中国骨质疏松杂志

日本长崎县中老年妇女跌倒相关疾病与髋部骨折的病例对照研究

Fall-related diseases and hip fractures among the elderly women: a case-control study in Nagasaki Prefecture in Japan

DOI：10.3969/j.issn.1006.7108.2014.07.025

中文关键词: 跌倒相关疾病；髋部骨折病例对照研究

英文关键词:Fall-related disease Hip fracture Case-control study

基金项目:

作者	单位
黄海蓉1 叶兆嘉2,3* 青柳潔3 田添英明4	1.深圳市麒麟山疗养院，深圳518055 2.深圳市疾病预防控制中心，深圳518055 3.长崎大学大学院公共卫生研究室，长崎8518523 4 长崎县国民健康保险团体连合会，长崎8500025

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中文摘要:

目的探讨中老年妇女跌倒相关疾病和髋部骨折的关系。方法研究对象为日本长崎县国民健康保险的参保者。收集45岁以上妇女髋部骨折住院患者1109例，按年龄配比随机抽取1109名其他患者，进行病例对照研究。髋部骨折和跌到相关疾病根据国际疾病分类标准编码第十版(ICD40)进行判定。卡方检验用于比较两组患者跌倒相关疾病的患病率差，条件Logistic回帰分析用于分析跌倒相关疾病与髋部骨折的关联性。结果75%以上的髋部骨折患者的年龄大于80岁。髋部骨折患者的视力障碍(14. 25% vs. 8. 66%，P < 0. 001)，脑卒中(14. 07% vs. 9. 92%，P = 0. 002)，肌肉骨骼疾病(43.91% vs. 38. 77%，P <0. 001)，帕金森氏病(5. 86% vs. 1.53%，P <0. 001)，认知障碍（11. 45% vs. 4. 33%，P <0. 001)和抑郁症（13. 89% vs.5. 86%，P <0.001)的患病率显著高于对照组。这些疾病的髋部骨折相对危险度分别为：视力障碍1.49(95% CI：1.13，1.98)、脑卒中 1.29(95%CI：0. 98，1. 69)、肌肉骨骼疾病 1. 29(95% CI：1. 08，1. 54)、帕金森氏病 3. 33(95%CI：1. 87，5. 92)、认知障碍2. 46(95% CI：1. 72，3. 52)和抑郁症2. 09(95% CI: 1. 54，2. 85)。合并的跌倒相关疾病越多，髋部骨折风险越大。结论在中老年妇女，跌倒相关疾病与髋部骨折有显著的关联性。积极预防和治疗跌倒相关疾病可能有益于降低髋部骨折的发生危险。

英文摘要:

Objective To study the correlation between fall-related diseases and hip fracture among the elderly women. Methods A total of 1109 women，who were over 45 years old and had hip fractures，were identified from health insurance claims in Nagasaki Prefecture in Japan. At the same time，a age-matched (within 5-year age groups) control patient was randomly selected for each patient with hip fracture. Diseases such as hip fracture and the fall-related diseases were coded following the International Classification of Diseases，10th Revision (ICD-L0 ). The prevalence of visual impairment，stroke，musculoskeletal diseases，Parkinson’s disease，cognitive impairment，depression，and the number of these risk factors were compared between patients with hip fractures and controls using the Chi-square test. The strength of the association between risk factors and hip fracture was estimated using a conditional Logistic regression model. Results Over 75% women with hip fracture were over 80 years old. Women with hip fracture had a significantly higher prevalence of ocular diseases (14. 25% vs. 8. 66%，P < 0. 001)，stroke (14. 07% vs. 9. 92% . P =0. 002) . musculoskeletal diseases (43. 91% vs. 38. 77% . P <0. 001) . Parkinson’s disease (5. 86% vs. 1. 53% . P < 0. 001) . cognitive impairment (11. 45% vs. 4. 33% . P <0.001) . and depression (13. 89% vs. 5. 86% . P <0. 001) than those in controls. The results of conditional Logistic regression showed that ocular diseases (OR = 1. 49 . 95% CI：1. 13,1.98), stroke (OR = 1.29, 95% CI: 0.98, 1.69), musculoskeletal diseases (OR = 1.29, 95% CI: 1.08, 1.54), Parkinson ’ s disease (OR = 3.33, 95% CI: 1.87, 5.92), cognitive impairment (OR = 2.46, 95% CI: 1.72, 3.52), and depression (OR =2.09 , 95% CI: 1. 54, 2. 85) were significantly associated with hip fracture. Women with multiple risk factors were at higher risk of the hip fractures. Conclusion Fall-related diseases play an important role in hip fracture among the middle-aged and elderly women. Positive prevention and treatment of the fall-related diseases may contribute to lower the risks of hip fracture.

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