Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China; Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China.
Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China; Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China.
J Am Med Dir Assoc. 2021 Sep;22(9):1819-1824. doi: 10.1016/j.jamda.2021.01.082. Epub 2021 Mar 2.
OBJECTIVES: Frailty, a multidimensional syndrome characterized by vulnerability to stressors, is an emerging public health priority with high prevalence in older adults. Frailty has been identified to predictive negative health outcomes, yet quantified evidence regarding its effect on health care systems is scarce. This study examines how frailty affects health care utilization, and explores whether these associations varied by gender. DESIGN: Cohort study with a 2-year follow-up. SETTING: and Participants: Data were derived from 2 waves (2011 and 2013) of the China Health and Retirement Longitudinal Study, and 3119 community-dwelling participants aged ≥60 years were analyzed. METHODS: Frailty was assessed by a validated frailty phenotype scale, and measures for health care utilization were self-reported. Panel data approach of mixed-effects regression models was used to examine the associations. RESULTS: Longitudinal results demonstrated that compared with robustness, prefrailty and frailty were both significantly associated with increased likelihood of outpatient visit, inpatient visit, and inpatient length of stay, even after adjusting for multimorbidity in multivariate analyses (all P < .05). Every 1-component increase in frailty was also found to significantly increase the risk for health care utilization [any outpatient visit: adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 1.14-1.48; number of outpatient visits: adjusted incident rate ratio (IRR) 1.34, 95% CI 1.18-1.53; any inpatient visit: adjusted OR 1.44, 95% CI 1.22-1.71; number of inpatient visits: adjusted IRR 1.40, 95% CI 1.20-1.62; inpatient length of stay: adjusted IRR 1.50, 95% CI 1.18-1.92]. The preceding associations were similarly observed irrespective of gender. CONCLUSIONS AND IMPLICATIONS: Frailty is a significant predictor for increased health care utilization among community-dwelling older adults. These findings have important implications for routine clinical practice and public health investment. Early screening and intervention for potentially modifiable frailty could translate into considerable savings for households and health care systems.
目的：衰弱是一种多维度的综合征，其特征是易受压力源影响，是老年人中一个新出现的公共卫生重点。衰弱已被确定为负面健康结果的预测因素，但关于其对医疗保健系统影响的量化证据却很少。本研究考察了衰弱如何影响医疗保健的利用，并探讨了这些关联是否因性别而异。
设计：具有 2 年随访的队列研究。
地点和参与者：数据来自中国健康与退休纵向研究的 2 个波次（2011 年和 2013 年），共分析了 3119 名居住在社区的 60 岁及以上参与者。
方法：使用经过验证的衰弱表型量表评估衰弱，医疗保健利用的测量指标为自我报告。采用混合效应回归模型的面板数据方法来检验相关性。
结果：纵向结果表明，与稳健性相比，衰弱前期和衰弱均与门诊就诊、住院就诊和住院住院时间延长的可能性增加显著相关，即使在多因素分析中调整了多种合并症（所有 P 值均<.05）。还发现，每增加一个衰弱成分，都会显著增加医疗保健利用的风险[任何门诊就诊：调整后的优势比（OR）1.30，95%置信区间（CI）1.14-1.48；门诊就诊次数：调整后的发病率比（IRR）1.34，95%CI 1.18-1.53；任何住院就诊：调整后的 OR 1.44，95%CI 1.22-1.71；住院就诊次数：调整后的 IRR 1.40，95%CI 1.20-1.62；住院住院时间：调整后的 IRR 1.50，95%CI 1.18-1.92]。无论性别如何，这些关联均相似。
结论和意义：衰弱是社区居住的老年人中医疗保健利用率增加的重要预测因素。这些发现对常规临床实践和公共卫生投资具有重要意义。对潜在可改变的衰弱进行早期筛查和干预可以为家庭和医疗保健系统节省大量费用。
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