多发性群集可能优于各个疾病，以分层老年人的骨折风险：一项全国人群研究
Multimorbidity clusters potentially superior to individual diseases for stratifying fracture risk in older people: a nationwide cohort study
影响因子:7.10000
分区:医学2区 Top / 老年医学1区
发表日期:2024 Jul 02
作者:
Thach Tran, Dana Bliuc, Bo Abrahamsen, Weiwen Chen, John A Eisman, Louise Hansen, Peter Vestergaard, Tuan V Nguyen, Robert D Blank, Jacqueline R Center
摘要
合并症在骨折患者中很常见，但骨折与合并症之间的相互作用尚不清楚。这项研究旨在定义老年人中特定的多发性簇，并量化多种多发性簇和断裂风险之间的关联。这项全国人群研究包括丹麦的170万成年人，年龄≥50岁的丹麦成年人从2001年到2014年，这些成年人因事件低潮而进行，从2001年到2014年。从丹麦国家医院出院登记册中确定了慢性疾病和骨折。进行潜在的类分析和COX的回归是为了定义簇并量化断裂风险。该研究包括793 815名男性（年龄：64±10）和873 524名女性（65.5±11），其中三分之一患有≥1种慢性病。先前存在的慢性疾病将个体分为低多重症状（男性80.3％，女性为83.6％），心血管（12.5％，10.6％），恶性肿瘤（4.1％，3.8％），糖尿病患者（2.4％，2.4％，2.0％）和肝簇（0.7％）（0.7％）。这些集群将患有晚期，复杂或晚期疾病的个体与患有早期疾病的人区分开。在14年（IQR：6.5、14）的中位随访期间，95 372名男性和212 498名妇女发生了事件骨折。多种疾病的存在与骨折的风险明显更大，与年龄和性别无关。重要的是，多发性簇在评估断裂风险方面具有最高的判别性能，而与裂缝风险相关的强度相等或超过了单个慢性疾病在每个集群中最普遍的慢性疾病的强度，并且基于计数的合并症indices。折磨骨折预防策略应考虑综合策略。比单个疾病或基于计数的合并症指数，多种症状群可能会对断裂风险提供更大的见解。
Abstract
Comorbidities are common in fracture patients, but the interaction between fracture and comorbidities remains unclear. This study aimed to define specific multimorbidity clusters in older adults and quantify the association between the multimorbidity clusters and fracture risk.This nationwide cohort study includes 1.7 million adults in Denmark aged ≥50 years who were followed from 2001 through 2014 for an incident low-trauma fracture. Chronic diseases and fractures were identified from the Danish National Hospital Discharge Register. Latent class analysis and Cox's regression were conducted to define the clusters and quantify fracture risk, respectively.The study included 793 815 men (age: 64 ± 10) and 873 524 women (65.5 ± 11), with a third having ≥1 chronic disease. The pre-existent chronic diseases grouped individuals into low-multimorbidity (80.3% in men, 83.6% in women), cardiovascular (12.5%, 10.6%), malignant (4.1%, 3.8%), diabetic (2.4%, 2.0%) and hepatic clusters (0.7%, men only). These clusters distinguished individuals with advanced, complex, or late-stage disease from those having earlier-stage disease. During a median follow-up of 14 years (IQR: 6.5, 14), 95 372 men and 212 498 women sustained an incident fracture. The presence of multimorbidity was associated with a significantly greater risk of fracture, independent of age and sex. Importantly, the multimorbidity clusters had the highest discriminative performance in assessing fracture risk, whereas the strength of their association with fracture risk equalled or exceeded that of both the individual chronic diseases most prevalent in each cluster and of counts-based comorbidity indices.Future fracture prevention strategies should take comorbidities into account. Multimorbidity clusters may provide greater insight into fracture risk than individual diseases or counts-based comorbidity indices.