Wolinsky F D, Overhage J M, Stump T E, Lubitz R M, Smith D M
School of Public Health, Saint Louis University Health Sciences Center, MO 63108-3342, USA.
Med Care. 1997 Oct;35(10):1031-43. doi: 10.1097/00005650-199710000-00005.
The purpose of the study was to estimate the 8-year rate of hospitalization for congestive heart failure (CHF), to report the resources consumed, and to evaluate previously reported risk factors in a nationally representative sample of 7,286 older white and black adults.
Secondary analysis of baseline interview data was linked to Medicare hospitalization and death records for 1984 to 1991. Hospitalization for CHF was defined as having one or more episodes with an International Classification of Diseases (ninth revision, clinical modification) discharge code of 428. Combined and separate analyses of first-listed and second-through fifth-listed CHF discharge diagnoses were conducted. Multivariable proportional hazards models were used to evaluate the risks in pooled analyses of all white and black men and women and in separate stratified analyses of white men and white women.
Over the 8-year period, 1,102 or 15.1% of the 7,286 older white and black adults were hospitalized for CHF (7.1% with first-listed and 8.1% with second- through fifth-listed diagnoses). The 1- and 5-year combined postdischarge mortality rates were 34.7% and 69.0%, respectively. In descending order, the major risk factors for being hospitalized for CHF in the combined, pooled analysis were age, being a white man, having lower body functional limitations, and having self-reported medical histories of coronary heart disease, heart attack, diabetes, and angina. The increased risk associated with age was not linear, and it diminished significantly over the course of life. Some significant differences were observed in the risk factors for hospitalization for first-listed versus second- through fifth-listed CHF and in the risk factors for white women versus white men.
Hospitalization for CHF among older adults is a common, costly event with a poor prognosis. The differential risk for white men remains unexplained and warrants further study.
本研究旨在估计充血性心力衰竭（CHF）的8年住院率，报告所消耗的资源，并在一个具有全国代表性的7286名老年白人和黑人成年人样本中评估先前报告的风险因素。
对基线访谈数据进行二次分析，并与1984年至1991年医疗保险住院和死亡记录相链接。CHF住院定义为有一次或多次发作，国际疾病分类（第九版，临床修订本）出院编码为428。对首次列出和第二至第五列出的CHF出院诊断进行联合和单独分析。多变量比例风险模型用于评估所有白人和黑人男性及女性的汇总分析以及白人男性和白人女性的单独分层分析中的风险。
在8年期间，7286名老年白人和黑人成年人中有1102人（15.1%）因CHF住院（首次列出诊断的占7.1%，第二至第五列出诊断的占8.1%）。出院后1年和5年的联合死亡率分别为34.7%和69.0%。在联合汇总分析中，因CHF住院的主要风险因素按降序排列为年龄、白人男性、身体功能受限程度较低以及有自我报告的冠心病、心脏病发作、糖尿病和心绞痛病史。与年龄相关的风险增加并非呈线性，且在生命过程中显著降低。在首次列出与第二至第五列出的CHF住院风险因素以及白人女性与白人男性的风险因素方面观察到一些显著差异。
老年人因CHF住院是一种常见且代价高昂的事件，预后较差。白人男性的差异风险仍无法解释，值得进一步研究。
