2016–2022年湛江市中老年慢性阻塞性肺疾病住院患者共病情况及流行趋势

杜培文; 梁力中; 吴家园; 陈超; 刘美莲; 陈令; 刘韦余; 刘建泽; 曾志嵘

doi:10.16462/j.cnki.zhjbkz.2025.05.012

2016–2022年湛江市中老年慢性阻塞性肺疾病住院患者共病情况及流行趋势

doi: 10.16462/j.cnki.zhjbkz.2025.05.012

1.
广东医科大学公共卫生学院流行病与卫生统计学系，湛江 524023
2.
广东医科大学医疗保障研究院，湛江 524023
3.
广东医科大学附属医院临床试验服务中心，湛江 524001
4.
广东医科大学附属医院肺部肿瘤专科，湛江 524001
5.
广东医科大学公共卫生与健康研究院，东莞 523808

详细信息

通讯作者:
曾志嵘, E-mail: zengzr@gdmu.edu.cn

中图分类号: R563; R181
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出版历程
- 收稿日期: 2024-11-28
- 修回日期: 2025-01-29
- 网络出版日期: 2025-06-28
- 刊出日期: 2025-05-10

Comorbidity patterns and temporal trends in hospitalized middle-aged and elderly patients with chronic obstructive pulmonary disease in Zhanjiang, China, 2016-2022

1.
Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Zhanjiang 524023, China
2.
Institute of Medical Insurance Research, Guangdong Medical University, Zhanjiang 524023, China
3.
Clinical Trial Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
4.
Department of Thoracic Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
5.
Institute of Public Health and Health Research, Guangdong Medical University, Dongguan 523808, China

More Information

Corresponding author: ZENG Zhirong, E-mail: zengzr@gdmu.edu.cn

摘要

摘要: 目的了解2016–2022年湛江市中老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)住院患者的共病情况及流行趋势，为开展区域性COPD共病管理提供参考。方法收集2016–2022年湛江市各级医院230 056例中老年COPD住院患者的电子病案首页数据。采用关联规则分析疾病间关联性，通过计算共病比例年度变化百分比(annual percent change, APC)分析共病流行趋势。结果中老年COPD住院患者的共病比例为90.29%；女性的共病比例(92.33%)高于男性(89.18%)(χ²=594.96, P<0.001)。中老年COPD住院患者中前5位共病依次为高血压、心力衰竭、脑血管病、慢性胃炎和肺源性心脏病。关联规则分析结果显示，高血压(χ²=505.78)、心力衰竭(χ²=164.76)和慢性胃炎(χ²=96.17)等疾病间存在强关联性(均P＜0.05)。湛江市中老年COPD住院患者的共病比例整体呈上升趋势，由2016年的87.03%上升至2022年的93.00%(APC=1.34%, P<0.001)。结论 2016–2022年湛江市中老年COPD住院患者的共病比例较高，呈上升趋势，心脑血管疾病和消化道疾病为主要共病。医疗部门应重视心脑血管疾病和消化道疾病的管理，以减轻主要共病负担。
- 慢性阻塞性肺疾病 /
- 中老年人 /
- 共病 /
- 关联规则 /
- 流行趋势
Abstract: Objective To investigate the comorbidity patterns and temporal trends among hospitalized middle-aged and elderly patients with chronic obstructive pulmonary disease (COPD) in Zhanjiang, China, and to provide evidence for regional management of COPD comorbidities. Methods Data from the electronic medical record front pages of 230 056 middle-aged and elderly COPD patients admitted to hospitals at all levels in Zhanjiang City from 2016 to 2022 were collected. Association rule analysis was used to examine disease associations, and the annual percentage change (APC) of comorbidity proportions was calculated to analyze comorbidity trends. Results The comorbidity rate among hospitalized middle-aged and elderly COPD patients was 90.29%. The comorbidity rate in women was higher (92.33%) than that in men (89.18%) (χ²=594.96, P<0.001). The top five comorbidities were hypertension, heart failure, cerebrovascular disease, chronic gastritis, and cor pulmonale. Association rule analysis revealed significant associations (all P<0.05) among hypertension (χ²=505.78), heart failure (χ²=164.76), and chronic gastritis (χ²=96.17). In Zhanjiang City, the comorbidity rate among these patients showed an increasing trend, rising from 87.03% in 2016 to 93.00% in 2022 (APC=1.34%, P<0.001). Conclusions From 2016 to 2022, middle-aged and elderly COPD hospitalized patients in Zhanjiang City exhibited a high and increasing prevalence of comorbidities, with cardiovascular/cerebrovascular diseases and digestive tract disorders being the predominant concurrent conditions. Medical authorities should prioritize the management of cardiovascular/cerebrovascular diseases and gastrointestinal conditions to alleviate the burden of these major comorbidities.
- Chronic obstructive pulmonary disease /
- Middle-aged and elderly /
- Comorbidity /
- Association rules /
- Temporal trends

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图 1 2016–2022年湛江市中老年COPD住院患者共病比例变化趋势

A：表示未标化的共病比例；B：表示按性别标化后的共病比例；C：表示按年龄标化后的共病比例; COPD：慢性阻塞性肺疾病。

Figure 1. Trend of comorbidity proportion in hospitalized middle-aged and elderly patients with COPD in Zhanjiang City from 2016 to 2022

A: unadjusted comorbidity rate; B: gender-standardized comorbidity rate; C: age-standardized comorbidity rate; COPD: chronic obstructive pulmonary disease.

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图 2 患有不同共病数的中老年COPD住院患者占比变化情况

0种共病：表示仅患有COPD；COPD：慢性阻塞性肺疾病; a: P<0.001; b: P≥0.05。

Figure 2. Proportion of hospitalized middle-aged and elderly COPD patients with different numbers of comorbidities

No comorbidities: indicates having COPD alone without other diseases; COPD: chronic obstructive pulmonary disease; a: P<0.001; b: P≥0.05.

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表 1 研究对象基本特征

Table 1. Composition of basic information

基本信息 Characteristics	总人数 Total^①	年份Year^①
基本信息 Characteristics	总人数 Total^①	2016	2017	2018	2019	2020	2021	2022
例数Number of cases	230 056	23 407	26 507	31 699	37 406	35 605	36 416	39 016
性别Gender
男Male	148 984(64.76)	14 515(62.01)	16 675(62.91)	20 271(63.95)	24 027(64.23)	23 214(65.20)	24 049(66.04)	26 233(67.24)
女Female	81 072(35.24)	8 892(37.99)	9 832(37.09)	11 428(36.05)	13 379(35.77)	12 391(34.80)	12 367(33.96)	12 783(32.76)
年龄组/岁Age group/years
45~<65	31 062(13.50)	3 075(13.14)	3 703(13.97)	4 444(14.02)	5 303(14.18)	5 140(14.44)	4 763(13.08)	4 634(11.88)
≥65	198 994(86.50)	20 332(86.86)	22 804(86.03)	27 255(85.98)	32 103(85.82)	30 465(85.56)	31 653(86.92)	34 382(88.12)
中位年龄/岁Median age/years	77(70, 83)	77(70, 83)	77(70, 83)	77(70, 83)	78(70, 83)	77(69, 84)	77(70, 84)	77(70, 84)
注：①以人数(占比/%)或M(P₂₅, P₇₅)表示。 Note: ① Number of people (proportion/%) or M(P₂₅, P₇₅).

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表 2 湛江市中老年慢性阻塞性肺疾病住院患者共病情况

Table 2. Comorbidity status of middle-aged and elderly hospitalized chronic obstructive pulmonary disease patients in Zhanjiang City

共病情况 Comorbidity	总人数 Total (n=230 056)^①	顺位 Rank	男Male (n=148 984)^①	顺位 Rank	女Female (n=81 072)^①	顺位 Rank	χ²值 value	P值 value
共病Comorbidities	207 712(90.29)	–	132 859(89.18)	–	74 853(92.33)	–	594.96	< 0.001
高血压Hypertension	74 347(32.32)	1	45 737(30.70)	1	28 610(35.29)	1	505.78	< 0.001
心力衰竭Heart failure	69 404(30.17)	2	43 596(29.26)	2	25 808(31.83)	3	164.76	< 0.001
脑血管病Cerebrovascular disease	65 614(28.52)	3	41 477(27.84)	3	24 137(29.77)	4	96.17	< 0.001
慢性胃炎Chronic gastritis	65 458(28.45)	4	38 195(25.64)	4	27 263(33.63)	2	1 646.93	< 0.001
肺源性心脏病Cor pulmonale	50 166(21.81)	5	31 638(21.24)	5	18 528(22.85)	5	80.60	< 0.001
冠心病Coronary heart disease	49 054(21.32)	6	30 585(20.53)	6	18 469(22.78)	6	158.71	< 0.001
心律失常Arrhythmia	35 150(15.28)	7	23 335(15.66)	7	11 815(14.57)	8	48.13	< 0.001
脂蛋白代谢紊乱Disorders of lipoprotein metabolism	26 877(11.68)	8	13 445(9.02)	11	13 432(16.57)	7	2 895.57	< 0.001
脊椎病Spinal disorders	26 085(11.34)	9	14 604(9.80)	9	11 481(14.16)	9	992.38	< 0.001
前列腺疾病Prostatic diseases	22 274(9.68)	10	22 264(14.94)	8	–	–	–	–
慢性肝病Chronic liver disease	20 533(8.93)	11	13 703(9.20)	10	6 830(8.42)	13	38.60	< 0.001
糖尿病Diabetes	20 509(8.91)	12	12 321(8.27)	12	8 188(10.10)	11	216.45	< 0.001
支气管扩张Bronchiectasis	20 131(8.75)	13	11 532(7.74)	13	8 599(10.61)	10	540.16	< 0.001
周围血管疾病Peripheral vascular disease	17 758(7.72)	14	11 363(7.63)	14	6 395(7.89)	14	5.02	< 0.05
贫血Anemia	17 420(7.57)	15	11 155(7.49)	15	6 265(7.73)	15	4.33	< 0.05
痛风Gout	13 901(6.04)	16	10 255(6.88)	16	3 646(4.50)	19	526.49	< 0.001
骨质疏松症Osteoporosis	12 516(5.44)	17	5 509(3.70)	20	7 007(8.64)	12	2 495.81	< 0.001
胆结石Cholelithiasis	12 022(5.23)	18	7 606(5.11)	17	4 416(5.45)	17	12.38	< 0.001
心绞痛Angina	11 410(4.96)	19	5 949(3.99)	18	5 461(6.74)	16	838.01	< 0.001
椎间盘疾病Intervertebral disc disorders	8 572(3.73)	20	4 918(3.30)	21	3 654(4.51)	18	212.90	< 0.001
慢性肾病Chronic kidney disease	7 683(3.34)	21	5 753(3.86)	19	1 930(2.38)	22	356.68	< 0.001
关节病Arthropathy	6 751(2.93)	22	3 737(2.51)	23	3 014(3.72)	20	269.58	< 0.001
肺癌Lung cancer	6 327(2.75)	23	4 561(3.06)	22	1 766(2.18)	23	153.09	< 0.001
甲状腺疾病Thyroid diseases	5 361(2.33)	24	2 704(1.81)	25	2 657(3.28)	21	493.31	< 0.001
慢性鼻咽炎Chronic nasopharyngitis	4 343(1.89)	25	2 762(1.85)	24	1 581(1.95)	24	2.63	0.110
哮喘Asthma	4 058(1.76)	26	2 478(1.66)	26	1 580(1.95)	24	24.72	< 0.001
缺血性心肌病Ischemic cardiomyopathy	3 820(1.66)	27	2 442(1.64)	27	1 378(1.70)	26	1.18	0.280
注：①以人数(占比/%)或M(P₂₅, P₇₅)表示；“–”表示数据无法获取。 Note: ① Number of people (proportion/%) or M(P₂₅, P₇₅); "–" indicates that the date can′t be obtained.

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表 3 关联规则分析

Table 3. Association rule analysis

前项集 Antecedent	后项集 Consequent	支持度 Support/%	置信度 Confidence/%	提升度 Lift	例数 Count
心绞痛Angina	冠心病Coronary heart disease	3.88	78.16	3.67	8 918
心绞痛Angina	心力衰竭Heart failure	4.50	90.74	3.01	10 354
心力衰竭、心绞痛Heart failure, angina	冠心病Coronary heart disease	3.66	81.26	3.81	8 414
高血压、心绞痛Hypertension, angina	冠心病Coronary heart disease	2.29	80.22	3.76	5 261
慢性胃炎、心绞痛Chronic gastritis, angina	冠心病Coronary heart disease	2.11	79.61	3.73	4 854
冠心病、心绞痛Coronary heart disease, angina	心力衰竭Heart failure	3.66	94.35	3.13	8 414
慢性胃炎、心绞痛Chronic gastritis, angina	心力衰竭Heart failure	2.45	92.27	3.06	5 626
高血压、心绞痛Hypertension, angina	心力衰竭Heart failure	2.64	92.44	3.06	6 062
高血压、心力衰竭、心绞痛Hypertension, heart failure, angina	冠心病Coronary heart disease	2.18	82.70	3.88	5 013
慢性胃炎、心力衰竭、心绞痛Chronic gastritis, heart failure, angina	冠心病Coronary heart disease	2.02	82.62	3.87	4 648
慢性胃炎、脑血管病、心力衰竭Chronic gastritis, cerebrovascular disease, heart failure	冠心病Coronary heart disease	2.35	67.73	3.18	5 405
慢性胃炎、冠心病、心绞痛Chronic gastritis, coronary heart disease, angina	心力衰竭Heart failure	2.02	95.76	3.17	4 648
高血压、冠心病、心绞痛Hypertension, coronary heart disease, angina	心力衰竭Heart failure	2.18	95.29	3.16	5 013
高血压、慢性胃炎、心力衰竭Hypertension, chronic gastritis, heart failure	冠心病Coronary heart disease	2.91	66.05	3.10	6 699
高血压、脑血管病、心力衰竭Hypertension, cerebrovascular disease, heart failure	冠心病Coronary heart disease	3.19	65.59	3.08	7 333

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