中国老年慢性病患者失能状况的Meta分析

Prevalence of Disability in Older Adults with Chronic Disease in China:a Meta-analysis

背景随着人口老龄化加深,失能成为老年人较突出的健康问题之一。我国老年慢性病群体庞大,且有多病共存特点,存在巨大的失能风险,而既往失能率研究结果不一。目的系统评价中国老年慢性病患者失能状况。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、Scopus、中国知网(CNKI)、万方数据知识服务平台、维普中文科技期刊库(VIP)、中国生物医学文献数据库(CBM)、中华医学期刊全文数据库共计10个数据库中关于中国老年慢性病患者失能状况的观察性研究,检索时限截至2023年8月。由2名研究者独立进行文献筛选、数据提取及质量评价,采用Stata 16.0软件对纳入文献进行Meta分析。结果共纳入32篇文献(34项研究),样本量为221~16566例,失能率为6.9%~82.8%。Meta分析结果表明,老年慢性病患者失能率为43.2%(95%CI=32.9%~53.5%)。亚组分析结果表明,女性失能率(36.6%,95%CI=27.0%~46.2%)高于男性(33.9%,95%CI=23.9%~43.9%);年龄越大,失能率越高(60~69岁:24.2%,95%CI=14.3%~34.0%;70~79岁:34.9%,95%CI=24.1%~45.7%;≥80岁:47.7%,95%CI=36.3%~59.1%);患慢性病种类失能率位列前3的为痴呆/帕金森病(56.3%,95%CI=40.9%~71.7%)、精神疾病(53.9%,95%CI=46.0%~61.7%)、脑血管疾病(49.2%,95%CI=33.5%~64.8%);老年人群失能率随合并慢性病种数增多而增高(1种:33.1%,95%CI=20.8%~45.3%;2种:36.3%,95%CI=22.6%~50.0%;≥3种:49.7%,95%CI=31.3%~68.0%)。结论我国老年慢性病人群失能率较高,慢性病种类和患病数量均对失能率有影响。建议加强对老年慢性病人群的监测和管理,以预防和减少失能的发生,促进健康老龄化。

Background As global population continues to age,disability has become one of the most prominent health problems in the aging population.Chinese older adults with chronic diseases often diagnosed with multi-morbidities resulting in increased risks for disability.However,previous evidence on disability rates in this population have been inconsistent.Objective To systematically evaluate the prevalence of disability in older adults with chronic diseases in China.Methods We searched databases including PubMed,Embase,Web of Science,Cochrane Library,Scopus,CNKI,Wanfang Data,VIP,CBM and China Medical Journal Full-text Database up until August 2023 for publications on disability prevalence in Chinese older adults with chronic diseases.Literature screening,quality appraisal and data extraction were performed independently by two researchers.Meta-analysis was conducted using Stata 16.0 software.Results A total of 32 publications(34 studies)were included.Sample sizes ranged from 221 to 16566 cases with a disability rate of 6.9%-82.8%.Meta-analysis showed that the prevalence of disability in Chinese older adults with chronic diseases was 43.2%(95%CI=32.9%-53.5%).Subgroup analyses showed:disability rate was higher in female(36.6%,95%CI=27.0%-46.2%)than in male(33.9%,95%CI=23.9%-43.9%);disability prevalence increased with age(60-69 years old:24.2%,95%CI=14.3%-34.0%;70-79 years old:34.9%,95%CI=24.1%-45.7%;≥80 years old:47.7%,95%CI=36.3%-59.1%);compared to other chronic diseases,individuals with dementia/Parkinson's disease(56.3%,95%CI=40.9%-71.7%),mental illness(53.9%,95%CI=46.0%-61.7%),and cerebrovascular disease(49.2%,95%CI=33.5%-64.8%)had the highest prevalence of disability;and the prevalence of disability increased with the number of comorbidities(1 disease:33.1%,95%CI=20.8%-45.3%;2 diseases:36.3%,95%CI=22.6%-50.0%;≥3 diseases:49.7%,95%CI=31.3%-68.0%).Conclusion The prevalence of disability among Chinese older adults with chronic diseases is high and can be impacted by both the type of chronic disease and the number of comorbidities.It is recommended to strengthen chronic disease monitoring and management efforts to prevent and eliminate disability and promote healthy aging in this population.