Pahor M, Guralnik J M, Salive M E, Chrischilles E A, Manto A, Wallace R B
Department of Gerontology, Catholic University, Rome, Italy.
J Am Geriatr Soc. 1994 Aug;42(8):816-25. doi: 10.1111/j.1532-5415.1994.tb06552.x.
To describe the occurrence of severe gastrointestinal bleeding in community-dwelling older persons and to examine whether disability is a risk factor for this life-threatening condition independent of other known predictors.
Prospective cohort survey.
Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE).
8205 persons age > or = 68 years.
The hospital discharge diagnoses provided by the Medicare Provider Analysis and Review files and the death certificates were prospectively surveyed for 3 years. Those with at least 1 discharge diagnosis of gastrointestinal bleeding and who received a blood transfusion or died were identified as cases of severe gastrointestinal hemorrhage. Physical disability, cognitive function, smoking and alcohol intake habits, body mass index, blood pressure, chronic conditions, number of hospital admissions in past year and medications taken were assessed at baseline.
The occurrence rate of severe gastrointestinal bleeding was 10.8 per 1000 person-years (241 events/22,277 person-years). In proportional hazards regression models, compared with no disability, > or = 1 disabilities in the Rosow-Breslau scale (RR = 2.1, 95% CI = 1.5-2.9), and > or = 1 ADLs limitations (RR = 3.1, 95% CI = 2.1-4.6) independently predicted gastrointestinal hemorrhage after adjusting for age, gender, body mass index, comorbidity, number of hospital admissions, blood pressure, intake of coumarin, corticosteroids, aspirin and other nonsteroidal anti-inflammatory drugs.
In this prospective analysis, disability is an independent predictor of gastrointestinal hemorrhage. Further studies are needed to explain the mechanisms by which disability may cause gastrointestinal hemorrhage. Because physical disability is potentially modifiable, strategies to lower the risk of gastrointestinal bleeding should be evaluated.
描述社区居住的老年人中严重胃肠道出血的发生率，并检查残疾是否是这种危及生命状况的危险因素，独立于其他已知的预测因素。
前瞻性队列研究。
老年人流行病学研究既定人群的三个社区（EPESE）。
8205名年龄≥68岁的人。
对医疗保险提供者分析与审查文件提供的医院出院诊断和死亡证明进行了为期3年的前瞻性调查。那些至少有1次胃肠道出血出院诊断且接受输血或死亡的人被确定为严重胃肠道出血病例。在基线时评估身体残疾、认知功能、吸烟和饮酒习惯、体重指数、血压、慢性病、过去一年的住院次数和服用的药物。
严重胃肠道出血的发生率为每1000人年10.8例（241例事件/22277人年）。在比例风险回归模型中，与无残疾相比，罗索-布雷斯劳量表中≥1项残疾（风险比=2.1，95%置信区间=1.5-2.9），以及≥1项日常生活活动受限（风险比=3.1，95%置信区间=2.1-4.6）在调整年龄、性别、体重指数、合并症、住院次数、血压、香豆素、皮质类固醇、阿司匹林和其他非甾体抗炎药的摄入量后，独立预测胃肠道出血。
在这项前瞻性分析中，残疾是胃肠道出血的独立预测因素。需要进一步研究来解释残疾可能导致胃肠道出血的机制。由于身体残疾可能是可改变的，应评估降低胃肠道出血风险的策略。
