Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
J Neurotrauma. 2021 Jun 1;38(13):1834-1841. doi: 10.1089/neu.2020.7484. Epub 2021 Apr 6.
While chronic neurological effects from concussion have been studied widely, little is known about possible links between concussion and long-term medical and behavioral comorbidities. We performed a retrospective cohort study of 9205 adult patients with concussion, matched to non-concussion controls from a hospital-based electronic medical registry. Patients with comorbidities before the index visit were excluded. Behavioral and medical comorbidities were defined by codes. Groups were followed for up to 10 years to identify comorbidity incidence after a concussion. Cox proportional hazards models were used to calculate associations between concussion and comorbidities after multi-variable adjustment. Patients with concussion were 57% male (median age: 31; interquartile range [IQR] = 23-48 years) at enrollment with a median follow-up time of 6.1 years (IQR = 4.2-9.1) and well-matched to healthy controls. Most (83%) concussions were evaluated in outpatient settings (5% inpatient). During follow-up, we found significantly higher risks of cardiovascular risks developing including hypertension (hazard ratio [HR] = 1.7, 95% confidence interval [CI]: 1.5-1.9), obesity (HR = 1.7, 95% CI: 1.3-2.0), and diabetes mellitus (HR = 1.8, 95% CI: 1.4-2.3) in the concussion group compared with controls. Similarly, psychiatric and neurological disorders such as depression (HR = 3.0, 95% CI: 2.6-3.5), psychosis (HR = 6.0, 95% CI: 4.2-8.6), stroke (HR = 2.1 95% CI: 1.5-2.9), and epilepsy (HR = 4.4, 95% CI: 3.2-5.9) were higher in the concussion group. Most comorbidities developed less than five years post-concussion. The risks for post-concussion comorbidities were also higher in patients under 40 years old compared with controls. Patients with concussion demonstrated an increased risk of development of medical and behavioral health comorbidities. Prospective studies are warranted to better describe the burden of long-term comorbidities in patients with concussion.
虽然人们对脑震荡的慢性神经影响进行了广泛研究，但对于脑震荡与长期的医疗和行为共病之间的可能联系知之甚少。我们对 9205 名成年脑震荡患者进行了回顾性队列研究，并从医院电子病历中匹配了非脑震荡对照组。排除了在指数就诊前有合并症的患者。通过代码定义了行为和医疗合并症。对两组进行了长达 10 年的随访，以确定脑震荡后合并症的发病率。使用 Cox 比例风险模型计算了多变量调整后脑震荡与合并症之间的关联。入组时脑震荡患者中 57%为男性（中位数年龄：31 岁；四分位距 [IQR] = 23-48 岁），中位随访时间为 6.1 年（IQR = 4.2-9.1），与健康对照组匹配良好。大多数（83%）脑震荡是在门诊环境中评估的（5%是住院）。在随访期间，我们发现患有包括高血压（风险比 [HR] = 1.7，95%置信区间 [CI]：1.5-1.9）、肥胖（HR = 1.7，95%CI：1.3-2.0）和糖尿病（HR = 1.8，95%CI：1.4-2.3）在内的心血管风险的发生风险显著高于对照组。同样，精神和神经障碍，如抑郁症（HR = 3.0，95%CI：2.6-3.5）、精神病（HR = 6.0，95%CI：4.2-8.6）、中风（HR = 2.1，95%CI：1.5-2.9）和癫痫（HR = 4.4，95%CI：3.2-5.9）在脑震荡组中也更高。大多数合并症发生在脑震荡后不到 5 年。与对照组相比，40 岁以下的脑震荡患者发生脑震荡后合并症的风险也更高。脑震荡患者表现出发生医疗和行为健康合并症的风险增加。需要前瞻性研究来更好地描述脑震荡患者的长期合并症负担。
