中国老年疾病临床多中心报告

Clinical multi-centers report of chronic diseases among elderly inpatients in China

摘要:

目的 通过分析解放军总医院等5个临床中心老年住院患者近十年的疾病谱的变化趋势及多重用药和医疗支出情况,旨在为老年共病患者的防治提供技术指导与客观评价。方法 收集2008年~2017年解放军总医院等5个临床中心老年住院患者的入院诊断等临床资料,按年龄及性别分类统计分析老年患者(≥65岁)前5位疾病的种类、构成比,多器官功能衰竭,口服用药,住院花费及十年变化趋势。结果 共纳入370996例老年患者资料(694138人次),平均年龄72.25岁。近十年老年住院人次呈逐年递增趋势,平均年增长率高达27.48%；恶性肿瘤(37.18%)、高血压病(36.69%)、缺血性心脏病(29.18%)、糖尿病(20.75%)、脑血管疾病(13.19%)是位居前五位的主要住院患病；老年住院共病的比例高达91.36%,其中,缺血性心脏病合并高血压居于首位,而恶性肿瘤合并高血压近三年间增长速度较快,年均增长达42.99%。老年住院患者中5种以上多重用药比例占43.88%。结论 (1)随着人口老龄化,老年住院患者迅速增加,老年慢病和共病尤为突出；(2)针对老年共病的发生率高及多重用药现状,需加强多学科联合诊疗和综合管理,制定合理用药方案以及策略；(3)恶性肿瘤仍是院内死亡的首要原因,提高早诊率和生存率、促进医疗资源的均质化是我国老年疾病防控重点。

Abstract:

Objective To assess the multimorbidity spectrum, multiple organ dysfunction, polypharmacy and expenditure among elderly inpatients from five clinical centers (Chinese PLA General Hospital, etc) over last 10 years,so as to provide technical guidance and objective evaluation for the study of prevention and treatment of multimorbidity. Methods Data were collected from elderly in-patients aged over 65 years form five clinical centers in China from January 2008 to December 2017. We further assessed multimorbidity spectrum, mortality, polypharmacy,expenditure among the elderly inpatients classified by gender and age over the decade.Results There were 370 996 inpatients enrolled in this study and the total number of hospitalizations reached 694 138. The average age of patients was 72.25 years. The number of elderly inpatients has increased significantly over the last decade, and the average annual growth rate was 27.48%. Malignant tumors(37.18%), hypertension(36.69%), ischemic heart disease(29.18%), diabetes mellitus (20.75%) and cerebrovascular diseases (13.19%) ranked top of the list.Ischemic heart disease with hypertension was the most prevalent comorbidity disease, and malignant tumors with hypertension increased with the annual rate of 42.99%.The proportion of taking more than 5 kinds of medications reached 43.88%. Conclusion (1) The problem of chronic diseases and comorbidity are prominent in the elderly with the ageing of the population. (2)We should strengthen multidisciplinary joint diagnosis and make reasonablemedication and treatment strategies for chronic diseases in the elderly, including ischemic heart disease, hypertension, malignant tumors, diabetes, etc. (3)Malignant tumor is the first cause of in-hospital death, therefore it′s important to facilitate early diagnosis and increase survival rate, and improve consistency of medical resources.