多种共病簇在分层老年人骨折风险方面可能优于单个疾病：一项全国性队列研究。

Multimorbidity clusters potentially superior to individual diseases for stratifying fracture risk in older people: a nationwide cohort study.

机构信息

Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales 2010, Australia.

Faculty of Medicine, UNSW Sydney, New South Wales 2052, Australia.

出版信息

Age Ageing. 2024 Jul 2;53(7). doi: 10.1093/ageing/afae164.

DOI:10.1093/ageing/afae164

PMID:39078154

Abstract

RATIONALE

Comorbidities are common in fracture patients, but the interaction between fracture and comorbidities remains unclear. This study aimed to define specific multimorbidity clusters in older adults and quantify the association between the multimorbidity clusters and fracture risk.

METHODS

This nationwide cohort study includes 1.7 million adults in Denmark aged ≥50 years who were followed from 2001 through 2014 for an incident low-trauma fracture. Chronic diseases and fractures were identified from the Danish National Hospital Discharge Register. Latent class analysis and Cox's regression were conducted to define the clusters and quantify fracture risk, respectively.

RESULTS

The study included 793 815 men (age: 64 ± 10) and 873 524 women (65.5 ± 11), with a third having ≥1 chronic disease. The pre-existent chronic diseases grouped individuals into low-multimorbidity (80.3% in men, 83.6% in women), cardiovascular (12.5%, 10.6%), malignant (4.1%, 3.8%), diabetic (2.4%, 2.0%) and hepatic clusters (0.7%, men only). These clusters distinguished individuals with advanced, complex, or late-stage disease from those having earlier-stage disease. During a median follow-up of 14 years (IQR: 6.5, 14), 95 372 men and 212 498 women sustained an incident fracture. The presence of multimorbidity was associated with a significantly greater risk of fracture, independent of age and sex. Importantly, the multimorbidity clusters had the highest discriminative performance in assessing fracture risk, whereas the strength of their association with fracture risk equalled or exceeded that of both the individual chronic diseases most prevalent in each cluster and of counts-based comorbidity indices.

CONCLUSIONS

Future fracture prevention strategies should take comorbidities into account. Multimorbidity clusters may provide greater insight into fracture risk than individual diseases or counts-based comorbidity indices.

摘要

背景

骨折患者常合并多种疾病，但骨折与合并症之间的相互作用尚不清楚。本研究旨在确定老年人中特定的多重合并症聚类，并定量评估这些聚类与骨折风险之间的关系。

方法

本全国性队列研究纳入了丹麦 170 万≥50 岁的成年人，自 2001 年至 2014 年进行了低创伤性骨折的随访。慢性疾病和骨折通过丹麦国家医院出院登记处进行识别。采用潜在类别分析和 Cox 回归分别对聚类进行定义并量化骨折风险。

结果

研究共纳入 793815 名男性（年龄：64±10）和 873524 名女性（65.5±11），其中三分之一的人患有≥1 种慢性疾病。既往存在的慢性疾病将个体分为低多重合并症（男性占 80.3%，女性占 83.6%）、心血管疾病（12.5%，10.6%）、恶性疾病（4.1%，3.8%）、糖尿病（2.4%，2.0%）和肝脏疾病聚类（男性占 0.7%）。这些聚类将处于晚期、复杂或晚期疾病阶段的个体与处于早期疾病阶段的个体区分开来。在中位数为 14 年（IQR：6.5，14）的随访期间，95372 名男性和 212498 名女性发生了骨折事件。存在多重合并症与骨折风险显著增加相关，与年龄和性别无关。重要的是，在评估骨折风险方面，多重合并症聚类具有最高的判别性能，而其与骨折风险的关联强度与每个聚类中最常见的个体慢性疾病或基于计数的合并症指数相当或超过。