Anaemia and the risk of injurious falls in a community-dwelling elderly population
Anaemia and the risk of injurious falls in a community-dwelling elderly population
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DOI：
10.2165/00002512-200825040-00005
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发表时间：
2008-01-01
期刊：
影响因子：
2.8
通讯作者：
Piech, Catherine Tak
中科院分区：
文献类型：
--
作者：
Duh, Mei Sheng;Mody, Samir H.;Piech, Catherine Tak
背景：老年人贫血与许多与健康相关的功能衰退有关，如虚弱、残疾和肌肉无力。这些可能会导致跌倒，在老年人中，大约10%的病例会导致严重伤害。目的：探讨贫血是否会增加老年人受伤性跌倒的风险。方法：对1999年1月至2004年4月参加30岁以上管理式医疗保健计划的47 530名65岁以上老年人的医疗保险索赔和实验室检查数据进行分析。采用开放队列设计，根据贫血状态（基于世卫组织定义）和血红蛋白（Hb）水平类别对患者的观察期进行分类。伤害性跌倒结果定义为在跌倒索赔后30天内，髋部/骨盆/股骨、椎骨/肋骨、肱骨或下肢骨折的伤害事件索赔；柯雷氏骨折的骨折;或头部受伤/血肿。进行单因素和多因素（调整年龄、性别、健康计划、跌倒史、合并症和伴随用药）分析。还进行了基于髋部和头部损伤性跌倒的子集分析。结果：在单因素分析中，与无贫血相比，贫血使伤害性跌倒的风险增加1.66倍（95% CI 1.41, 1.95）。当Hb水平从13 g/dL降至< 10 g/dL时，伤害性跌倒的发生率从每1000人年6.5例增加到15.8例（趋势检验：p < 0.001）。多因素分析证实，Hb水平与伤害性跌倒风险显著相关（Hb水平= 13 g/dL的比率分别为1.47、1.39和1.14,p < 0.001）。在髋部和头部损伤性跌倒的亚群中观察到更强的线性负趋势。结论：贫血与伤害性跌倒风险增加显著且独立相关。此外，随着贫血程度的恶化，摔伤的风险也在增加。贫血是一种可改变的危险因素，纠正贫血作为预防老年人跌倒的一种手段值得进一步研究。
Background: Anaemia in the elderly is associated with a number of health-related functional declines, such as frailty, disability and muscle weakness. These may contribute to falls which, in the elderly, result in serious injuries in perhaps 10% of cases.Objective: To investigate whether anaemia increases the risk of injurious falls in an elderly population.Method: Health insurance claims and laboratory test results data from January 1999 to April 2004 for 47 530 individuals >= 65 years of age enrolled in over-30 managed care plans were analysed. An open-cohort design was employed to classify patients' observation periods by anaemia status (based on the WHO definition) and haemoglobin (Hb) level category. Injurious falls outcomes were defined as an injurious event claim, within 30 days after a fall claim, for fractures of the hip/pelvis/femur, vertebrae/ribs, humerus or lower limbs; Colles' fracture; or head injuries/haematomas. Univariate and multivariate (adjusted for age, gender, health plan, history of falls, co-morbidities and concomitant medications) analyses were conducted. Subset analyses based on injurious falls of the hip and head were also conducted.Results: In the univariate analysis, anaemia increased the risk of injurious falls by 1.66 times (95% CI 1.41, 1.95) compared with no anaemia. The incidence of injurious falls increased from 6.5 to 15.8 per 1000 person-years when Hb levels decreased from >= 13 to < 10 g/dL (trend test: p < 0.001). Multivariate analysis confirmed that Hb levels were significantly associated with the risk of injurious falls (rate ratio = 1.47, 1.39 and 1.14 for Hb levels of = 13 g/dL; p < 0.001). Even stronger linear negative trends were observed in the subsets of hip and head injurious falls.Conclusion: Anaemia was significantly and independently associated with a risk increase for injurious falls. Furthermore, the risk of injurious falls increased as the degree of anaemia worsened. Correction of anaemia, a modifiable risk factor, warrants further investigation as a means of preventing falls in the elderly.