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背景住院患者长期生存率还不清楚,此研究调查了住院患者的1年生存情况,并根据同期普通人群的生存率进行了调整。方法检索重要数据库的数据,对加拿大安大略省1994、1999、2004、2009年住院患者的1年生存情况进行调查,采用寿命表法得出安大略省普通人群的各年度的生存率。结果 1994—2009年,医院使用率有下降的趋势(成年普通人群从8.8%降至6.3%),而住院患者1年粗病死率有上升的趋势(从9.2%升至11.6%)。此期间住院患者的年龄有显著增大的趋势(中位年龄从51岁升至58岁)、病情明显有加重的趋势(查尔森合并症指数为0分的比例从68.2%降至60.0%),入院时的病情有更重的趋势(选择性住院从47.4%降至42.0%;用救护车接送住院从16.1%升至24.8%)。与1994年相比,2009年根据1年死亡情况进行校正后的OR值为0.78〔95%CI(0.77,0.79)〕。然而,同期普通人群1年死亡风险下降了24%。根据普通人群的生存率进行调整后,与1994年相比,2009年住院患者1年死亡风险明显要低〔调整后的超额相对风险为0.81,95%CI(0.80,0.82)〕。解释1994—2009年,就普通人群来说,患者疾病负担加重,而生存率提升了;住院患者1年生存率显著上升。以上数据不能解释生存率改善的原因。
Background The long-term survival of hospitalized patients is unclear. This study examined the 1-year survival of hospitalized patients and adjusted for survival in the general population over the same period. Methods The data of important databases were retrieved and the in-patients’ 1-year survival rates in Ontario, Canada in 1994, 1999, 2004 and 2009 were investigated. The life table method was used to obtain the annual survival rates of the general population in Ontario. Results In 1994-2009, the hospital utilization rate showed a downward trend (from 8.8% in the general population to 6.3% in the general population), while the 1-year crude mortality rate in inpatients showed an upward trend (from 9.2% to 11.6%). Inpatients during this period significantly increased the age of the trend (median age from 51 to 58 years old), the disease was significantly aggravating trend (Charlessen comorbidity index of 0 points decreased from 68.2% to 60.0% ), With a heavier tendency to hospitalization (selective hospitalization decreased from 47.4% to 42.0%; ambulance shuttle hospitalization increased from 16.1% to 24.8%). Compared with 1994, the OR adjusted for 2009 based on one-year deaths was 0.78 [95% CI (0.77, 0.79)]. However, the 1-year risk of death among the general population has dropped 24% over the same period. Adjusted for survival in the general population, in-hospital deaths were significantly lower at 1 year in 2009 than in 1994 (adjusted for excess relative risk 0.81, 95% CI 0.80, 0.82). Interpretation 1994 to 2009, the general population, the disease burden of patients increased, while the survival rate increased; 1-year survival rate of hospitalized patients increased significantly. The above data can not explain the reasons for the improvement of survival.