Health Technology Assessment Agency, Carlos III Health Institute, Madrid, Spain.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Age Ageing. 2021 Sep 11;50(5):1607-1615. doi: 10.1093/ageing/afab023.
Critical care demand for older people is increasing. However, there is scarce population-based information about the use of life-support measures such as invasive mechanical ventilation (IMV) in this population segment.
To examine the characteristics and recent trends of IMV for older adults.
Retrospective cohort study on IMV in adults ≥65 years using the 2004-15 Spanish national hospital discharge database. Primary outcomes were incidence, inhospital mortality and resource utilization. Trends were assessed for average annual percentage change in rates using joinpoint regression models.
233,038 cases were identified representing 1.27% of all-cause hospitalizations and a crude incidence of 248 cases/100,000 older adult population. Mean age was 75 years, 62% were men and 70% had comorbidities. Inhospital mortality was 48%. Across all ages, about 80% of survivors were discharged home. Incidence rates of IMV remained roughly unchanged over time with an average annual change of -0.2% (95% confidence interval (CI): -0.9, 0.6). Inhospital mortality decreased an annual average of -0.7% (95% CI: -0.5, -1.0), a trend detected across age groups and most clinical strata. Further, there was a 3.4% (95% CI: 3.0, 3.8) annual increase in the proportion of adults aged ≥80 years, an age group that showed higher mortality risk, lower frequency of prolonged IMV, shorter hospital stays and lower costs.
Overall rates of IMV remained roughly stable among older adults, while inhospital mortality showed a decreasing trend. There was a notable increase in adults aged ≥80 years, a group with high mortality and lower associated hospital resource use.
对老年人的重症监护需求正在增加。然而，关于这一人群使用生命支持措施（如有创机械通气[IMV]）的基于人群的信息却很少。
研究老年人使用 IMV 的特征和近期趋势。
使用 2004 年至 2015 年西班牙全国医院出院数据库，对年龄≥65 岁的成年人进行回顾性队列研究，分析 IMV。主要结局为发病率、住院死亡率和资源利用。使用 Joinpoint 回归模型评估各年龄段的平均年变化百分比。
共确定 233038 例病例，占所有因病因住院的 1.27%，老年人发病率为 248 例/10 万。平均年龄为 75 岁，62%为男性，70%有合并症。住院死亡率为 48%。在所有年龄段，约 80%的幸存者出院回家。IMV 的发病率基本保持不变，平均年变化率为-0.2%（95%置信区间[CI]：-0.9，0.6）。住院死亡率平均每年下降 0.7%（95% CI：-0.5，-1.0），这一趋势在各年龄组和大多数临床亚组中都有体现。此外，年龄≥80 岁的成年人比例每年增加 3.4%（95% CI：3.0，3.8），这一年龄组死亡率较高，接受长期 IMV 的频率较低，住院时间较短，费用较低。
老年人的 IMV 总体发病率基本保持稳定，而住院死亡率呈下降趋势。年龄≥80 岁的成年人显著增加，这一年龄组死亡率较高，与住院相关的资源使用量较低。
