Vaman Raman Swathy, Valamparampil Mathew J, Dalmita Niya James, Reghukumar Aravind, Anish T S
Scholar, ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India.
Department of Health Services, Kerala, India.
J Family Med Prim Care. 2023 Aug;12(8):1593-1601. doi: 10.4103/jfmpc.jfmpc_2061_22. Epub 2023 Aug 29.
Multimorbidity is the coexistence of two or more chronic medical conditions in a person. The study aims to investigate the immediate cause of death and risk factors of mortality including multimorbidity among patients hospitalized with SARS CoV2 infection in Kasaragod district in Kerala, India.
A record-based case-control study was done using the hospital records and follow-up surveillance system of SARS-COV 2 patients admitted in the Kasaragod district. SARS-COV 2 patients who had expired during the study period from June to December 2020 and reported as COVID-19 deaths (N = 226) were the cases, and an equal number of hospital controls were the study participants.
The mean (SD) age of the cases and controls were found to be 64.6 (14.2) years and 61.5 (13.4) years, respectively. Covid pneumonia alone was reported as the cause of death in more than half (52%) of the study participants. This was followed by cardiovascular events (8.5%) and acute kidney injury (6.5%). Among individual comorbidities among people who expired, diabetes mellitus (53%) was the most common, followed by hypertension (46%) and cardiovascular diseases (23%). More than 50% were found to have multimorbidity. Logistic regression showed chronic kidney disease (CKD) (Adjusted odds ratio (AOR) = 2.18 (1.24-3.83)) and malignancy (AOR = 3.05 (1.27-7.32)) to be significantly associated with mortality as individual determinants. Hypertension-diabetes mellitus [AOR = 1.68 (1.02-2.76), = 0.043] and hypertension-CKD [AOR = 3.49 (1.01-12.01), = 0.48] dyads were multimorbidities significantly associated with mortality.
Combinations of hypertension with diabetes mellitus and CKD were found to be significant determinants for mortality in hospitalized COVID-19 patients. Uniformity in death certification is required to understand the causes and contributors to death in COVID-19.
多病共存是指一个人同时患有两种或更多种慢性疾病。本研究旨在调查印度喀拉拉邦卡萨拉戈德地区因感染新冠病毒住院患者的直接死因以及包括多病共存在内的死亡风险因素。
采用基于记录的病例对照研究，利用卡萨拉戈德地区收治的新冠患者的医院记录和随访监测系统。在2020年6月至12月研究期间死亡并报告为新冠死亡的患者（N = 226）为病例组，数量相等的医院对照为研究参与者。
病例组和对照组的平均（标准差）年龄分别为64.6（14.2）岁和61.5（13.4）岁。超过一半（52%）的研究参与者报告单独的新冠肺炎为死因。其次是心血管事件（8.5%）和急性肾损伤（6.5%）。在死亡患者的个体合并症中，糖尿病（53%）最为常见，其次是高血压（46%）和心血管疾病（23%）。超过50%的患者存在多病共存情况。逻辑回归显示，作为个体决定因素，慢性肾脏病（CKD）（调整优势比（AOR）= 2.18（1.24 - 3.83））和恶性肿瘤（AOR = 3.05（1.27 - 7.32））与死亡率显著相关。高血压 - 糖尿病二元组[AOR = 1.68（1.02 - 2.76），P = 0.043]和高血压 - CKD二元组[AOR = 3.49（1.01 - 12.01），P = 0.048]是与死亡率显著相关的多病共存情况。
高血压与糖尿病以及CKD的组合被发现是新冠住院患者死亡的重要决定因素。需要统一死亡证明以了解新冠死亡的原因和影响因素。
