Associations of frailty with health care costs--results of the ESTHER cohort study.
Associations of frailty with health care costs--results of the ESTHER cohort study.
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DOI：
10.1186/s12913-016-1360-3
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发表时间：
2016-04-14
影响因子：
2.8
通讯作者：
Heider D
中科院分区：
文献类型：
--
作者：
Bock JO;König HH;Brenner H;Haefeli WE;Quinzler R;Matschinger H;Saum KU;Schöttker B;Heider D
虚弱的概念作为一种独立的综合征在老年人中的高患病率正在迅速获得关注。因此，虚弱往往与某些不良后果有关，如死亡或残疾。讨论的另一个不利结果是增加了医疗保健的利用。然而，只有少数研究探讨了脆弱性对卫生保健利用和相应费用的影响。因此，本研究的目的是全面调查之间的关系脆弱，卫生保健利用和成本。使用了2008年至2010年期间在德国萨尔兰招募的2598名老年参与者（57-84岁）的横断面数据。参与者通过了老年评估，其中包括弗里德的五个脆弱标准：虚弱，缓慢，疲惫，无意减肥和身体活动不足。住院治疗、门诊治疗、药品和护理部门记录了医疗保健利用情况。虚弱（≥3种症状）的患病率为8.0%。虚弱参与者的平均3个月总费用为3659欧元（4或5个症状）和1616欧元（3个症状），而非虚弱参与者（无症状）为642欧元。在多元回归模型中控制合并症和一般社会人口统计学特征，虚弱和非虚弱参与者之间的总成本差异仍然达到1917欧元; p <0.05（4或5个症状）和680欧元; p <0.05（3个症状）。在控制共病后，在虚弱的5个症状中，体重减轻和疲惫与总费用显著相关。这项研究提供了证据表明，虚弱与增加的医疗保健费用有关。分析进一步表明，虚弱是独立于纯年龄和合并症的医疗保健费用的一个重要因素。费用主要归因于虚弱（和合并症），而不是年龄。这强调了多重死亡和虚弱的重叠概念对于解释老年人的医疗保健使用和相应费用都是必要的。本文的在线版本（doi：10.1186/s12913-016-1360-3）包含补充材料，可供授权用户使用。
The concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults. Thereby, frailty is often related to certain adverse outcomes like mortality or disability. Another adverse outcome discussed is increased health care utilization. However, only few studies examined the impact of frailty on health care utilization and corresponding costs. The aim of this study was therefore to investigate comprehensively the relationship between frailty, health care utilization and costs. Cross sectional data from 2598 older participants (57–84 years) recruited in the Saarland, Germany, between 2008 and 2010 was used. Participants passed geriatric assessments that included Fried’s five frailty criteria: weakness, slowness, exhaustion, unintentional weight loss, and physical inactivity. Health care utilization was recorded in the sectors of inpatient treatment, outpatient treatment, pharmaceuticals, and nursing care. Prevalence of frailty (≥3 symptoms) was 8.0 %. Mean total 3-month costs of frail participants were €3659 (4 or 5 symptoms) and €1616 (3 symptoms) as compared to €642 of nonfrail participants (no symptom). Controlling for comorbidity and general socio-demographic characteristics in multiple regression models, the difference in total costs between frail and non-frail participants still amounted to €1917; p < .05 (4 or 5 symptoms) and €680; p < .05 (3 symptoms). Among the 5 symptoms of frailty, weight loss and exhaustion were significantly associated with total costs after controlling for comorbidity. The study provides evidence that frailty is associated with increased health care costs. The analyses furthermore indicate that frailty is an important factor for health care costs independent from pure age and comorbidity. Costs were rather attributable to frailty (and comorbidity) than to age. This stresses that the overlapping concepts of multimorbidity and frailty are both necessary to explain health care use and corresponding costs among older adults. The online version of this article (doi:10.1186/s12913-016-1360-3) contains supplementary material, which is available to authorized users.