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慢性硬膜下血肿患者健康的社会决定因素与长期死亡率:存在关联吗?

Social Determinants of Health and Long-Term Mortality of Patients with Chronic Subdural Hematoma: Is There an Association?

作者信息

Lepić Sanja, Mićić Aleksa, Lepić Milan, Rasulić Lukas, Mandić-Rajčević Stefan

机构信息

Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia.

Institute of Hygiene, Military Medical Academy, 11000 Belgrade, Serbia.

出版信息

Healthcare (Basel). 2024 Aug 15;12(16):1627. doi: 10.3390/healthcare12161627.

Abstract

(1) Background: A chronic subdural hematoma (CSDH) is considered an acute life-threatening event that is easily treated surgically, but little is known about the longer-term mortality of these patients. The objective of this study was to evaluate the association of social determinants of health (SDoH) and the long-term mortality of patients with a chronic subdural hematoma. (2) Methods: This retrospective cohort study included 121 (88 male and 33 female) patients with a surgically treated unilateral or bilateral CSDH. Mortality was evaluated at 1, 2, 6, and 12 months after treatment. (3) Results: Most of the patients were >65 and retired, N = 96 (79.3%); of them, the majority presented with a neurological deficit, N = 71 (73.9%). Patients who lived alone more often had a neurological deficit, N = 57 (75.0%), compared to those who lived in communities, N = 25 (55.5%). Mortality at 1, 2, 6, and 12 months after surgery was 10.7%, 17.4%, 19.0%, and 45.5%, respectively, and there was a significant difference in the median age between the survival and deceased groups at 1 month ( < 0.01), 2 months ( < 0.01), and 6 months ( < 0.01) of follow-up, but not in the long-term (12 months) follow-up ( = 0.200). Patients who lived alone had 3.7 times higher odds of dying at the 12-month follow-up ( < 0.01), compared to those who lived in the community. (4) Conclusions: Living alone is related to an increased case fatality risk after CSDH surgery in the Serbian context. Social determinants of health can be associated with CSDH presentation and survival, indicating that further studies should include SDoH to obtain a deeper understanding of the occurrence, presentation, and outcomes of SDoH and propose additional preventive measures.

摘要

(1)背景:慢性硬膜下血肿(CSDH)被视为一种急性危及生命的事件,手术治疗相对容易,但对于这些患者的长期死亡率了解甚少。本研究的目的是评估健康的社会决定因素(SDoH)与慢性硬膜下血肿患者长期死亡率之间的关联。(2)方法:这项回顾性队列研究纳入了121例(88例男性和33例女性)接受手术治疗的单侧或双侧CSDH患者。在治疗后1、2、6和12个月评估死亡率。(3)结果:大多数患者年龄>65岁且已退休,共96例(79.3%);其中,大多数患者存在神经功能缺损,共71例(73.9%)。与居住在社区的患者(25例,55.5%)相比,独居患者更常出现神经功能缺损,共57例(75.0%)。术后1、2、6和12个月的死亡率分别为10.7%、17.4%、19.0%和45.5%,在随访1个月(<0.01)、2个月(<0.01)和6个月(<0.01)时,存活组和死亡组的中位年龄存在显著差异,但在长期(12个月)随访中无差异(=0.200)。与居住在社区的患者相比,独居患者在12个月随访时死亡的几率高3.7倍(<0.01)。(4)结论:在塞尔维亚背景下,独居与CSDH手术后死亡风险增加有关。健康的社会决定因素可能与CSDH的表现和生存相关,这表明进一步的研究应纳入SDoH,以更深入地了解SDoH的发生、表现和结局,并提出额外的预防措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/815d/11353836/f6d56336ca39/healthcare-12-01627-g001.jpg

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