肥胖与住院脑瘫患者结局的关联。

Association of Obesity on Outcomes of Hospitalized Patients with Cerebral Palsy.

机构信息

From the Department of General Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.

出版信息

South Med J. 2021 Dec;114(12):772-776. doi: 10.14423/SMJ.0000000000001328.

DOI:10.14423/SMJ.0000000000001328

PMID:34853853

Abstract

OBJECTIVE

Among hospitalized adults with cerebral palsy (CP), it is unknown whether obesity is associated with clinical and resource utilization outcomes. We sought to identify the association of obesity on clinical and resource utilization outcomes in this population.

METHODS

This retrospective cohort study analyzed years 2016 and 2017 of the Nationwide Inpatient Sample database and examined hospitalized adults with CP. Regression analyses were used to evaluate mortality and resource utilization.

RESULTS

In total, 154,219 adults with CP were hospitalized. Among them, 13,475 (8.7%) had a secondary diagnosis for obesity. Patients with obesity were older (mean age ± standard error of the mean: 49.9 ± 0.18 versus 44.7 ± 0.18 years, < 0.01), a greater proportion were female (60.7% vs 43.2%, < 0.01), and were more likely to be insured by Medicare (65.2% vs 56.2%, < 0.01). Patients with obesity had higher comorbidity burdens (Charlson comorbidity score ≥ 3: 22.3% vs 9.8%, < 0.01). Those with obesity had lower mortality rates (1.6% vs 2.4%; < 0.01). After adjustment for confounders, mortality for patients with obesity remained lower (adjusted odds ratio 0.5, 95% confidence interval [CI] 0.4-0.7, < 0.01). Hospital charges (adjusted mean difference $2499, 95% CI $6202-$1202, 0.18) and length of stay (adjusted mean difference 0.01 days; 95% CI -0.28 to 0.31, 0.93) were not significantly different between the groups.

CONCLUSIONS

Obesity was associated with reduced mortality among adult patients in the hospital who had CP. This finding is consistent with the obesity paradox that has been observed repeatedly in patients with other chronic diseases. Further studies investigating hospitalized patients with CP are needed to corroborate these findings.

摘要

目的

在患有脑瘫（CP）的住院成人中，肥胖是否与临床和资源利用结果相关尚不清楚。我们旨在确定该人群中肥胖对临床和资源利用结果的影响。

方法

本回顾性队列研究分析了 2016 年和 2017 年全国住院患者样本数据库中患有 CP 的住院成人，并使用回归分析评估了死亡率和资源利用情况。

结果

共有 154219 名 CP 成人住院患者，其中 13475 人（8.7%）有肥胖的次要诊断。肥胖患者年龄较大（平均年龄±标准误差：49.9±0.18 岁 vs. 44.7±0.18 岁，<0.01），女性比例更高（60.7% vs. 43.2%，<0.01），且更有可能由医疗保险（Medicare）承保（65.2% vs. 56.2%，<0.01）。肥胖患者的合并症负担更重（Charlson 合并症评分≥3：22.3% vs. 9.8%，<0.01）。肥胖患者的死亡率较低（1.6% vs. 2.4%；<0.01）。在调整混杂因素后，肥胖患者的死亡率仍然较低（调整后的优势比 0.5，95%置信区间[CI] 0.4-0.7，<0.01）。住院费用（调整后的平均差异为 2499 美元，95%CI 6202-1202 美元，0.18）和住院时间（调整后的平均差异 0.01 天；95%CI -0.28 至 0.31，0.93）在两组之间无显著差异。