (4) without CP and without NTFx (w/o CP w/o NTFx; n = 4.8 M) after adjusting for demographics and pre-NTFx comorbidities.
RESULTS
The crude incidence rate was elevated for CP + NTFx vs. CP w/o NTFx and w/o CP + NTFx for any CVD and for each CVD subtype. After adjustments, the HR was elevated for CP + NTFx vs. CP w/o NTFx for any CVD (HR = 1.16; 95%CI = 0.98-1.38), heart failure (HR = 1.31; 95%CI = 1.01-1.70), and cerebrovascular disease (HR = 1.23; 95%CI = 0.98-1.55); although, only heart failure was statistically significant. The adjusted HR was elevated for CP + NTFx vs. w/o CP + NTFx for any CVD and for each CVD subtype (all P < .05). Stratified analyses showed a higher CVD risk by NTFx location, <65 year olds, and men when comparing CP + NTFx vs. CP w/o NTFx and w/o CP + NTFx.
CONCLUSIONS
NTFx increases 2-year CVD risk among adults with CP and compared to adults without CP. Findings suggest that NTFx is a risk factor for CVD among adults with CP.
背景
脑瘫（CP）患者易发生非创伤性骨折（NTFx），且心血管疾病（CVD）相关发病率和死亡率较高。然而，我们对 CP 患者中 NTFx 对 CVD 风险的影响知之甚少。本研究旨在确定 NTFx 是否是 CP 成人 CVD 的危险因素，以及与无 CP 的成人相比，NTFx 是否会加剧 CVD 风险。
方法
本回顾性队列研究使用了 2011 年至 2016 年 Optum Clinformatics® Data Mart 和 Medicare 按服务收费的随机 20%样本数据。使用诊断代码来识别患有和不患有 CP、NTFx、2 年内新发 CVD（即缺血性心脏病、心力衰竭、脑血管疾病）以及 NTFx 前合并症的成年人（18 岁以上）。估计每 100 人年 CVD 测量的粗发病率。Cox 回归估计 CVD 测量的风险比（HR 和 95%置信区间[CI]），比较：（1）CP 和 NTFx（CP+NTFx；n=1012）；（2）CP 无 NTFx（CP 无 NTFx；n=8345）；（3）无 CP 且有 NTFx（无 CP+NTFx；n=257355）；以及（4）无 CP 且无 NTFx（无 CP 无 NTFx；n=480 万），调整了人口统计学和 NTFx 前合并症。
结果
CP+NTFx 与 CP 无 NTFx 和无 CP+NTFx 相比，任何 CVD 以及每种 CVD 亚型的粗发病率均升高。调整后，CP+NTFx 与 CP 无 NTFx 相比，任何 CVD（HR=1.16；95%CI=0.98-1.38）、心力衰竭（HR=1.31；95%CI=1.01-1.70）和脑血管疾病（HR=1.23；95%CI=0.98-1.55）的 HR 升高；然而，只有心力衰竭有统计学意义。CP+NTFx 与无 CP+NTFx 相比，CP+NTFx 与任何 CVD 和每种 CVD 亚型的调整 HR 升高（均 P<.05）。分层分析显示，CP+NTFx 与 CP 无 NTFx 和无 CP+NTFx 相比，NTFx 位置、<65 岁和男性的 CVD 风险更高。
结论
NTFx 增加了 CP 成年患者 2 年内 CVD 风险，与无 CP 成年患者相比。结果表明，NTFx 是 CP 成年患者 CVD 的一个危险因素。
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