昆明市60岁及以上老年人伤害住院特征及未治愈影响因素分析

Characteristics of injury elderly inpatients and factors influencing un-healing in Kunming City

目的分析昆明市老年人伤害住院的流行特征及影响未治愈的因素,为伤害的预防控制提供科学依据。方法整群抽取昆明市6所医院2003—2007年间因伤害首诊住院的≥60岁老年人,收集住院病案资料,采用描述性流行病学方法分析病例人口学特征、伤害住院类型、伤害外因、意外事故原因等,并采用logistic逐步回归法对未治愈的影响因素进行多因素分析。结果 5年间因伤害住院老年人共6 966例;男女分别为5 743和1 223例。住院天数中位数为16 d。伤害住院类型首位为损伤,60~69、70~79、≥80岁3个年龄组损伤者分别占各年龄组伤害总病例的85.4%（2 616/3 064）,86.1%（2 333/2 711）和91.2%（1 086/1 191）;各年龄组损伤部位的构成有差异,60~69岁损伤部位以＂头部＂为主（34.5%）,而70~79岁和≥80岁以＂腿部＂为主,分别为38.6%和46.4%。伤害外因以意外事故为主（95.8%）,各年龄组的意外事故原因的构成首位均是跌落,3个年龄组分别为44.1%、60.6%和70.4%。伤害转归中治愈占56.8%,未完全治愈占43.2%,其中3.9%死亡。Logistic逐步回归分析结果显示伤害住院时间越长者的未治愈风险越小（OR=0.992 2）;年龄越大者、有手术患者的未治愈的风险越大（OR=1.027 2、2.072 7）;入院情况一般者比入院情况危重患者、跌落患者较交通伤害的未治愈的风险小（OR=0.837 3、0.843 5）;颈部损伤患者较头部的未治愈风险大（OR=3.412 0）（P〈0.05或P〈0.01）。结论昆明市受调查的老年伤害住院患者以损伤为主,损伤部位多为头部和腿部,原因以意外事故为主。年龄、住院天数、手术、入院情况、损伤部位和事故原因等可能是伤害住院患者未治愈的影响因素。

Objective To analyze the epidemiological characteristics among injury inpatients aged over 60 years old for prevention and control.Methods Data of injury inpatients from 2003 to 2007 were collected in 6 hospitals in Kunming City.Descriptive epidemiological method is used to analyze demographic characteristics,type of injuries,external causes,accidents and other causes of cases.ICD-10 coding was used for injury classification.Meanwhile descriptive and multivariable analyses（logistic regression） were conducted to analyze the prognosis of inpatients with injuries and possible influencing un-healing factors. Results A total of 6 966 injury elderly patients were hospitalized,including 5 743 males and 1 223 females.Trauma was the number one of injuries in three age groups of 60-69,70-79,and ≥80 years,with ratio 85.4%（2 616/3 064）,86.1%（2 333/2 711） and 91.2%（1 086/1 191）,respectively.Unintentional injuries were the primary cause resulting in the aged inpatients accounting for 95.8%.There were distinct differences among three groups for injury positions.Mainly injury positions were heads in the 60-69 age group（34.5%）,and legs in the 70-79 and ≥80 age groups（38.6% and 46.4%）.The principal type of unexpected accidents was falling in 3 age groups（44.1%,60.6 % and 70.4%,respectively）.The ratio of un-healing accounted for 43.2%,including 3.9% of death.Factors influencing un-healing of injury inpatients included age（OR=1.027 2,）,days in hospitals（OR=0.992 2）,surgery（OR=2.072 7）,status of admission to hospital,positions and causes of injury.The risk of common inpatients was lower than severe inpatients（OR=0.837 3）;the risk of neck injury was higher than head injury（OR=3.412 0）;the risk of falling inpatients was lower than traffic injury（OR=0.843 5）（P0.05,P0.01）.Conclusion The trauma was ranked number one in all types of injuries.The principal positions of trauma were head and leg.Unexpected accidents accounted for the largest proportion.Six factors influencing un-healing of injury inpatients were age,days in hospitals,surgery,status of admission to hospital,positions and causes of injury.