【摘要】 目的利用全国城镇医疗保险数据库探讨我国≥55岁髋部骨折患者共患疾病的特点,为完善髋部骨折的防治提供证据支持,并探索基于医疗保险数据库开展共患疾病研究的思路。方法从2012-2016年全国城镇职工基本医疗保险和城镇居民基本医疗保险数据库中,识别年龄≥55岁的髋部骨折患者,提取患者的人口学特征、主要和次要诊断名称和编码等。利用自然语言处理技术进行分词,再由研究人员根据《中华人民共和国国家标准疾病分类与代码》进行"归一化"处理,描述患者前50位共患疾病情况并计算Charlson共患疾病指数(charlson comorbidity index,CCI)。结果 190 560例患者的平均年龄为(74.44±8.95)岁,63.99%为女性患者。高血压是最常见的共患疾病(23.59%),其次是急性上呼吸道感染(22.19%)、脑梗死(15.29%)、冠状动脉粥样硬化性心脏病(12.60%)等。对于前50位共患疾病,34.98%的患者没有共患疾病,18.50%的患者合并1种疾病,合并2种及以上占46.52%。最常见的疾病合并模式为髋部骨折+脑梗死(3.44%),其次为髋部骨折+高血压(3.24%)。女性患者的共患疾病数量多于男性,男性患者人数随着共患疾病数量的增加略呈上升趋势;汉族(66.62%)和华东地区(70.50%)患者并发共患疾病的比例较高。CCI评分方面,全部患者中位CCI为1 (0,1)分,97.58%患者的CCI集中在0～3分;男性患者、65～74岁年龄组、华东地区、汉族患者的CCI得分较高(P<0.05)。结论我国≥55岁髋部骨折患者合并共患疾病的现象较为普遍,特别是对合并多种共患疾病情况需要引起重视。在制定髋部骨折患者治疗方案时,应充分考虑共患疾病,同时应适当重视男性患者。更多还原

【Abstract】 Objective To estimate the characteristics of comorbidities in hip fracture patients aged 55 years and older in China by using the national insurance database,and to provide evidence for improving the prevention and treatment of hip fractures.Further to explore new methods of conducting comorbidity studies with insurance database.Methods A retrospective study was conducted by using the Urban Employee Basic Medical Insurance(UEBMI) database and Urban Resident Basic Medical Insurance(URBMI) database from 2012 to 2016.Patients with hip fractures and aged 55 years and older were identified from the database.Demographic characteristics,International Classification of Diseases(ICD) code,and name of primary and secondary diagnosis names were extracted.Natural language processing(NLP)was used to perform word segmentation and normalized by Chinese classification and codes of diseases.Then,we described the patient’ s top 50 comorbidities and calculated the charlson comorbidity index(CCI).Results Totally 190 560 patients were identified in our study.The mean age was(74.44±8.95) years old,and 63.99% were female.Hypertension is the most common comorbidity(23.59%),followed by acute upper respiratory infections(22.19%),cerebral infarction(15.29%),coronary atherosclerotic heart disease(12.6%),and so on.For the first 50 diseases,only34.98% of patients did not have comorbidity,followed by 18.50% of patients with 1 comorbidity,and 46.52% with 2 or more comorbidities.The most common comorbidity pattern was hip fracture + cerebral infarction(3.44%),followed by hip fracture + hypertension(3.24%).Although female had more comorbidities than male,the number of male patients increased slightly with the increase of the number of comorbidities,the proportion of Han(66.62%) and Eastern area(70.50%) patients with comorbidities was higher.In terms of charison comorbidity index(CCI) scores,the median CCI of all patients was 1(0,1) score,and 97.58% of patients’ CCI was concentrated at 0 to 3 scores.The CCI scores of male patients,65-74 age group,eastern area,and Han patients were higher(P <0.05).Conclusions Comorbidities are common in hip fracture patients aged 55 years and older in China,and special attention needs to be paid on patients with multiple comorbidities.When developing a treatment plan for patients with hip fractures,full consideration should be given to comorbidities,male patients with hip fracture should be paid more attention at the same time.更多还原