下呼吸道感染对老年人医疗保健利用和死亡率的影响：一项基于瑞典人群的队列研究。
Impact of lower-respiratory tract infections on healthcare utilization and mortality in older adults: a Swedish population-based cohort study.
作者信息
Abbadi Ahmad, Gentili Susanna, Tsoumani Eleana, Brandtmüller Agnes, Hendel Merle K, Salomonsson Stina, Calderón-Larrañaga Amaia, Vetrano Davide L
机构信息
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Solna, 171 65, Stockholm, Sweden.
出版信息
Aging Clin Exp Res. 2024 Jul 17;36(1):146. doi: 10.1007/s40520-024-02808-5.
BACKGROUND
Lower respiratory tract infections (LRTIs) have an immediate significant impact on morbidity and mortality among older adults. However, the impact following the infectious period of LRTI remains understudied. We aimed to assess the short- to long-term impact of LRTIs on hospitalization, mortality, and healthcare utilization in older adults.
METHODS
Data from the Swedish National Study of Aging and Care in Kungsholmen (SNAC-K) was analyzed, with data from 2001 to 2019 for mortality and 2001-2016 for healthcare utilization. LRTI-exposed participants were identified and matched with LRTI-nonexposed based on sociodemographics, lifestyle factors, and functional and clinical characteristics. Statistical models evaluated post-LRTI hospitalization risk, days of inpatient hospital admissions, healthcare visits, and mortality.
RESULTS
567 LRTIs-exposed participants during the study period and were matched with 1.701 unexposed individuals. LRTI-exposed individuals exhibited increased risk of hospitalization at 1-year (HR 2.14, CI 1.74, 2.63), 3-years (HR 1.74, CI 1.46, 2.07), and 5-years (HR 1.59, CI 1.33, 1.89). They also experienced longer post-LRTI hospital stays (IRR 1.40, CI 1.18, 1.66), more healthcare visits (IRR 1.47, CI 1.26, 1.71), specialist-care visits (IRR 1.46, CI 1.24, 1.73), and hospital admissions (IRR 1.57, CI 1.34, 1.83) compared to nonexposed participants over 16-years of potential follow-up. Additionally, the 19-year risk of mortality was higher among LRTI-exposed participants (HR 1.45, CI 1.24, 1.70). Men exhibited stronger associations with these risks compared to women.
CONCLUSIONS
LRTIs pose both short- and long-term risks for older adults, including increased risks of mortality, hospitalization, and healthcare visits that transpire beyond the acute infection period, although these effects diminish over time. Men exhibit higher risks across these outcomes compared to women. Given the potential preventability of LRTIs, further public health measures to mitigate infection risk are warranted.
背景
下呼吸道感染（LRTIs）对老年人的发病率和死亡率有直接的重大影响。然而，LRTI感染期后的影响仍未得到充分研究。我们旨在评估LRTIs对老年人住院、死亡率和医疗保健利用的短期至长期影响。
方法
分析了瑞典 Kungsholmen 地区老年与护理国家研究（SNAC-K）的数据，其中2001年至2019年的数据用于死亡率分析，2001 - 2016年的数据用于医疗保健利用分析。根据社会人口统计学、生活方式因素以及功能和临床特征，确定暴露于LRTIs的参与者并与未暴露者进行匹配。统计模型评估LRTI后住院风险、住院天数、医疗就诊次数和死亡率。
结果
在研究期间，567名暴露于LRTIs的参与者与1701名未暴露个体进行了匹配。暴露于LRTIs的个体在1年（HR 2.14，CI 1.74，2.63）、3年（HR 1.74，CI 1.46，2.07）和5年（HR 1.59，CI 1.33，1.89）时住院风险增加。在长达16年的潜在随访期内，与未暴露参与者相比，他们在LRTI后的住院时间更长（IRR 1.40，CI 1.18，1.66），医疗就诊次数更多（IRR 1.47，CI 1.26，1.71），专科护理就诊次数更多（IRR 1.46，CI 1.24，1.73），住院次数更多（IRR 1.57，CI 1.34，1.83）。此外，暴露于LRTIs的参与者19年的死亡风险更高（HR 1.45，CI 1.24，1.70）。与女性相比，男性与这些风险的关联更强。
结论
LRTIs对老年人构成短期和长期风险，包括死亡率、住院率和医疗就诊次数增加，这些风险在急性感染期之后仍会出现，尽管这些影响会随着时间推移而减弱。与女性相比，男性在这些结果方面的风险更高。鉴于LRTIs具有潜在的可预防性，有必要采取进一步的公共卫生措施来降低感染风险。
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