哮喘联盟

   摘要
   背景：如何降低再次入院率是引起许多相关人士关注的话题。但是，成人因哮喘入院后30天的再次入院特征仍然是未知的。老年人为何有更高的30天再入院率也不清楚。
   目的：为了调查患哮喘的成人30天再入院的比率、时机以及主要诊断，还有为了判断年龄相关的差异。
   方法：使用从2005年到2011年间三个州(加利福尼亚, 佛罗里达和内布拉斯加州)基于人群的住院患者样本进行的关于成人因哮喘发作住院就医的回顾性队列研究。患者被分为3个年龄组：青年(18-39 岁),中年（40-64岁）和老年(≥65 岁)成人。结果为30天的全因再入院率、时机以及再入院的主要诊断。
   结果：在301,164例有30天再入院风险的哮喘相关患者中，再入院率为14.5%。与年轻人相比，老年人的再入院率显著增高(10.1% vs. 16.5%; OR, 2.15 [95%CI, 2.07-2.23]; P<0.001)。通过校正对较高的比率进行稀释(OR, 1.19 [95%CI, 1.13-1.26]; P<0.001)表明绝大多数的年龄相关的差异可以用社会人口统计资料和并发症来解释。在所有的年龄组中，出院后第一周的再入院率是最高的，此后会逐渐降低。总的来说，仅有47.1%的再入院者是由于呼吸系统的诊断（哮喘、COPD、肺炎和呼吸衰竭）。因非呼吸系统诊断再入院的老年人更多(41.7% vs. 53.8%; P<0.001)。
   结论：因哮喘相关因素入院后，14.5%的患者会因为各种主要诊断而在30天内再入院。与年轻人相比，老年患者30天再入院的比率更高并且因非呼吸系统的诊断再入院的比例更高。

 

（杨冬 审校）
Chest.2016 Jan 21.pii: S0012-3692(16)00467-0. doi: 10.1016/j.chest.2015.12.039. [Epub ahead of print]


 

Age-related differences in the rate, timing, and diagnosis of 30-day readmissions in hospitalized adultswithasthma exacerbation.
 

Hasegawa K1, Gibo K2, Tsugawa Y3, Shimada YJ4, Camargo CA Jr5.
 

Abstract
BACKGROUND:Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission.
OBJECTIVES:To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with asthma and to determine age-related differences.
METHODS:Retrospective cohort study of adults hospitalized for asthma exacerbation using the population-based inpatient samples of 3 states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into 3 age groups: younger (18-39 years), middle-age (40-64 years) and older (≥65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission.
RESULTS:Of 301,164 asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared to younger adults, older adults had significantly higher readmission rates (10.1% vs. 16.5%; OR, 2.15 [95%CI, 2.07-2.23]; P<0.001). The higher rate attenuated with adjustment (OR, 1.19 [95%CI, 1.13-1.26]; P<0.001), indicating that most of the age-related difference is explained by sociodemographics and comorbidities. For all age groups, readmission rate was highest in the first week after discharge and declined thereafter. Overall, only 47.1% of readmissions were assigned respiratory diagnoses (asthma, COPD, pneumonia, and respiratory failure). Older adults were more likely to present with non-respiratory diagnoses (41.7% vs. 53.8%; P<0.001).
CONCLUSIONS:After asthma-related admission, 14.5% had 30-day readmission with wide range of principal diagnoses. Compared to younger adults, older adults had higher 30-day readmission rates and proportions of non-respiratory diagnoses.
 

Chest.2016 Jan 21.pii: S0012-3692(16)00467-0. doi: 10.1016/j.chest.2015.12.039. [Epub ahead of print]