Prevalence, incidence, and outcomes across cardiovascular diseases in homeless individuals using national linked electronic health records.
Prevalence, incidence, and outcomes across cardiovascular diseases in homeless individuals using national linked electronic health records.
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DOI：
10.1093/eurheartj/ehaa795
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发表时间：
2020-11-01
影响因子：
39.3
通讯作者：
Banerjee A
中科院分区：
文献类型：
--
作者：
Nanjo A;Evans H;Direk K;Hayward AC;Story A;Banerjee A
无家可归者的心血管疾病 (CVD) 风险和负担高于有住房的人，但缺乏基于人群的分析。本研究的目的是调查无家可归者中一系列特定心血管疾病的患病率、发病率和结果。利用关联的英国初级保健电子健康记录 (EHR) 和经过验证的表型，我们确定了 1998 年至 2019 年间年龄≥16 岁的无家可归者，以及按 1:5 比例进行年龄和性别匹配的居住对照。对于 12 种 CVD（稳定型心绞痛、不稳定型心绞痛、心肌梗塞、心源性猝死或心脏骤停、未预见的冠心病死亡、心力衰竭、短暂性脑缺血发作、缺血性中风、蛛网膜下腔出血、脑出血、外周动脉疾病、腹主动脉瘤），我们评估了诊断后的患病率、发生率和 1 年死亡率，比较了无家可归者和有家可归者群体。我们确定了 8492 名无家可归者（32 134 名匹配的有住房者）。合并症和危险因素在无家可归者中更为普遍，例如吸烟：78.1% vs. 48.3%，房颤：9.9% vs. 8.6%，P < 0.001。 CVD患病率（11.6% vs. 6.5%）、发病率（14.7 vs. 8.1/1000人年）和1年死亡风险[调整后危险比1.64，95%置信区间（CI）1.29–2.08，P < 0.001]较高，且发病较早（差异4.6，95% CI） 2.8–6.3 年，P<0.001），与有住房的人相比，无家可归者。无家可归者在所有三个动脉区域的 CVD 发病率均高于有住房者。无家可归者的 CVD 患病率、发病率和诊断后 1 年死亡风险较高，且发病较早，且危险因素负担较高。包容性健康和社会关怀战略应反映这种可预防和可治疗的沉重负担，这在当前的 COVID-19 背景下变得越来越重要。
The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals but population-based analyses are lacking. The aim of this study was to investigate prevalence, incidence and outcomes across a range of specific CVDs among homeless individuals. Using linked UK primary care electronic health records (EHRs) and validated phenotypes, we identified homeless individuals aged ≥16 years between 1998 and 2019, and age- and sex-matched housed controls in a 1:5 ratio. For 12 CVDs (stable angina; unstable angina; myocardial infarction; sudden cardiac death or cardiac arrest; unheralded coronary death; heart failure; transient ischaemic attack; ischaemic stroke; subarachnoid haemorrhage; intracerebral haemorrhage; peripheral arterial disease; abdominal aortic aneurysm), we estimated prevalence, incidence, and 1-year mortality post-diagnosis, comparing homeless and housed groups. We identified 8492 homeless individuals (32 134 matched housed individuals). Comorbidities and risk factors were more prevalent in homeless people, e.g. smoking: 78.1% vs. 48.3% and atrial fibrillation: 9.9% vs. 8.6%, P < 0.001. CVD prevalence (11.6% vs. 6.5%), incidence (14.7 vs. 8.1 per 1000 person-years), and 1-year mortality risk [adjusted hazard ratio 1.64, 95% confidence interval (CI) 1.29–2.08, P < 0.001] were higher, and onset was earlier (difference 4.6, 95% CI 2.8–6.3 years, P < 0.001), in homeless, compared with housed people. Homeless individuals had higher CVD incidence in all three arterial territories than housed people. CVD in homeless individuals has high prevalence, incidence, and 1-year mortality risk post-diagnosis with earlier onset, and high burden of risk factors. Inclusion health and social care strategies should reflect this high preventable and treatable burden, which is increasingly important in the current COVID-19 context.
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