上海市静安区社区多病共存老年患者病种构成及特点分析  

Disease composition and characteristics of elderly patients with multymorbidity in Jing′an district of Shanghai

作　　者：华明 金花 胡敏 陈晨 于德华 Hua Ming;Jin Hua;Hu Min;Chen Chen;Yu Dehua(Yangpu Hospital,Tongji University,Shanghai 200090,China;Linfen Road Subdistrict Community Health Service Center,Jing′an District,Shanghai 200082,China;Jiangning Road Subdistrict Community Health Service Center,Jing′an District,Shanghai 200041,China)

机构地区：[1]同济大学附属杨浦医院,上海200090 [2]上海市静安区临汾路街道社区卫生服务中心,200082 [3]上海市静安区江宁路街道社区卫生服务中心,200041

出　　处：《中华全科医师杂志》2021年第8期838-844,共7页Chinese Journal of General Practitioners

基　　金：上海市卫生和计划生育委员会科研课题(201840132);上海市医院协会医院管理研究基金(Se1201931);上海市领军人才课题(YDH-20170627)。

摘　　要：目的分析上海市静安区社区就诊的多病共存老年患者的病种构成及特点,为建立和优化基于社区的老年人多病共存慢性病管理模式提供依据。方法于2020年4月13日,通过分层随机抽样方法,从静安区北、中、南各选取1家社区卫生服务中心,并从其医院管理信息系统导出2017年1月2日至2018年12月29日全部门诊诊疗数据,依据多病共存纳入排除标准,获取研究数据,运用SPSS 22.0软件进行多病共存单病种疾病谱和组合疾病谱分析,通过χ^(2)检验描述组间差异。结果(1)就诊的68147例60岁以上老年患者中患2种及以上慢性病者43953例,多病共存占64.5%。(2)总患病人数前5位的慢性疾病是高血压、慢性缺血性心脏病、糖尿病、高脂血症和脑血管病,也是多病共存核心构成病种。(3)男性与女性多病共存情况差异有统计学意义(χ^(2)=15.276,P<0.01),女性多病共存发生率更高(Ref=男性,OR=1.152,P<0.01)。(4)不同年龄组人群多病共存情况差异有统计学意义(χ^(2)=48.547,P=0.001),年龄越高具有2种及以上多病共存情形的发生率越高(Ref=60~69岁组,70~79岁组OR=1.629,P<0.01;≥80岁组OR=2.686,P<0.01)。(5)4种慢性病共存时,男性泌尿系统疾病和女性关节疾病进入前5序位,5种慢性病共存时,女性睡眠障碍进入前5序位。≥80岁患者5种慢性病共存时,前5序位组合病种中不再有糖尿病。结论上海市静安区老年患者中,女性和高龄患者多病共存情况显著,高血压仍是社区老年人慢性疾病管理的重点,不同特征人群具有差异性的多病共存特征;建议提高多病共存组合外的病种处置能力,建立社区老年人慢性病精准防控机制。Objective To analyze the disease composition and characteristics among elderly patients with multimorbidity in Jing′an district of Shanghai.Methods A total of 68147 patients aged 60 and above in Shanghai Jing′an district were selected in the study by stratified random sampling method,The clinical data of patients from January 2017 to December 2018 were obtained from hospital information system,the status of multimorbidity,the disease composition and characteristics were analyzed with SPSS software.Results Among 68147 elderly patients,43953 had 2 or more chronic diseases.The top five chronic diseases were hypertension,chronic ischemic heart disease,diabetes,hyperlipidemia,and cerebrovascular disease.There was significant difference in prevalence of multimorbidity between male and female patients(χ^(2)=15.276,P<0.01);compared to males,females had higher prevalence of multimorbidity(OR=1.152,P<0.01).There was significant difference in prevalence of multimorbidity among different age groups of patients(χ^(2)=48.547,P<0.01);compared to age group 60-69,patients age 70-79(OR=1.629,P<0.01)and aged 80 and above(OR=2.686,P<0.01)had higher prevalence of multimorbidity.When 4 chronic diseases coexist,male urinary system diseases and female joint diseases rank in the top five comorbid diseases,while when 5 chronic diseases coexist,female sleep disorders rank in the top five positions.For patients aged≥80 years,when 5 chronic diseases coexist,diabetes mellitus is no longer among in the top five comorbid diseases.Conclusions The elderly women and older-aged patients have higher prevalence of multiomorbidity.Hypertension is still the top priority of chronic disease prevention and control for the elderly in the community.It is suggested to establish the precise prevention and control mechanism for the aging chronic disease.

关 键 词：老年人 慢性病 多病共存 

分 类 号：R195.4[医药卫生—卫生统计学]