Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Diabetes Obes Metab. 2023 Feb;25(2):454-467. doi: 10.1111/dom.14889. Epub 2022 Nov 2.
To evaluate the association between the number of co-morbidities, all-cause mortality and public health system expenditure in patients with type 2 diabetes (T2D) across different age groups.
A retrospective observational study of T2D patients using electronic health records in Hong Kong was conducted. Patients were stratified by age (< 50, 50-64, 65-79, ≥ 80 years) and the number of co-morbidities (0, 1, 2, 3, ≥ 4), defined using the Charlson Comorbidity Index and prevalent chronic diseases identified in local surveys. The association between the number of co-morbidities, all-cause mortality and direct medical costs was examined using Cox proportional hazard regression and the gamma generalized linear model with log link function.
A total of 262 212 T2D patients with a median follow-up of 10 years were included. Hypertension and dyslipidaemia were the most common co-morbidities in all age groups. After age stratification, cardiovascular diseases dominated the top pair of co-morbidities in the older age groups (65-79 and ≥ 80 years), while inflammatory and liver disease were predominant among younger individuals. Compared with co-morbidity-free T2D patients, the hazard ratios (95% CI) of death for patients aged younger than 50 and 80 years or older with two co-morbidities were 1.31 (1.08-1.59) and 1.25 (1.15-1.36), respectively, and increased to 3.08 (2.25-4.21) and 1.98 (1.82-2.16), respectively, as the number of co-morbidities increased to four or more. Similar trends were observed for medical costs.
Age-specific co-morbidity patterns were observed for patients with T2D. A greater number of co-morbidities was associated with increased mortality and healthcare costs, with stronger relationships observed among younger patients.
评估 2 型糖尿病（T2D）患者共病数量、全因死亡率与公共卫生系统支出之间的关系，并按不同年龄组进行分析。
本研究为香港电子健康记录的 T2D 患者回顾性观察研究。患者按年龄（<50、50-64、65-79、≥80 岁）和共病数量（0、1、2、3、≥4）分层，使用 Charlson 共病指数和当地调查中确定的常见慢性病进行定义。使用 Cox 比例风险回归和对数链接函数的伽马广义线性模型来检验共病数量、全因死亡率与直接医疗费用之间的关联。
共纳入 262212 例 T2D 患者，中位随访时间为 10 年。高血压和血脂异常是所有年龄组最常见的共病。按年龄分层后，心血管疾病在年龄较大的年龄组（65-79 岁和≥80 岁）中占主要共病对，而炎症性和肝脏疾病在较年轻的患者中更为常见。与无共病的 T2D 患者相比，共病数量为 2 种的 50 岁以下和 80 岁及以上患者的死亡风险比（95%CI）分别为 1.31（1.08-1.59）和 1.25（1.15-1.36），当共病数量增加至 4 种或更多时，分别增加至 3.08（2.25-4.21）和 1.98（1.82-2.16）。医疗费用也呈现出类似的趋势。
T2D 患者存在特定年龄的共病模式。共病数量越多，死亡率和医疗保健费用越高，在年轻患者中相关性更强。
