自评健康状况作为住院高风险老年人死亡率和医疗保健使用情况的预测指标：瑞典的一项前瞻性队列研究。

Self-rated health as a predictor of mortality and healthcare use in older adults at high risk of hospitalisation: a prospective cohort study in Sweden.

作者信息

Hansén Kristin, Lyth Johan, Segernäs Anna, Alwin Jenny, Nord Magnus

机构信息

Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Östergötland County, Sweden.

Primary Health Care Center Valla, Region Östergötland, Linkoping, Östergötland, Sweden.

出版信息

BMJ Open. 2025 Sep 1;15(9):e091787. doi: 10.1136/bmjopen-2024-091787.

DOI:10.1136/bmjopen-2024-091787

PMID:40889980

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12406932/

Abstract

OBJECTIVE

This study aimed to evaluate the predictive value of self-rated health (SRH) on mortality and healthcare use in older adults (aged ≥75 years) at high risk of hospitalisation in comparison to an objective measure of comorbidities, the Charlson Comorbidity Index (CCI).

DESIGN

Prospective cohort study conducted within the research project 'Proactive Primary Care for Frail Elderly Persons'.

SETTING

19 primary care practices in south-east Sweden, between January 2018 and December 2019.

PARTICIPANTS

In total, 355 adults aged ≥75 years were included in the study. They were among the 11% older adults with the highest predicted risk of hospitalisation, as identified by a statistical prediction model for unplanned hospital admission.

OUTCOME MEASURES

Outcomes were all-cause mortality and healthcare use measured as hospital care days and the number of physician visits in primary and secondary care. These were analysed for different groups of SRH and comorbidities measured using the CCI.

RESULTS

SRH was grouped into Excellent/Very good, Good, Fair and Poor. The overall mortality rate was 26.5%. Compared with the group, the adjusted HRs were significantly lower for (HR=0.2; 95% CI: 0.1 to 0.8, p=0.02) and (HR=0.5; 95% CI: 0.3 to 1.0, p=0.04). Compared with the comorbidity group CCI 0-1, CCI 2-3 had an adjusted HR of 2.2 (95% CI: 1.1 to 4.6, p=0.03), CCI 4-5 had an adjusted HR of 2.6 (95% CI: 1.2 to 5.4, p=0.01) and CCI>5 had an HR of 4.9 (95% CI: 2.4 to 10.2, p<0.001). The number of hospital care days was 70% lower (adjusted relative difference=0.3; 95% CI: 0.1 to 0.8) for (3.9 days) compared with (10.7 days). All groups of CCI diagnoses (2-3, 4-5 and >5) had significantly more hospital care days than CCI 0-1.For physician visits in secondary care, both the SRH (p=0.004) and (p=0.02) groups had significantly fewer visits compared with . In the comorbidity groups, no statistical differences were found between CCI categories.

CONCLUSIONS

In a cohort of older adults at high risk of hospitalisation, the predictive value of SRH for risk stratification was limited. Objective health measures appeared to offer greater utility than SRH for guiding healthcare planning and tailoring interventions for vulnerable older adults in this cohort.

TRIAL REGISTRATION NUMBER

Clinical Trials NCT03180606.

摘要

目的

本研究旨在评估与共病客观测量指标查尔森共病指数（CCI）相比，自评健康（SRH）对住院风险高的老年人（年龄≥75岁）死亡率和医疗保健利用情况的预测价值。

设计

在“体弱老年人主动初级保健”研究项目中进行的前瞻性队列研究。

地点

2018年1月至2019年12月期间，瑞典东南部的19家初级保健机构。

参与者

共有355名年龄≥75岁的成年人纳入研究。他们是通过非计划住院统计预测模型确定的预测住院风险最高的11%老年人中的一部分。

结局指标

结局指标为全因死亡率以及以住院天数和初级及二级保健中医生诊疗次数衡量的医疗保健利用情况。针对使用CCI测量的不同SRH和共病组对这些指标进行了分析。

结果

SRH分为优秀/非常好、良好、中等和差。总死亡率为26.5%。与差组相比，优秀/非常好组（HR = 0.2；95%CI：0.1至0.8，p = 0.02）和良好组（HR = 0.5；95%CI：0.3至1.0，p = 0.04）的校正HR显著更低。与共病组CCI 0 - 1相比，CCI 2 - 3的校正HR为2.2（95%CI：1.1至4.6，p = 0.03），CCI 4 - 5的校正HR为2.6（95%CI：1.2至5.4，p = 0.01），CCI>5的HR为4.9（95%CI：2.4至10.2，p<0.001）。优秀/非常好组（3.9天）的住院天数比差组（10.7天）低70%（校正相对差异 = 0.3；95%CI：0.1至0.8）。所有CCI诊断组（2 - 3、4 - 5和>5）的住院天数均显著多于CCI 0 - 1组。对于二级保健中的医生诊疗次数，优秀/非常好组（p = 0.004）和良好组（p = 0.02）与差组相比诊疗次数均显著更少。在共病组中，CCI类别之间未发现统计学差异。