患有心力衰竭、慢性肾脏病和 2 型糖尿病等多种疾病的个体的风险因素、结局和医疗保健利用情况：一项全国性电子健康记录研究。
Risk factors, outcomes and healthcare utilisation in individuals with multimorbidity including heart failure, chronic kidney disease and type 2 diabetes mellitus: a national electronic health record study.
机构信息
Institute of Health Informatics, University College London, London, UK.
Department of Cardiology, Barts Heart Centre, London, UK.
出版信息
Open Heart. 2023 Sep;10(2). doi: 10.1136/openhrt-2023-002332.
BACKGROUND
Heart failure (HF), type 2 diabetes (T2D) and chronic kidney disease (CKD) commonly coexist. We studied characteristics, prognosis and healthcare utilisation of individuals with two of these conditions.
METHODS
We performed a retrospective, population-based linked electronic health records study from 1998 to 2020 in England to identify individuals diagnosed with two of: HF, T2D or CKD. We described cohort characteristics at time of second diagnosis and estimated risk of developing the third condition and mortality using Kaplan-Meier and Cox regression models. We also estimated rates of healthcare utilisation in primary care and hospital settings in follow-up.
FINDINGS
We identified cohorts of 64 226 with CKD and HF, 82 431 with CKD and T2D, and 13 872 with HF and T2D. Compared with CKD and T2D, those with CKD and HF and HF and T2D had more severe risk factor profile. At 5 years, incidence of the third condition and all-cause mortality occurred in 37% (95% CI: 35.9%, 38.1%%) and 31.3% (30.4%, 32.3%) in HF+T2D, 8.7% (8.4%, 9.0%) and 51.6% (51.1%, 52.1%) in HF+CKD, and 6.8% (6.6%, 7.0%) and 17.9% (17.6%, 18.2%) in CKD+T2D, respectively. In each of the three multimorbid groups, the order of the first two diagnoses was also associated with prognosis. In multivariable analyses, we identified risk factors for developing the third condition and mortality, such as age, sex, medical history and the order of disease diagnosis. Inpatient and outpatient healthcare utilisation rates were highest in CKD and HF, and lowest in CKD and T2D.
INTERPRETATION
HF, CKD and T2D carry significant mortality and healthcare burden in combination. Compared with other disease pairs, individuals with CKD and HF had the most severe risk factor profile, prognosis and healthcare utilisation. Service planning, policy and prevention must take into account and monitor data across conditions.
背景
心力衰竭（HF）、2 型糖尿病（T2D）和慢性肾脏病（CKD）通常并存。我们研究了同时患有其中两种疾病的个体的特征、预后和医疗保健利用情况。
方法
我们在英格兰进行了一项回顾性、基于人群的电子健康记录研究，从 1998 年到 2020 年，以确定同时诊断为 HF、T2D 或 CKD 的个体。我们在第二次诊断时描述了队列特征，并使用 Kaplan-Meier 和 Cox 回归模型估计了发展第三种疾病和死亡的风险。我们还估计了随访中初级保健和医院环境中的医疗保健利用率。
结果
我们确定了 CKD 和 HF 队列 64226 例、CKD 和 T2D 队列 82431 例和 HF 和 T2D 队列 13872 例。与 CKD 和 T2D 相比，CKD 和 HF 以及 HF 和 T2D 患者的风险因素谱更为严重。在 5 年内，HF+T2D 组中第三种疾病的发生率和全因死亡率分别为 37%（95%CI：35.9%，38.1%）和 31.3%（30.4%，32.3%），HF+CKD 组分别为 8.7%（8.4%，9.0%）和 51.6%（51.1%，52.1%），CKD+T2D 组分别为 6.8%（6.6%，7.0%）和 17.9%（17.6%，18.2%）。在这三个多病种组中，前两种诊断的顺序也与预后相关。在多变量分析中，我们确定了发展第三种疾病和死亡的风险因素，如年龄、性别、病史和疾病诊断顺序。住院和门诊医疗保健利用率在 CKD 和 HF 中最高，在 CKD 和 T2D 中最低。
解释
HF、CKD 和 T2D 结合在一起会带来严重的死亡率和医疗保健负担。与其他疾病组合相比，CKD 和 HF 患者的风险因素谱、预后和医疗保健利用率最为严重。服务规划、政策和预防必须考虑并监测各种疾病的数据。
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