Incidence of coexistence of multiple diseases in patients over 65 years of age and its impact on the risk of death in hospital / 公共卫生与预防医学

ABSTRACT

Objective To investigate the incidence of multiple disease coexistence in emergency department patients over 65 years old and its impact on the risk of death in hospital, so as to provide theoretical basis for reducing the risk of death in emergency department patients over 65 years old. Methods From January 2019 to January 2020, elderly patients over 65 years old who received emergency treatment in our hospital were selected as subjects to analyze the coexistence of multiple diseases. The information of current disease, blood pressure, blood glucose level and other potential influencing factors, as well as the incidence of hospitalization after emergency treatment were collected, and the factors influencing the risk of death in hospital were analyzed and discussed. Results During the study period, there were 1 195 patients over 65 years old, including 469 patients with multi-disease coexistence (excluding malignant tumors), with an incidence rate of 39.25%. Among the elderly patients in the emergency department, the top four diseases with multiple coexisting diseases are as follows ischemic stroke (43.92%), acute myocardial infarction (24.95%), hemorrhagic stroke (16.84%), and falls (11.30%). In addition, “ischemic stroke + hypertension + diabetes + coronary heart disease” accounted for the highest proportion (42.22%) in the combination of multi-disease coexisting diseases, followed by "myocardial infarction + ischemic stroke + hypertension + Diabetes + coronary heart disease” (21.11%), and the third in the composition ratio was “fall + ischemic stroke + hypertension + diabetes + coronary heart disease” (0.66%). Among the 469 patients with multi-disease coexistence, a total of 68 died during hospitalization after emergency department; 469 patients were divided into two groups the dead and the survivors, and the potential factors affecting the risk of death were analyzed. The multivariate regression analysis showed that male (OR=1.485 , P<0.001), age over 80 years (OR=3.090, P<0.05), more than four types of comorbidities (OR=4.407, P<0.001), BMI level showed weight loss (OR=4.366, P<0.001) and Comorbidities included hypertension (OR=3.564, P<0.001) as a potential risk factor, which would increase the risk of death; while normal blood pressure (OR=0.581, P<0.001) might potentially reduce the risk of death. Conclusion Special attention should be paid to the elderly patients over 65 years old who are male, over 80 years old, thin and with many types of comorbidities (more than four types), especially those with hypertension at the same time, in order to reduce hospitalization after emergency department risk of death during the period.