上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 6: 778 - 785

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.06.012

论著 · 临床研究

基于真实世界的缺血性心脑血管共患疾病的临床特征及卫生经济学评价

  • 谢依热·哈木拉提null ,
  • 赵倩 ,
  • 李丞 ,
  • 宋宁 ,
  • 王颖 ,
  • 古丽洁合热·吐尔逊null ,
  • 卜军 ,
  • 杨毅宁 ,
  • 李晓梅
展开
  • 1.新疆医科大学第一附属医院心脏中心，乌鲁木齐 830054
    2.上海交通大学医学院附属仁济医院心内科，上海 200127
    3.新疆维吾尔自治区人民医院心内科，乌鲁木齐 830001
谢依热·哈木拉提（1995—），女，维吾尔族，硕士生；电子信箱：905368281@qq.com。
李晓梅，电子信箱：lixm505@163.com。

收稿日期: 2022-02-10

  录用日期: 2022-04-28

  网络出版日期: 2022-08-19

基金资助

国家重点研发计划(2018YFC1312804)

收起

Clinical characteristics and health economics evaluation of real-world-based ischemic cardiovascular and cerebrovascular co-morbidities

  • Xieyire·HAMULATI ,
  • Qian ZHAO ,
  • Cheng LI ,
  • Ning SONG ,
  • Ying WANG ,
  • Gulijiehere·TUERXUN ,
  • Jun PU ,
  • Yining YANG ,
  • Xiaomei LI
Expand
  • 1.Heart Center of the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
    2.Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    3.Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
LI Xiaomei, E-mail: lixm505@163.com.

Received date: 2022-02-10

  Accepted date: 2022-04-28

  Online published: 2022-08-19

Supported by

National Key Research and Development Program of China(2018YFC1312804)

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摘要

目的·探讨缺血性心脑血管共患疾病的临床特征、住院天数延长的实际影响因素。方法·利用电子病历（electronic medical record，EMR）选取新疆医科大学第一附属医院2009年12月—2020年6月首次就诊并诊断为冠心病（coronary artery heart disease，CHD）或脑血管疾病的患者，根据其诊断分为冠心病组、脑血管病组、共患组，回顾分析比较各组的临床资料、住院费用及住院天数，比较各组不同费用与住院总费用之间的相关性，采用Logistic回归分析影响住院天数延长的因素。结果·研究共纳入22 216例患者。与单患组相比，共患组患者年龄较大，为（67±9）岁，且高血压、房颤患病率较高，分别为75.4%、9.0%；低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-Ch）、白细胞（white blood cell，WBC）、血红蛋白（hemoglobin，Hb）水平高（均P<0.05）。CHD组男性占比高（65.8%，P=0.000），有吸烟、饮酒习惯的患者占比高为37.2%和23.5%，且糖尿病、血脂异常患病率高，分别为43.8%、64.0%（均P<0.05）。在住院费用方面，共患组耗材费与住院总费用之间相关性较强（P=0.000），共患病的发生导致耗材费和自费费用增加。多因素Logistic回归分析显示，性别（男性）（OR=1.158，95%CI 1.004~1.336，P=0.045）、年龄（≥65岁）（OR=1.317，95%CI 1.112~1.559，P=0.000）、血脂异常（OR=1.361，95%CI 1.167~1.586，P=0.000）均与住院天数延长存在一定相关性（均P<0.05）。患者血压升高、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-Ch）降低、患有房颤会增加住院天数。结论·心脑血管共患疾病患者具有年龄大，血压高，房颤患病率高，以及LDL-Ch、WBC、Hb水平较高的特点。而男性、年龄增长、血脂异常为影响心脑血管共患病患者住院天数延长的主要危险因素。

关键词： 心血管病; 脑血管病; 卫生经济学评价; 临床特征; 真实世界研究

本文引用格式

谢依热·哈木拉提null , 赵倩 , 李丞 , 宋宁 , 王颖 , 古丽洁合热·吐尔逊null , 卜军 , 杨毅宁 , 李晓梅 . 基于真实世界的缺血性心脑血管共患疾病的临床特征及卫生经济学评价[J]. 上海交通大学学报（医学版）, 2022 , 42(6) : 778 -785 . DOI: 10.3969/j.issn.1674-8115.2022.06.012

Abstract

Objective

·To investigate the clinical characteristics of ischemic cardiovascular and cerebrovascular co-morbidities and the actual factors influencing the extension of hospitalization days.

Methods

·Patients with first diagnosis of coronary artery heart disease (CHD) or cerebrovascular disease in the First Affiliated Hospital of Xinjiang Medical University from December 2009 to June 2020 were selected as participants by retrieving electronic medical record (EMR) and divided into CHD group, cerebrovascular disease group, and cardiovascular and cerebrovascular co-morbidities group. Retrospective analysis was performed to compare the characteristics, hospitalization days and costs of each group, and compare the correlation between different costs and total hospitalization costs in each group. Logistic regression analysis was used to explore the influencing factors associated with hospitalization days extension.

Results

·A total of 22 216 patients were selected. Compared with single-disease groups, the patients in the comorbid group were older [(67±9) years] and had a higher prevalence of hypertension and atrial fibrillation, 75.4% and 9.0%, respectively; low-density lipoprotein cholesterol (LDL-Ch), leukocyte, and hemoglobin (Hb) levels were the highest (all P< 0.05). CHD group had a higher proportion of males (65.8%, P=0.000), 37.2% and 23.5% of patients with smoking and drinking habits,and high prevalence of diabetes and dyslipidemia, 43.8% and 64.0%, respectively (all P<0.05). In terms of hospitalization costs, the total hospital costs had a stronger correlation with consumables costs in the cardiovascular and cerebrovascular co-morbidity group (P=0.000). The occurrence of co-morbidities led to increased costs for supplies and out-of-pocket expenses. Multifactorial Logistic regression analysis showed that gender (OR=1.158,95%CI 1.004?1.336, P=0.045), age (OR=1.317,95%CI 1.112?1.559, P=0.000) and prevalence of dyslipidemia (OR=1.361, 95%CI 1.167?1.586, P=0.000) all correlated with longer hospitalization days (all P<0.05). Elevated blood pressure, higher low-density lipoprotein, and atrial fibrillation prevalence increased the number of hospital days in the cardiovascular and cerebrovascular co-morbidities group.

Conclusion

·Patients with cardiovascular and cerebrovascular co-morbidities are characterized by older age, high prevalence of hypertension and atrial fibrillation, as well as higher LDL-Ch, WBC, and Hb levels. The male age, and prevalence of dyslipidemia are the main risk factors that mainly influence the extension of hospitalization days in patients with cardiovascular and cerebrovascular co-morbidities.

Key words： cardiovascular disease; cerebrovascular disease; health economic evaluation; clinical characteristic; real-world study

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