从中年后期到老年的脆弱及其与医疗影像学使用和影像学相关费用的关系：一项纵向研究。
Frailty in Late Midlife to Old Age and Its Relationship to Medical Imaging Use and Imaging-related Costs: A Longitudinal Study.
机构信息
From the Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland (O.A.); Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (O.A.); Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Folkhälsan Research Center, Helsinki, Finland (J.N.I., J.G.E., M.J.H.); Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland (J.N.I., E.K.); Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland (E.K.); Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway (E.K.); Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.G.E.); Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore (J.G.E.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (M.J.H.).
出版信息
Radiology. 2023 Nov;309(2):e230283. doi: 10.1148/radiol.230283.
Background Frailty, defined as an increased vulnerability to and impaired recovery from stressors, is common in individuals in late midlife to old age. While frailty predisposes individuals to adverse health outcomes and increased health care utilization, how it impacts imaging service use and related costs remains unclear. Purpose To determine whether frailty is associated with greater use of imaging services and higher imaging-related costs. Materials and Methods This longitudinal study included a subset of participants from the Helsinki Birth Cohort Study who were clinically assessed up to three times from late midlife to old age between August 2001 and September 2018. A frailty index (FI) based on 41 variables was calculated, and an FI of 0.25 or more indicated frailty. Associations of baseline frailty and its rate of change during the study with medical imaging service use and imaging-related costs were assessed using covariate-adjusted negative binomial and other generalized linear models. Results Of the 1995 participants (mean age, 61.5 years ± 2.9 [SD]; 1074 female participants) included in this study, 569 (28.5%) were identified as frail at baseline, and these participants underwent 10 677 (42.4%) of the 25 172 medical imaging examinations among the participants. Compared to participants who were not frail at baseline, participants who were frail at baseline showed increased use of all imaging modalities (incidence rate ratio [IRR], 2.28 [95% CI: 1.97, 2.64]; < .001) and higher imaging costs (log annual cost, 3.26 [95% CI: 2.36, 4.50]; < .001). Compared to participants with stable or slow change in frailty (<0.0010 FI units per year), participants with a rapid increase in frailty (>0.0064 FI units per year) from late midlife to old age showed greater use of all medical imaging services, independent of FI at baseline (IRR, 1.82 [95% CI: 1.53, 2.17]; < .001) and had higher imaging costs (log annual cost, 1.62 [95% CI: 1.30, 2.01)]; < .001). Conclusion The presence of frailty and its progression rate are associated with increased use of imaging services and higher imaging-related costs. © RSNA, 2023
背景 衰弱是指个体对压力源的易感性增加和恢复能力受损，常见于中老年人群。尽管衰弱使个体更容易出现不良健康后果和增加医疗保健利用，但衰弱对影像服务利用和相关成本的影响尚不清楚。目的 确定衰弱是否与更多的影像学检查服务利用和更高的影像学相关成本相关。材料与方法 本纵向研究纳入了赫尔辛基出生队列研究的一部分参与者，他们在 2001 年 8 月至 2018 年 9 月期间从中年后期到老年接受了多达 3 次临床评估。根据 41 个变量计算衰弱指数（FI），FI 达到或超过 0.25 表示衰弱。使用协变量调整的负二项式和其他广义线性模型评估基线时的衰弱及其在研究期间的变化率与医学影像学服务利用和影像学相关成本的关系。结果 在这项研究中，纳入了 1995 名参与者（平均年龄 61.5 岁±2.9[标准差]；1074 名女性参与者），其中 569 名（28.5%）在基线时被确定为衰弱，这些参与者接受了 25172 次影像学检查中的 10677 次（参与者中的 42.4%）。与基线时不衰弱的参与者相比，基线时衰弱的参与者所有影像学模式的利用增加（发病率比[IRR]，2.28[95%置信区间：1.97，2.64]；<0.001），影像学相关成本更高（每年对数成本，3.26[95%置信区间：2.36，4.50]；<0.001）。与从中年后期到老年时衰弱稳定或缓慢变化（<0.0010 FI 单位/年）的参与者相比，衰弱快速增加（>0.0064 FI 单位/年）的参与者，无论基线时的 FI 如何，所有医学影像学服务的利用都更大（发病率比，1.82[95%置信区间：1.53，2.17]；<0.001），影像学相关成本更高（每年对数成本，1.62[95%置信区间：1.30，2.01]；<0.001）。结论 衰弱的存在及其进展速度与影像学服务的利用增加和影像学相关成本的增加相关。©RSNA，2023
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