中国多中心横断面研究：多种慢性病合并社会隔离与老年脑卒中患者功能障碍的相关性。
Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China.
机构信息
Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, 518035, Shenzhen, China.
Shenzhen Dapeng New District Nan'ao People's Hospital, 518121, Shenzhen, China.
出版信息
BMC Geriatr. 2021 Sep 16;21(1):495. doi: 10.1186/s12877-021-02439-9.
BACKGROUND
Multiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients.
METHODS
A multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60-90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability.
RESULTS
A total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89-64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89-64.69) for moderate disability than those without social isolation and MCDs.
CONCLUSIONS
MCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs.
TRIAL REGISTRATION
NO: ChiCTR2000034067 .
背景
多种慢性疾病（MCDs）和社会隔离是与中风和残疾相关的独立风险因素，但尚不清楚这两种情况的组合是否是由于与中风患者相关的与年龄相关的功能障碍引起的。本研究旨在探讨老年中风患者中 MCDs、社会隔离与功能障碍之间的关系。
方法
在中国 23 个城市的 103 家医院的康复科进行了一项多中心、横断面研究。选择年龄在 60-90 岁的中风患者进行分析。通过问卷和病历调查了人口统计学特征、生活方式和临床信息。MCDs（高血压/糖尿病/高脂血症/心脏病/肾病）分为三个级别：0、1 和≥2。功能障碍通过 Barthel 指数评估，并分为四个组别：无、轻度、中度和重度残疾。采用多分类逻辑回归模型探讨 MCDs 和社会隔离与功能障碍的独立和联合关联。
结果
共纳入 4046 名老年中风患者（55%为男性）进行最终分析。社会隔离、MCDs≥2 和重度残疾的患病率随年龄增长而增加。在完全调整的模型中，有社会隔离或 MCDs 的患者发生功能障碍的风险明显高于没有的患者。与没有社会隔离和 MCDs 的患者相比，有社会隔离且 MCDs≥2 的患者中风后发生重度残疾的风险高 35 倍（95%CI：18.89-64.69），中度残疾的风险高 8 倍（95%CI：18.89-64.69）。
结论
MCDs、社会隔离及其组合与中国老年中风患者的功能障碍风险增加相关。应鼓励老年人群更多地参与社会活动，特别是患有 MCDs 的人群。未来针对老年中风患者功能能力的二级预防和康复治疗应强调社会活动和 MCDs 的联合治疗。
试验注册
NO：ChiCTR2000034067。
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