目的:为了检查诊断为高血压(HTN)后的社会经济状况是否与预后相关,在65岁以上的人口中,在社区环境中。
方法:回顾性队列研究。
方法:马德里社区的所有初级保健中心(n=392)。
方法:所有患者(>65岁)在2007-08年新诊断为HTN,没有先前的肾脏或心血管(K/CV)事件(n=21754)。从2007年1月至2018年12月,对初级保健电子健康记录和西班牙死亡率数据库的患者记录进行了分析。社会人口统计数据,如年龄,性别,区域剥夺指数(MEDEA-MortalidadenáreaspegueñasEspañolasyDesigualdadesSocioeconómicasyAmbientales-Indexinquenttiles),和特点,比如吸烟,2型糖尿病和高胆固醇血症,是在入学时收集的。
方法:使用Cox回归评估K/CV事件的发生(包括这些原因导致的死亡率)和总死亡率。
结果:患者的平均年龄为73.5(SD6.5)岁,63.5%是女性。中位随访时间为128.7个月(IQR:110.6-136.7个月)。有10648个第一K/CV事件,包括这些原因造成的1508例死亡和其他原因造成的4273例死亡。根据年龄调整,性别,吸烟,糖尿病和高胆固醇血症,当比较第三个时,相对于第一个五分之一,剥夺指数的第四个和最后一个五分之一(不太富裕),K/CV事件的危险性增加了14.8%(95%CI:3.3至27.6%),16.0%(95%CI:6.4至26.4%)和19.1%(95%CI:8.9至30.2%),分别。MEDEA指数与调整后总死亡率的差异无关。
结论:生活在社会经济地位较低的地区与65岁后诊断的高血压患者的肾脏或心血管事件增加有关。这将导致疾病负担显着增加,即使与总死亡率的增加无关。
OBJECTIVE: To examine whether socioeconomic status is associated with prognosis after the diagnosis of hypertension (HTN), in a population older than 65 years, in the community setting.
METHODS: Retrospective cohort study.
METHODS: All the primary care centres of the Community of Madrid (n=392).
METHODS: All patients (>65 years) with a new diagnosis of HTN in 2007-08, without previous kidney or cardiovascular (K/CV) events (n=21 754).Patient records from primary care electronic health records and Spanish mortality database were analysed from January 2007 through December 2018. Sociodemographic data such as age, gender, Area Deprivation Index (MEDEA-Mortalidad en áreas pequeñas Españolas y Desigualdades Socioeconómicas y Ambientales-Index in quintiles), and characteristics, such as smoking, type 2 diabetes mellitus and hypercholesterolaemia, were collected at the time of enrolment.
METHODS: The occurrence of K/CV events (including mortality from these causes) and total mortality were evaluated using Cox regression.
RESULTS: Patients had a mean age of 73.5 (SD 6.5) years, and 63.5% were women. The median follow-up was 128.7 months (IQR: 110.6-136.7 months). There were 10 648 first K/CV events, including 1508 deaths from these causes and 4273 deaths from other causes. Adjusted for age, gender, smoking, diabetes and hypercholesterolaemia, when comparing the third, fourth and last quintiles (less affluent) of the Deprivation Index with respect to the first quintile, the hazard of K/CV events increased by 14.8% (95% CI: 3.3 to 27.6%), 16.0% (95% CI: 6.4 to 26.4%) and 19.1% (95% CI: 8.9 to 30.2%), respectively. The MEDEA Index was not associated with differences in adjusted total mortality.
CONCLUSIONS: Living in a low socioeconomic status area is associated with an increase in kidney or cardiovascular events in hypertensive patients diagnosed after age 65 years, which will result in a significant increase in disease burden even if not related to an increase in total mortality.