多发病簇可能优于单一疾病用于老年人骨折风险的分层：一项全国性队列研究

Multimorbidity clusters potentially superior to individual diseases for stratifying fracture risk in older people: a nationwide cohort study

AGE AND AGEING

影响因子:7.1

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

DOI: 10.1093/ageing/afae164

摘要

共病在骨折患者中普遍存在，但骨折与共病的相互作用尚不清楚。本研究旨在定义老年人中特定的多发病簇，并量化这些簇与骨折风险的关系。本全国性队列研究包括丹麦50岁及以上的170万成人，从2001年至2014年追踪观察低创伤性骨折的发生。通过丹麦国家医院出院登记系统识别慢性疾病和骨折情况。采用潜在类别分析和Cox回归分析，分别用于定义疾病簇和量化骨折风险。本研究包括男性793,815人（平均年龄：64±10岁）和女性873,524人（65.5±11岁），其中三分之一有≥1种慢性疾病。根据既往疾病，将个体归入低多发病（男性占80.3%、女性占83.6%）、心血管（占12.5%、10.6%）、恶性肿瘤（占4.1%、3.8%）、糖尿病（占2.4%、2.0%）和肝脏簇（占0.7%，仅男性）等。上述簇区分了晚期、复杂或晚期疾病患者与早期疾病患者。在中位随访14年（四分位距：6.5至14年）期间，95,372名男性和212,498名女性发生了骨折。多发病的存在与骨折风险显著相关，且与年龄和性别无关。更重要的是，多发病簇在评估骨折风险方面表现出最高的判别能力，其与骨折风险的关联强度等同或超过每个簇中最常见的单一疾病及基于计数的共病指数。未来的骨折预防策略应考虑共病因素。多发病簇可能比单一疾病或基于计数的共病指数提供更深入的骨折风险信息。

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.