Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, Calif.
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol Pract. 2021 Jul;9(7):2831-2843.e8. doi: 10.1016/j.jaip.2021.03.032. Epub 2021 Mar 30.
The US older adult population (age ≥65 years) is increasing and may be at increased risk for severe anaphylaxis. Little is known about the health care use for acute allergic reactions (AAR), including anaphylaxis, among older adults.
To characterize trends in emergency department (ED) visits and hospitalizations for AAR and anaphylaxis among US older adults from 2006 to 2014 and examine factors associated with severe anaphylaxis.
We performed cross-sectional analyses of trends in ED visits and hospitalizations among older adults using data from the Nationwide Emergency Department Sample and the National (Nationwide) Inpatient Sample in 2006 to 2014. We used International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes to identify visits for AAR, including anaphylaxis. Multivariable logistic regression modeling was used to identify factors associated with severe anaphylaxis (cardiac arrest, intubation, and death).
In 2006 to 2014, older adults experienced approximately 1,019,967 AAR-related ED visits, 173,844 AAR-related hospitalizations, 93,795 anaphylaxis-related ED visits, and 72,677 anaphylaxis-related hospitalizations. Whereas AAR-related ED visit and hospitalization rates remained stable (P = .28 and .16, respectively), anaphylaxis-related ED visit and hospitalization rates increased significantly over time (37 visits/100,000 in 2006 to 51 in 2014, P < .001; and from 13 hospitalizations/100,000 in 2006 to 23 in 2014, P < .001), especially hospitalization rates for drug-related anaphylaxis (47 hospitalizations/100,000 in 2006 to 85 in 2014; P < .001). Risk factors for anaphylaxis-related death included older age and drug-related trigger.
In a nationally representative sample of US older adults, the rate of anaphylaxis-related ED visits and hospitalizations increased over time. Drug-related triggers represented a substantial portion of increased health care use and are a growing risk in this vulnerable population.
美国老年人口（年龄≥65 岁）不断增加，他们可能面临更严重过敏反应（包括过敏反应）的风险。关于老年人急性过敏反应（AAR），包括过敏反应，在急诊室（ED）就诊和住院的情况知之甚少。
本研究旨在描述 2006 年至 2014 年期间，美国老年人群中 ED 就诊和住院治疗的急性过敏反应（AAR）和过敏反应的趋势，并探讨与严重过敏反应相关的因素。
我们使用 2006 年至 2014 年全国急诊部样本（Nationwide Emergency Department Sample）和全国（全国）住院患者样本（National Inpatient Sample）的数据，进行了老年人群中 ED 就诊和住院趋势的横断面分析。我们使用国际疾病分类，第九版，临床修正诊断代码来识别包括过敏反应在内的 AAR 就诊。采用多变量逻辑回归模型确定与严重过敏反应（心脏骤停、插管和死亡）相关的因素。
在 2006 年至 2014 年期间，老年人经历了约 1019967 例 AAR 相关 ED 就诊、173844 例 AAR 相关住院、93795 例过敏反应相关 ED 就诊和 72677 例过敏反应相关住院。尽管 AAR 相关 ED 就诊和住院率保持稳定（P=.28 和 P=.16），但过敏反应相关 ED 就诊和住院率随时间显著增加（2006 年为 37 例/100000 人，2014 年为 51 例/100000 人，P<0.001；2006 年为 13 例/100000 人，2014 年为 23 例/100000 人，P<0.001），特别是药物相关过敏反应的住院率（2006 年为 47 例/100000 人，2014 年为 85 例/100000 人，P<0.001）。过敏反应相关死亡的危险因素包括年龄较大和药物相关诱因。
在具有全国代表性的美国老年人群样本中，过敏反应相关 ED 就诊和住院率随时间呈上升趋势。药物相关诱因代表了卫生保健利用增加的一个重要部分，并且是这一脆弱人群中不断增长的风险。
