基于医疗大数据的上海市嘉定区冠心病患者多病共存模式研究

Exploring comorbidity patterns in coronary heart disease patients in Jiading district of Shanghai based on medical big datasets

目的分析上海市嘉定区冠心病患者多病共存现状与模式,为冠心病多病共存精准管理提供理论依据和数据支撑。方法收集上海市嘉定区全部医疗机构2020年12月—2021年12月的192060例冠心病患者的诊疗数据,分析其多病共存现状,通过Apriori算法进行关联规则分析,挖掘关键共病病种,通过2-STEP聚类法,探索主要疾病的共病模式。结果192060例冠心病患者中有166969人存在多病共存(86.94%)。女性共病占比(98802人,87.18%)略高于男性(68167人,86.59%,χ^(2)=695.555,P<0.001)。随年龄递增共病占比显著增加,18~60岁组、61~75岁组和75岁以上组分别为18017人(73.46%)、87180人(86.94%)和61772人(91.85%),Z=-13.704,P<0.001。多病共存以2~4种为主,高血压(支持度为71.59%)和慢性胃肠炎(支持度为49.96%)为主要共病病种。聚类分析发现5种典型共病模式:诱发因素共病、合并症共病、心血管-代谢共病、循环系统共病和多系统混合共病。结论冠心病具有高共病比例、共病人群差异化、共病病种高集中度和共病模式典型等特征,提示应根据这些典型特征,在主动健康、多重用药、延缓病程等方面研制差异化防控策略。

Objective This study aims to explore the comorbidities associated with CHD and support its precise management.Methods Data on CHD patients from all medical institutions in Jiading District,Shanghai,from December 2020 to December 2021 were analyzed.The Apriori algorithm was used to identify key comorbidities,and 2-STEP clustering method was used to explore patterns of multimorbidity.Results Among 192060 CHD patients,166969(86.94%)exhibited comorbidities,with a higher rate in women(98802,87.18%)than in men(68167,86.59%,χ^(2)=695.555,P<0.001).The proportion of comorbidity increased significantly along with the age increase:73.46%in the 18-60 age group(18017),86.94%in the 61-75 age group(87180),and 91.85%in the over 75 age group(61772,Z=-13.704,P<0.001).CHD typically presents with 2-4 comorbidities,with hypertension(71.59%)and chronic gastroenteritis(49.96%)being the primary comorbidities identified through association rule analysis.Five distinct multimorbidity patterns were identified by 2-STEP clustering analysis:triggers,complications,cardiovascular-metabolic,circulatory system,and multi-system mixed.Conclusion CHD patients exhibit high comorbidity rates and diverse patterns of co-existing diseases,indicating the need for differentiated management strategies.These strategies should focus on proactive health measures,managing polypharmacy,and delaying progression to effectively address multimorbidity.