住院患者慢性病共病现状调查及流行病学分析

doi:10.3969/j.issn.1674-8115.2024.04.006

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (4): 462-468.doi: 10.3969/j.issn.1674-8115.2024.04.006

• 论著 · 临床研究 • 上一篇

住院患者慢性病共病现状调查及流行病学分析

郝明秀(), 陈鸿伟(), 王俊琳, 唐吟菡, 吴芸芸, 金玉华, 胡耀敏()

上海交通大学医学院附属仁济医院老年医学科，上海 200127

收稿日期:2023-09-25 接受日期:2024-03-04 出版日期:2024-04-28 发布日期:2024-04-28
通讯作者: 胡耀敏 E-mail:haomingxiu@renji.com;chw13026736003@163.com;amin99@163.com
作者简介:郝明秀（1981—），女，副主任医师，博士；电子信箱：haomingxiu@renji.com
陈鸿伟（1997—），男，硕士生；电子信箱：chw13026736003@163.com
基金资助:
国家自然科学基金(81870554)

Investigation and epidemiological analysis of chronic diseases and comorbidities in hospitalized patients

HAO Mingxiu(), CHEN Hongwei(), WANG Junlin, TANG Yinhan, WU Yunyun, JIN Yuhua, HU Yaomin()

Department of Geriatrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2023-09-25 Accepted:2024-03-04 Online:2024-04-28 Published:2024-04-28
Contact: HU Yaomin E-mail:haomingxiu@renji.com;chw13026736003@163.com;amin99@163.com
Supported by:
National Natural Science Foundation of China(81870554)

摘要/Abstract

摘要：

目的·分析慢性病共病的现状及分布特征，为进一步加强共病患者对疾病自我管理，实施全程、全方位的共病管理提供参考依据。方法·选取2020年12月—2023年2月上海交通大学医学院附属仁济医院老年科2 045例住院患者，收集患者一般生命体征、实验室检查指标及患病情况等资料，分析慢性病及共病的流行病学患病分布特征。结果·调查人群慢性病发生率为99.6%，共病患者占94.2%。患病率排名前5位的慢性病依次为高血压（43.68%）、糖尿病（24.81%）、恶性肿瘤（21.48%）、高脂血症（18.38%）和冠心病（11.99%）。其中男性高血压、糖尿病、冠心病、慢性阻塞性肺病、脑卒中、慢性肾脏病检出率均明显高于女性（P<0.05）。共病患者中，合并5种慢性病的患者比例最高（11.99%），其次为合并7种慢性病（10.26%）、6种慢性病（10.04%）。在不同年龄段患者中，50~59岁的患者共病发生率最高（27.78%）。合并2种慢性病的人群中，50~59岁的患者比例高达40.82%。男性患者发生共病的比例（95.37%）高于女性（93.77%），但差异无统计学意义（P=0.125）；合并2种和5种慢性病的男性患者比例分别为70.41%和60.63%，均显著高于女性患者（29.59%和39.37%）。其中冠心病与糖尿病、高血压与冠心病、高血压与糖尿病的发病具有相关性（r=0.24，r=0.27，r=0.35，均P<0.05）。结论·中老年人群慢性病及共病患病率较高，并且随着年龄的增长，共病数量明显增加。

关键词: 老年人, 老龄化, 共病, 慢性病, 流行病学

Abstract:

Objective ·To investigate the current situation and distribution characteristics of chronic comorbidities, and to provide reference for further improving the self-management of comorbidities and implementing the whole course and all-round management of comorbidity. Methods ·Two thousand and forty-five inpatients in the Department of Geriatrics,Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled in this study from December 2020 to February 2023. The general vital signs, routine laboratory examination and disease status were collected. The epidemiological distribution characteristics of chronic diseases and comorbidities were analyzed. Results ·The incidence of chronic diseases in the surveyed population was 99.6%, and the incidence of comorbidities was 94.2%. The top 5 chronic diseases were hypertension (43.68%), diabetes mellitus (24.81%), malignant tumor (21.48%), hyperlipidemia (18.38%) and coronary heart disease (11.99%). The detection rates of hypertension, diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, stoke and chronic kidney disease in males were significantly higher than those in females (P<0.05). The proportion of patients with 5 chronic diseases was the highest (11.99%), followed by 7 chronic diseases (10.26%) and 6 chronic diseases (10.04%). Among the patients of different ages, the comorbidity rate was the highest in the patients aged 50?59 years (27.78%). In different age groups, patients aged 50 to 59 with 2 chronic diseases had the highest incidence of comorbidity, which was as high as 40.82%. Although the overall proportion of comorbidities among male patients (95.37%) was higher than that among females (93.77%), there was no statistically significant difference (P=0.125). However, the proportions of male patients with 2 and 5 chronic diseases were 70.41% and 60.63%, respectively, which were significantly higher than those of female patients (29.59% and 39.37%). The correlations between coronary heart disease and diabetes mellitus, hypertension and coronary heart disease, hypertension and diabetes mellitus were higher (r=0.24, r=0.27, r=0.35, all P<0.05). Conclusion ·The prevalence of chronic diseases and comorbidities is high in the middle-aged and elderly population, and the number of comorbidities increases significantly with the increase of age.

Key words: elderly people, aging, comorbidity, chronic diseases, epidemiology

中图分类号:

R592

郝明秀, 陈鸿伟, 王俊琳, 唐吟菡, 吴芸芸, 金玉华, 胡耀敏. 住院患者慢性病共病现状调查及流行病学分析[J]. 上海交通大学学报（医学版）, 2024, 44(4): 462-468.

HAO Mingxiu, CHEN Hongwei, WANG Junlin, TANG Yinhan, WU Yunyun, JIN Yuhua, HU Yaomin. Investigation and epidemiological analysis of chronic diseases and comorbidities in hospitalized patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(4): 462-468.

图/表 5

参考文献 27

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Variable	Total (n=2 045)	Female (n=771)	Male (n=1 274)	P value
Age/year	61.5±15.2	60.7±15.3	62.0±15.0	0.057
Age range/n(%)				0.173
30‒39 years	114 (5.57)	56 (7.26)	58 (4.55)
40‒49 years	362 (17.70)	136 (17.64)	226 (17.74)
50‒59 years	568 (27.78)	213 (27.63)	355 (27.86)
60‒69 years	370 (18.09)	135 (17.51)	235 (18.45)
70‒79 years	332 (16.23)	128 (16.60)	204 (16.01)
80‒89 years	209 (10.22)	76 (9.86)	133 (10.44)
90‒99 years	90 (4.40)	27 (3.50)	63 (4.95)
Hypertension/n(%)	809 (43.68)	235 (34.46)	574 (49.06)	0.000
Diabetes mellitus/n(%)	457 (24.81)	113 (16.64)	344 (29.58)	0.000
Hyperlipidemia/n(%)	330 (18.38)	107 (16.24)	223 (19.63)	0.074
Coronary artery disease/n(%)	213 (11.99)	46 (7.01)	167 (14.90)	0.000
Stroke/n(%)	164 (9.29)	41 (6.26)	123 (11.08)	0.000
COPD/n(%)	52 (2.96)	4 (0.61)	48 (4.35)	0.000
CKD/n(%)	98 (5.56)	24 (3.67)	74 (6.67)	0.008
Malignant tumor/n(%)	384 (21.48)	140 (20.99)	244 (21.77)	0.704
Thyroid nodule/n(%)	452 (25.87)	169 (26.45)	283 (25.54)	0.681
Hyperthyroidism/n(%)	20 (1.13)	6 (0.92)	14 (1.26)	0.512
Hypothyroidism/n(%)	75 (4.24)	43 (6.52)	32 (2.89)	0.000
Rheumatic disease/n(%)	35 (2.00)	16 (2.45)	19 (1.73)	0.302
Anxiety/depression/n(%)	39 (2.22)	13 (1.98)	26 (2.36)	0.673

Variable	Total (n=2 045)	Female (n=771)	Male (n=1 274)	P value
Age/year	61.5±15.2	60.7±15.3	62.0±15.0	0.057
Age range/n(%)				0.173
30‒39 years	114 (5.57)	56 (7.26)	58 (4.55)
40‒49 years	362 (17.70)	136 (17.64)	226 (17.74)
50‒59 years	568 (27.78)	213 (27.63)	355 (27.86)
60‒69 years	370 (18.09)	135 (17.51)	235 (18.45)
70‒79 years	332 (16.23)	128 (16.60)	204 (16.01)
80‒89 years	209 (10.22)	76 (9.86)	133 (10.44)
90‒99 years	90 (4.40)	27 (3.50)	63 (4.95)
Hypertension/n(%)	809 (43.68)	235 (34.46)	574 (49.06)	0.000
Diabetes mellitus/n(%)	457 (24.81)	113 (16.64)	344 (29.58)	0.000
Hyperlipidemia/n(%)	330 (18.38)	107 (16.24)	223 (19.63)	0.074
Coronary artery disease/n(%)	213 (11.99)	46 (7.01)	167 (14.90)	0.000
Stroke/n(%)	164 (9.29)	41 (6.26)	123 (11.08)	0.000
COPD/n(%)	52 (2.96)	4 (0.61)	48 (4.35)	0.000
CKD/n(%)	98 (5.56)	24 (3.67)	74 (6.67)	0.008
Malignant tumor/n(%)	384 (21.48)	140 (20.99)	244 (21.77)	0.704
Thyroid nodule/n(%)	452 (25.87)	169 (26.45)	283 (25.54)	0.681
Hyperthyroidism/n(%)	20 (1.13)	6 (0.92)	14 (1.26)	0.512
Hypothyroidism/n(%)	75 (4.24)	43 (6.52)	32 (2.89)	0.000
Rheumatic disease/n(%)	35 (2.00)	16 (2.45)	19 (1.73)	0.302
Anxiety/depression/n(%)	39 (2.22)	13 (1.98)	26 (2.36)	0.673

Variable	Number of comorbidities							P value
Variable	0	1	2	3	4	5	≥6	P value
Age/n(%)								0.000
30‒39 years	1 (12.5)	12 (12.12)	5 (5.10)	19 (13.77)	13 (7.56)	19 (8.6)	25 (2.26)
40‒49 years	3 (37.5)	14 (14.14)	23 (23.47)	35 (25.36)	48 (27.91)	57 (25.79)	162 (14.63)
50‒59 years	3 (37.5)	38 (38.38)	40 (40.82)	43 (31.16)	52 (30.23)	62 (28.05)	298 (26.92)
60‒69 years	1 (12.5)	15 (15.15)	19 (19.39)	20 (14.49)	24 (13.95)	38 (17.19)	199 (17.98)
70‒79 years	0 (0)	16 (16.16)	9 (9.18)	19 (13.77)	21 (12.21)	15 (6.79)	207 (18.70)
80‒89 years	0 (0)	2 (2.02)	1 (1.02)	2 (1.45)	11 (6.40)	29 (13.12)	142 (12.83)
90‒99 years	0 (0)	2 (1.01)	1 (1.02)	0 (0)	3 (1.74)	1 (0.45)	74 (6.68)
Gender/n(%)								0.043
Female	4 (50.0)	44 (44.44)	29 (29.59)	45 (32.61)	78 (45.35)	87 (39.37)	390 (35.23)
Male	4 (50.0)	55 (55.56)	69 (70.41)	93 (67.39)	94 (54.65)	134 (60.63)	717 (64.77)

Variable	Number of comorbidities							P value
Variable	0	1	2	3	4	5	≥6	P value
Age/n(%)								0.000
30‒39 years	1 (12.5)	12 (12.12)	5 (5.10)	19 (13.77)	13 (7.56)	19 (8.6)	25 (2.26)
40‒49 years	3 (37.5)	14 (14.14)	23 (23.47)	35 (25.36)	48 (27.91)	57 (25.79)	162 (14.63)
50‒59 years	3 (37.5)	38 (38.38)	40 (40.82)	43 (31.16)	52 (30.23)	62 (28.05)	298 (26.92)
60‒69 years	1 (12.5)	15 (15.15)	19 (19.39)	20 (14.49)	24 (13.95)	38 (17.19)	199 (17.98)
70‒79 years	0 (0)	16 (16.16)	9 (9.18)	19 (13.77)	21 (12.21)	15 (6.79)	207 (18.70)
80‒89 years	0 (0)	2 (2.02)	1 (1.02)	2 (1.45)	11 (6.40)	29 (13.12)	142 (12.83)
90‒99 years	0 (0)	2 (1.01)	1 (1.02)	0 (0)	3 (1.74)	1 (0.45)	74 (6.68)
Gender/n(%)								0.043
Female	4 (50.0)	44 (44.44)	29 (29.59)	45 (32.61)	78 (45.35)	87 (39.37)	390 (35.23)
Male	4 (50.0)	55 (55.56)	69 (70.41)	93 (67.39)	94 (54.65)	134 (60.63)	717 (64.77)

Variable	Age group							P for trend
Variable	30‒39 years	40‒49 years	50‒59 years	60‒69 years	70‒79 years	80‒89 years	90‒99 years	P for trend
Hypertension/n(%)	10 (11.49)	77 (24.06)	175 (34.25)	158 (47.59)	176 (57.14)	148 (71.84)	65 (73.86)	0.000
Diabetes mellitus/n(%)	15 (15.63)	37 (11.60)	89 (17.62)	95 (28.27)	102 (33.89)	87 (43.50)	32 (37.65)	0.000
Hyperlipidemia/n(%)	15 (16.30)	71 (22.12)	103 (20.52)	56 (17.55)	48 (16.61)	27 (13.92)	10 (12.82)	0.010
Coronary artery disease/n(%)	0 (0)	7 (2.28)	34 (6.92)	44 (13.88)	39 (13.3)	54 (27.14)	35 (41.67)	0.000
Stroke/n(%)	0 (0)	2 (0.65)	11 (2.25)	19 (6.05)	25 (8.68)	65 (32.83)	42 (50.0)	0.000
COPD/n(%)	0 (0)	0 (0)	2 (0.41)	5 (1.60)	16 (5.59)	13 (6.60)	16 (19.51)	0.000
CKD/n(%)	0 (0)	3 (0.98)	4 (0.82)	6 (1.92)	18 (6.25)	37 (18.69)	30 (35.71)	0.000
Malignant tumor/n(%)	15 (17.24)	30 (9.84)	79 (15.86)	72 (22.50)	102 (34.69)	63 (31.50)	23 (27.38)	0.000
Rheumatic disease/n(%)	1 (1.16)	2 (0.66)	5 (1.02)	8 (2.56)	12 (4.20)	4 (2.12)	3 (3.70)	0.002
Anxiety/depression/n(%)	2 (2.30)	1 (0.33)	3 (0.61)	8 (2.56)	9 (3.11)	9 (4.62)	7 (8.33)	0.000

住院患者慢性病共病现状调查及流行病学分析

Investigation and epidemiological analysis of chronic diseases and comorbidities in hospitalized patients

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Metrics

Variable	Diabetes mellitus	Hyperlipidemia	Coronary artery disease	Stroke	COPD	CKD	Malignant tumor	Rheumatic disease	Anxiety/ depression
Hypertension	0.35^①	0.11^①	0.27^①	0.23^①	0.06^①	0.18^①	0.02	0.04	0.07^①
Diabetes mellitus		0.06^①	0.24^①	0.20^①	0.01	0.19^①	0.06^①	0.06^①	-0.01
Hyperlipidemia			0.11^①	0.10	-0.02	0.08	-0.06^①	-0.02	-0.01
Coronary artery disease				0.21^①	0.10^①	0.19^①	0.01	0.004	0.10^①
Stroke					0.13^①	0.29^①	-0.004	0.03	0.15^①
COPD						0.11^①	0.04	0.03	0.07^①
CKD							0.04	0.04	0.05^①
Malignant tumor								-0.02	0.05^①
Rheumatic disease									0.04

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