西瓜太郎头像


552419研究文章2014

JAHXXX10.1177 / 0898264314552419衰老与健康杂志

文章

慢性阻塞性肺疾病,医院就诊和合并症:2010年全国住宅护理设施调查

Journal of Aging and Health 2015, Vol. 27(3) 480-–499 ? The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0898264314552419 jah.sagepub.com

Anne G. Wheaton,博士1,Earl S. Ford,医学博士,MPH1,Timothy J. Cunningham,ScD1和Janet B. Croft,博士1

摘要目的:表征美国居民护理设施(RCF)居民中慢性阻塞性肺疾病(COPD)的患病率,并比较无COPD居民的医院就诊和合并症的模式。方法:分析了2010年全国住宅护理设施调查中的居民数据。通过与RCF工作人员的访谈获得了病史和8089名成年居民过去一年的医院就诊信息。结果:COPD患病率为12.4%。与没有COPD的居民相比,上一年急诊就诊或过夜医院的住院率更高(p< .05) among residents with COPD. Less than 3% of residents with COPD had no comorbidities. Arthritis, depression, congestive heart failure (CHF), diabetes, coronary heart disease, and asthma were more common (p < .05) among residents with COPD than those without COPD, but Alzheimer’s disease was less common. Discussion: COPD is associated with more emergency department visits, hospital stays, and comorbidities among RCF residents. 1Centers

美国佐治亚州亚特兰大市疾病预防控制中心

通讯作者:国家慢性病预防与健康促进中心,疾病控制与预防中心4770 Buford Hwy的人口健康部Anne G. Wheaton。 NE Mailstop F-78,美国乔治亚州亚特兰大30341-3717。电子邮件:[email protected]

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

惠顿等。

481

关键词慢性阻塞性肺疾病住院合并症居住设施

简介慢性阻塞性肺疾病(COPD)是一种进行性疾病,其特征在于气流阻塞引起的呼吸困难。它包括肺气肿和慢性支气管炎,在美国通常归因于吸烟(疾病控制与预防中心,2008年)。 COPD是美国死亡率和发病率的重要原因(Ford等,2013)。患有COPD的个体还可能患有多种其他慢性疾病,例如心血管疾病和癌症(Barr等,2009; Cazzola,Bettoncelli,Sessa,Cricelli,& 比西奥内(Biscione),2010年; Divo等,2012; Feary,Rodrigues,Smith,Hubbard,& 吉布森(Gibson),2010年; Garcia-Olmos等,2013;约翰,兰格,霍尼格,威特,& 安克(Anker),2006年;林德伯格,拉尔森,朗马克,& 伦德巴克,2011年;纳齐尔& 埃布兰(Erbland),2009年; Schnell等,2012;罪& 曼,2005年; Soriano,Visick,Muellerova,Payvandi,& 汉塞尔(2005)。随着COPD变得越来越严重,肺功能受损和呼吸急促等症状可能会影响个人进行基本活动的能力。在美国65岁及以上的成年人中,约有12%的人被诊断出患有COPD,但这一估计是基于非住院成人的数据(疾病控制与预防中心,2012年)。这些调查不包括居民护理设施(RCF)等长期护理设施的居民。 RCF为无法独自生活但不需要养老院提供照料的个人提供住房和支持服务(Moss等,2011)。重要的是要考虑这一人口,因为2010年全国估计有733,000个人居住在RCF中(Caffrey等人,2012)。这项研究的目的是表征美国RCF居民中COPD的患病率,并根据COPD和合并症状况比较居民就诊的方式。

本报告中分析的方法设计和研究人群数据是疾病控制与预防中心的全国住宅护理设施调查的一部分

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

482

老年与健康杂志27(3)

(NSRCF). The National Center for Health Statistics conducted the NSRCF in 2010. The survey used a stratified two-stage probability sampling design. The first stage was the selection of residential care facilities (RCFs). Lists of licensed RCFs were acquired from licensing agencies in the 50 states and District of Columbia and concatenated to form a sampling frame of nearly 40,000 RCFs. The RCFs surveyed were state-regulated, had four or more beds, and provided room and board with at least two meals per day, aroundthe-clock supervision, and help with personal care or health-related services. Facilities licensed to serve developmentally disabled or severely mentally ill populations exclusively were excluded, as were nursing homes, unless they had a unit or wing meeting the RCF definition and residents who could be evaluated separately from other nursing home residents. The second stage was the selection of residents at the RCFs. Data for 8,094 residents aged ≥18 years were obtained from in-person interviews with RCF staff (proxy respondents) of 2,302 facilities. The overall weighted survey response rate was 79.4% (the product of the facility weighted response rate and the resident weighted response rate; Moss et?al., 2011). Additional details regarding the design and operation of the survey are available at /nchs/ nsrcf.htm. NSRCF was approved by the Research Ethics Review Board of the National Center for Health Statistics.

COPD and Comorbidities For each resident selected, the survey respondent (RCF staff) was asked, “As far as you know, has a doctor or other health professional ever diagnosed [the resident] with any of the following conditions?” The respondent was shown a card with a list of 30 conditions and asked to select all that applied. The list included emphysema, chronic bronchitis, and COPD (each listed separately). These responses were not mutually exclusive and a resident could have more than one of these conditions (e.g., emphysema and chronic bronchitis). In this study, COPD was defined as having any of these three conditions. Responses to this question were also used to categorize residents according to comorbidity status for the individual conditions included on the list, as well as categories of comorbidities: circulatory system disorders (congestive heart failure [CHF], coronary heart disease, heart attack or myocardial infarction, high blood pressure or hypertension, stroke, other heart condition or heart disease), mental and behavioral disorders (Alzheimer’s disease or other dementia, depression, intellectual or developmental disabilities, serious mental problems [e.g., schizophrenia or psychosis], other mental, emotional, or nervous conditions), musculoskeletal or connective tissue disorders (arthritis or rheumatoid arthritis; gout, lupus, or fibromyalgia; osteoporosis), eye diseases

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

惠顿等。

483

(青光眼,黄斑变性)和神经系统疾病(包括多发性硬化症,帕金森氏病和癫痫症的神经系统疾病;部分或全 部麻痹;脊髓损伤;脑外伤;脑瘫;肌营养不良症)。

Hospital Visits Survey respondents also were asked the following questions about the resident’s hospital visits in the past 12 months (or in the months since the resident moved into the RCF): “During this time, has [the resident] been treated in a hospital emergency room?” “During this time, has [the resident] been a patient in a hospital overnight or longer (excluding trips to the emergency room that did not result in a hospital stay)?” and “How many times has [the resident] been treated in a hospital emergency room over this period?”

Sociodemographic Variables Data were also collected on residents’ sex, age (18-64 years, 65-74 years, 75-84 years, ≥85 years), race/ethnicity (non-Hispanic White, non-Hispanic Black, other), education (high school or less, some college or more, unknown), and marital status (married, divorced/separated, widowed, never married).

统计分析统计分析是使用SAS 9.2(SAS Institute,Inc。)和SUDAAN 10.0.1(RTI International)进行的,以说明复杂的采样设计。嵌套变量是RSTRATUM(第一阶段的层次)和FACID(第一阶段的主要采样单位)。居民加权变量为RESFNWT。设计选项WOR(无替换抽样)与变量R POPFAC(在第一阶段用于计算有限总体校正所需的总设施变量)和TOTCNT语句中的POPRES一起使用。 (其他统计软件包应使用的变量的说明包含在/nchs/nsrcf/nsrcf_questionnaires.htm上的“调查方法和文档”中。)COPD的加权流行率估计值为95通过社会人口统计学特征获得置信区间%(CIs)。还计算了COPD状态下的就诊,过夜和慢性健康状况的患病率。最后,还根据COPD和合并症状态计算了急诊就诊的患病率。使用T检验比较患有COPD的居民和没有COPD的居民。统计上的显着差异定义为p值< .05.

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

484

老年与健康杂志27(3)

Table 1.? Characteristics of Study Population—National Survey of Residential Care Facilities, 2010. Characteristic

样本量

Total Sex ?Men ?Women Age (years) ?18-64 ?65-74 ?75-84 ?85+ Race/ethnicity ? White non-Hispanic ? Black non-Hispanic ?Other Education ? High school or less ? Some college or more ?Unknown Marital statusb ?Married ?Divorced/separated ?Widowed ? Never married History of ? Chronic bronchitis ?Emphysema ?COPD ? Any COPDc

加权编号百分率

[95% CI] ?

8,089

732,987

100.0

2,582 5,507

222,710 510,277

30.4 69.6

[29.1, 31.7] [68.3, 70.9]

1,238 792 2,037 4,022

77,218 62,424 198,727 394,618

10.5 8.5 27.1 53.8

[9.5, 11.6] [7.8, 9.4] [25.9, 28.4] [52.3, 55.4]

7,197 458 434

667,486 31,680 33,821

91.1 4.3 4.6

[90.1, 91.9] [3.8, 5.0] [4.0, 5.3]

4,514 2,470 1,105

369,024 252,719 111,244

50.4 34.5 15.2

[48.7, 52.2] [32.9, 36.2] [13.6, 16.9]

957 932 4,694 1,406

94,583 73,094 456,927 98,889

13.1 10.1 63.2 13.7

[12.2, 14.1] [9.3, 11.0] [61.6, 64.7] [12.6, 14.8]

199 103 878 1,034

14,483 8,635 78,994 91,119

2.0 1.2 10.8 12.4

[1.6, 2.4] [0.9, 1.5] [9.9, 11.7] [11.5, 13.4]

Note. COPD = chronic obstructive pulmonary disease. aWeighted percentage and 95% confidence interval. bMarital status was not identified for 100 residents. cAny COPD includes history of chronic bronchitis, emphysema, or COPD.

结果在收集的8,094位居民中,有5位缺少慢性病数据,因此没有进行分析。表1列出了样本人口的特征。被调查的8,089名居民代表了732,987名居民。居民人口主要是

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

485

惠顿等。

Table 2.?COPDa Prevalence by Sociodemographic Characteristics—NSRCF, 2010. Characteristic Total Sex ?Men ?Women Age (years) ?18-64 ?65-74 ?75-84 ? ≥85 Race/ethnicity ? White non-Hispanic ? Black non-Hispanic ?Other Education ? High school or less ? Some college or more ?Unknown Marital status ?Married ?Divorced/separated ?Widowed ? Never married

百分比b

[95% CI]

12.4

[11.5, 13.4]

14.8 11.4

[13.1, 16.6] [10.4, 12.5]

14.1 17.0 14.6 10.3

[11.5, 17.1] [13.8, 20.8] [12.8, 16.6] [9.2, 11.5]

12.4 12.7 13.7

[11.4, 13.4] [8.7, 18.0] [10.2, 18.2]

13.2 11.8 11.3

[11.9, 14.6] [10.3, 13.5] [9.1, 13.9]

9.8 15.1 12.2 13.6

[7.8, 12.2] [12.4, 18.3] [11.1, 13.5] [11.1, 16.5]

Note. COPD = chronic obstructive pulmonary disease; NSRCF = National Survey of Residential Care Facilities. aIncludes history of chronic bronchitis, emphysema, or COPD. bWeighted percentage and 95% confidence interval.

妇女(69.6%),年龄在85岁以上(53.8%),非西班牙裔白人(91.1%),受过高中学历的妇女(50.4%)和丧偶的妇女(63.2%)。据报道,至少有一种COPD疾病(慢性支气管炎,肺气肿或COPD)占研究人群的12.4%,相当于全国91,000多名居民。 COPD的患病率较高(p< .05) among men than women (14.8% vs. 11.4%) and was lower among residents aged 85 years and above (10.3%) compared with the other age groups (Table 2). COPD prevalence did not differ significantly between groups defined by race/ethnicity or level of education, but was significantly lower among married residents (9.8%) compared with residents who were divorced or separated (15.1%), as well as never married residents (13.6%).

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

486

老年与健康杂志27(3)

Figure 1.? Prevalence of hospital visits and overnight stays in the previous 12 months by COPD status—NSRCF, 2010. Note. COPD = chronic obstructive pulmonary disease; NSRCF = National Survey of Residential Care Facilities.

Compared with residents without COPD, those with COPD were significantly more likely to have visited a hospital emergency room in the previous 12 months (42.5%, 95% CI [38.6%, 46.5%], compared with 33.4%, 95% CI [31.9%, 34.8%]; p < .0001), to have made at least three visits to a hospital emergency room in that time (10.5%, 95% CI [8.3%, 13.2%], compared with 5.3%, 95% CI [4.7%, 6.1%]; p = .0001), and to have stayed in a hospital overnight (31.6%, 95% CI [28.3%, 35.2%], compared with 22.7%, 95% CI [21.4%, 24.0%]; p < .0001) after adjustment for age differences (Figure 1). Compared with residents without COPD, the age-adjusted prevalence of the following chronic conditions was significantly higher among residents with COPD: depression, arthritis, diabetes, coronary heart disease, CHF, anemia, serious mental problems such as schizophrenia or psychosis, kidney disease, heart attack, and asthma (Table 3). The following conditions were significantly less prevalent among residents with COPD: Alzheimer’s disease or other dementia and nervous system disorders including multiple sclerosis, Parkinson’s disease, and epilepsy. We also grouped categories of chronic conditions. Residents with COPD were more likely to have circulatory system disorders and musculoskeletal or connective tissue disorders than residents without COPD. Overall, the age-adjusted mean number of chronic health conditions (excluding COPD) was higher among residents with COPD (M = 3.97 vs. 3.25).

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

487

从jah.sagepub.com于2015年4月8日从纽约州立大学健康科学中心下载

高血压/高血压阿尔茨海默氏病或 其他痴呆抑郁症关节炎或类风湿性关节炎骨质疏松症糖尿病其他心脏病(未在其他地方列出)冠心病充血性心力衰竭其他精神,情感或神经疾病中风癌症或任何类型的恶性肿瘤贫血神经系统疾病,包括多发性硬化症,帕金森氏病和癫痫病严重的精神问题,例如精神分裂症或精神病胃肠道问题青光眼黄斑变性肾脏疾病心脏病/心肌梗塞

Chronic health condition [55.1, 58.3] [40.2, 43.5] [26.1, 28.8] [25.6, 28.6] [19.1, 21.7] [16.1, 18.3] [13.3, 15.6] [12.2, 14.4] [12.2, 14.3] [10.8, 12.7] [10.1, 11.8] [9.9, 11.6] [8.8, 10.6] [7.0, 8.5] [6.8, 8.5] [6.7, 8.4] [5.6, 7.0] [5.3, 6.6] [5.1, 6.4] [3.7, 4.8]

7.6 7.5 6.3 5.9 5.7 4.2

[95% CI]

56.7 41.8 27.4 27.1 20.4 17.2 14.4 13.2 13.2 11.7 10.9 10.7 9.6 7.7

百分率



8.6 5.7 6.8 9.6 6.4

10.9

59.4 33.7 31.5 33.7 22.4 25.3 15.4 18.0 26.4 14.8 12.4 10.9 13.5 5.8

百分比

[6.6, 11.2] [4.2, 7.7] [5.2, 8.8] [7.6, 12.1] [4.6, 8.7]

[8.6, 13.8]

[55.4, 63.3] [30.1, 37.5] [28.1, 35.1] [30.1, 37.5] [19.3, 25.8] [22.1, 28.7] [12.7, 18.5] [15.2, 21.2] [23.2, 29.9] [12.5, 17.6] [10.1, 15.1] [8.8, 13.4] [10.9, 16.5] [4.3, 7.7]

[95% CI]

慢性阻塞性肺病

7.3 6.3 5.8 5.1 3.9

7.1

56.4 43.0 26.8 26.2 20.1 16.0 14.3 12.6 11.3 11.2 10.7 10.7 9.1 8.0

百分比

[6.5, 8.3] [5.6, 7.1] [5.1, 6.6] [4.5, 5.9] [3.4, 4.5]

[6.3, 8.0]

[54.6, 58.1] [41.3, 44.7] [25.4, 28.3] [24.7, 27.7] [18.8, 21.5] [14.9, 17.2] [13.1, 15.5] [11.4, 13.8] [10.4, 12.4] [10.3, 12.3] [9.8, 11.7] [9.8, 11.7] [8.2, 10.0] [7.2, 8.8]

[95% CI]

无COPD

Table 3.? Prevalence of Individual Chronic Health Conditions by COPD Status—NSRCF 2010.

1.3 ?0.61 0.95 4.47 2.47

3.84

3.01 ?9.32 4.67 7.55 2.28 9.26 1.12 5.42 15.05 3.61 1.73 0.23 4.38 ?2.15

Difference in prevalence (COPD ? no COPD)

(继续)

NS NS NS
网站地图