医疗保险受益人残疾、自评健康和死亡率的联合模型——慢性疾病和种族/民族差异。
A Joint Model for Disability, Self-Rated Health, and Mortality Among Medicare Beneficiaries-Differences by Chronic Disease and Race/Ethnicity.
机构信息
Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
OHSU-PSU School of Public Health, Portland, OR, USA.
出版信息
J Aging Health. 2024 Dec;36(10):642-653. doi: 10.1177/08982643231210027. Epub 2023 Oct 25.
OBJECTIVES
Quantifying interdependence in multiple patient-centered outcomes is important for understanding health declines among older adults.
METHODS
Medicare-linked National Health and Aging Trends Study data (2011-2015) were used to estimate a joint longitudinal logistic regression model of disability in activities of daily living (ADL), fair/poor self-rated health (SRH), and mortality. We calculated personalized concurrent risk (PCR) and typical concurrent risk (TCR) using regression coefficients.
RESULTS
For fair/poor SRH, highest odds were associated with COPD. For mortality, highest odds were associated with dementia, hip fracture, and kidney disease. Dementia and hip fracture were associated with highest odds of ADL disability. Hispanic respondents had highest odds of ADL disability. Hispanic and NH Black respondents had higher odds of fair/poor SRH, ADL disability, and mortality. PCRs/TCRs demonstrated wide variability for respondents with similar sociodemographic-multimorbidity profiles.
DISCUSSION
These findings highlight the variability of personalized risk in examining interdependent outcomes among older adults.
目的
量化多个以患者为中心的结局指标之间的相互依存关系，对于了解老年人的健康状况下降至关重要。
方法
使用与医疗保险相关的国家健康老龄化趋势研究（2011-2015 年）数据，估计日常生活活动（ADL）残疾、一般/较差自我报告健康状况（SRH）和死亡率的联合纵向逻辑回归模型。我们使用回归系数计算个性化同期风险（PCR）和典型同期风险（TCR）。
结果
对于一般/较差的 SRH，COPD 与最高的可能性相关。对于死亡率，痴呆症、髋部骨折和肾脏疾病与最高的可能性相关。痴呆症和髋部骨折与 ADL 残疾的最高可能性相关。西班牙裔受访者 ADL 残疾的可能性最高。西班牙裔和非西班牙裔黑人受访者的一般/较差 SRH、ADL 残疾和死亡率的可能性更高。PCR/TCR 显示，具有相似社会人口统计学-多疾病谱的受访者存在很大的变异性。
讨论
这些发现强调了在检查老年人相互依存的结果时，个性化风险的变异性。
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