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胃轻瘫的流行病学、病因学和治疗:来自美国大型国家索赔数据库的真实世界证据。

Epidemiology, Etiology, and Treatment of Gastroparesis: Real-World Evidence From a Large US National Claims Database.

机构信息

Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, Massachusetts.

Safety and Health Value Statistics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts.

出版信息

Gastroenterology. 2022 Jan;162(1):109-121.e5. doi: 10.1053/j.gastro.2021.09.064. Epub 2021 Oct 6.

Abstract

BACKGROUND & AIMS: Although gastroparesis carries a considerable health care and patient burden, associated epidemiological data are limited. To provide new real-world evidence for gastroparesis, we estimated disease prevalence, and investigated patient demographics and disease etiology in a large US claims database.

METHODS

This retrospective, cross-sectional analysis used de-identified, longitudinal patient-level enrollment and billing data for adults from the Optum Clinformatics Data Mart database, a large US national administrative health insurance claims database. Prevalence was age-, sex-, and geographical region-standardized using the 2018 US census. Descriptive analyses of demographic and clinical variables and underlying disease etiologies were performed.

RESULTS

The overall standardized prevalence of gastroparesis was 267.7 (95% confidence interval [CI] 264.8-270.7) per 100,000 US adults, whereas prevalence of "definite" gastroparesis (individuals diagnosed within 3 months of gastric emptying scintigraphy testing with persistent symptoms for more than 3 months) was 21.5 (95% CI 20.6-22.4) per 100,000 persons. Patients with gastroparesis had an overall Charlson Comorbidity Index score of 4.2, indicating substantial comorbidity burden. The most frequently documented comorbidities were chronic pulmonary disease (46.4%), diabetes with chronic complication (37.3%), and peripheral vascular disease (30.4%). Patients most commonly had a diabetic etiology (57.4%; type 1, 5.7% and type 2, 51.7%), followed by postsurgical (15.0%), drug-induced (11.8%), and idiopathic (11.3%) etiologies.

CONCLUSIONS

New evidence is provided regarding the prevalence, patient demographics, and etiology of gastroparesis in the US general population. Wider availability of reliable objective gastric emptying measures and further education of medical professionals in recognizing and diagnosing gastroparesis would benefit future studies and improve understanding of disease epidemiology.

摘要

背景与目的

尽管胃轻瘫给医疗保健和患者带来了相当大的负担,但相关的流行病学数据有限。为了为胃轻瘫提供新的真实世界证据,我们使用大型美国索赔数据库估算了疾病的患病率,并调查了患者的人口统计学特征和疾病病因。

方法

本回顾性、横断面分析使用来自 Optum Clinformatics Data Mart 数据库的成年人匿名、纵向患者水平登记和计费数据,该数据库是一个大型的美国国家行政健康保险索赔数据库。使用 2018 年美国人口普查对年龄、性别和地理区域进行标准化。对人口统计学和临床变量以及潜在疾病病因进行描述性分析。

结果

在美国成年人中,胃轻瘫的总体标准化患病率为 267.7(95%置信区间[CI] 264.8-270.7)/100000 人,而“明确”胃轻瘫(在胃排空闪烁成像测试后 3 个月内诊断为在 3 个月以上持续出现症状的个体)的患病率为 21.5(95%CI 20.6-22.4)/100000 人。患有胃轻瘫的患者总体Charlson 合并症指数评分为 4.2,表明存在严重的合并症负担。最常记录的合并症为慢性肺部疾病(46.4%)、糖尿病伴慢性并发症(37.3%)和外周血管疾病(30.4%)。患者最常见的病因是糖尿病(57.4%;1 型,5.7%,2 型,51.7%),其次是手术后(15.0%)、药物诱导(11.8%)和特发性(11.3%)。

结论

本研究提供了美国普通人群中胃轻瘫的患病率、患者人口统计学特征和病因的新证据。更广泛地提供可靠的客观胃排空测量方法,并进一步教育医疗保健专业人员识别和诊断胃轻瘫,将有益于未来的研究并提高对疾病流行病学的理解。

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