目的:很少有报告显示心源性猝死(SCD)发生率和停搏前合并症的长期趋势。本研究旨在全面分析SCD发病趋势及其与逮捕前合并症的关系。
方法:这项基于人群的队列研究分析了台湾的国民健康保险(NHI)研究数据库,并通过检查2011年至2018年所有急诊科就诊的数据来确定SCD事件。纳入标准为ICD-9:427.5或427.41,或ICD-10:I46.9、I46.8或I46.2。根据药物使用确认了先前存在的合并症。采用多变量logistic回归与年龄,性别,和预先存在的合并症。
结果:这项研究回顾了总共184,164,969人年记录,并确定了92,138例SCD事件。从2011年到2018年,台湾每100,000名参与者的SCD发病率从36.3增加到55.4。前五大合并症稳定,而慢性肾脏病的患病率明显上升。与20-29岁的人群相比,年龄>65岁的参与者患SCD的几率明显更高(aOR:27.30,95%CI:26.05-28.61)。在癫痫发作的参与者中发现了更高的SCD几率(aOR:2.24,95%CI:2.12-2.38),帕金森病(AOR:1.81,95%CI:1.73-1.89),心理障碍(AOR:1.59,95%CI:1.56-1.62),糖尿病(aOR:1.44,95%CI:1.41-1.46),心脏病(aOR:1.41,95%CI:1.38-1.44)。
结论:从2011年到2018年,台湾的SCD发病率稳步上升。高血压,糖尿病,心脏病,心理障碍,关节炎是停药前的主要合并症。年龄是SCD最重要的危险因素。除了亚洲人之外,还需要进一步进行大规模的基于人口的研究,以调查不同种族的国家。
OBJECTIVE: Few reports have indicated the secular trend in the sudden cardiac death (SCD) incidence and pre-arrest comorbidities. This study aimed to comprehensively analyze the trend of SCD incidence and its association with pre-arrest comorbidities.
METHODS: This population-based cohort study analyzed Taiwan\'s National Health Insurance (NHI) research database and identified SCD incidents by inspecting data from all emergency department visits from 2011 to 2018. The inclusion criteria were ICD-9:427.5 or 427.41, or ICD-10:I46.9, I46.8, or I46.2. Pre-existing comorbidities were confirmed based on medication use. Multivariable logistic regression was adopted with covariates age, sex, and pre-existing comorbidities.
RESULTS: This study reviewed a total of 184,164,969 person-year records, and identified 92,138 SCD incidents. From 2011 to 2018, the SCD incidence rate increased from 36.3 to 55.4 per 100,000 enrollees in Taiwan. The top five pre-arrest comorbidities were stable, while the prevalence of chronic kidney disease rose significantly. Compared to those aged 20-29, enrollees aged >65 years had significantly higher odds of SCD (aOR:27.30, 95% CI:26.05-28.61). Higher odds of SCD were noted in the enrollees who had a seizure (aOR:2.24, 95% CI:2.12-2.38), parkinsonism (aOR:1.81, 95% CI:1.73-1.89), psychological disorders (aOR:1.59, 95% CI:1.56-1.62), diabetes mellitus (aOR:1.44, 95% CI:1.41-1.46), heart diseases (aOR:1.41, 95% CI:1.38-1.44).
CONCLUSIONS: The incidence of SCD steadily increased in Taiwan from 2011 to 2018. Hypertension, diabetes mellitus, heart disease, psychological disorders, and arthritis were major pre-arrest comorbidities. Age is the most important risk factor for SCD. Further large-scaled population-based study that investigated in diverse ethnicities from countries in addition to Asians would be warranted.