基于数据挖掘的社区高血压患者共病现状及关联规则分析

彭德荣; 陈晨; 喻梦珠; 范峰; 石建伟; 王朝昕; 谭军

doi:10.16766/j.cnki.issn.1674-4152.003012

基于数据挖掘的社区高血压患者共病现状及关联规则分析

doi: 10.16766/j.cnki.issn.1674-4152.003012

彭德荣¹,
陈晨¹,
喻梦珠¹,
范峰²,
石建伟³,
王朝昕⁴,
谭军^1, ,

1.
上海市静安区彭浦新村社区卫生服务中心，上海 200435
2.
同济大学医学院，上海 200092
3.
上海交通大学医学院公共卫生学院，上海 200025
4.
海南医学院管理学院，海南海口 570216

基金项目:

上海市卫生健康委员会卫生行业临床研究专项立项面上项目 201940052

上海市浦江人才计划项目 2019PJC072

详细信息

通讯作者:
谭军，E-mail: 18770030151@163.com

中图分类号: R473.59 R544.1
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- 文章访问数: 164
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- PDF下载量: 20
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-15
- 网络出版日期: 2023-08-26

Data mining-based analysis of comorbidity status and association rules of hypertensive patients in the community

1.
Pengpu Xincun Community Health Care Center of Jing' an District, Shanghai 200435, China

摘要

摘要: 目的了解上海社区高血压患者共病现状及各共病病种间的关联分析，为高血压患者的社区共病管理提供理论依据和数据支撑。方法收集上海某社区2018年1月—2020年12月的高血压患者诊疗和健康档案数据，分析不同性别和年龄的高血压患者多病共存现状，通过Apriori算法对共病病种、病种组合进行关联规则分析，找出高血压患者多病共存的关键疾病。结果上海社区高血压患者共病的比例为88.1%(34 311/38 961)，远高于一般老龄人群，呈现女性高于男性、高年龄组高于低年龄组的特征，差异有统计学意义(均P＜0.001)。总体病种数量分布较为分散，不同年龄组间存在差异，低年龄组以2~4种共病为主，高年龄组以4种以上为主。关联规则分析结果2种共病病种生成8条强关联规则，第1位是“高血压and慢性缺血性心脏病”；3种共病病种生成9条强关联规则，第1位是“慢性缺血性心脏病and脑血管and高血压”；4种共病病种生成的3条强关联规则中排第一的是“慢性缺血性心脏病and高脂血症and脑血管and高血压”。结论上海社区高血压患者多病共存问题不容忽视，需要有针对性地考虑共病的禁忌证、相互作用和多重用药问题。尤其是中青年的高血压共病预防尤为重要，需要做到早预警、准评估、精干预。共病病种管理在关注慢性缺血性心脏病、脑血管病、高脂血症等临床相关疾病同时，还需要关注慢性功能性肠疾患和慢性阻塞性肺病等其他系统的合并疾病。
- 高血压 /
- 关联分析 /
- 多病共存 /
- 数据挖掘 /
- 社区管理
Abstract: Objective To understand the comorbidity status of hypertensive patients in Shanghai community and the correlation analysis of comorbidity, and provide theoretical basis and data support for community comorbidity management of hypertension patients. Methods The diagnosis and treatment data and health records of hypertensive patients in a community in Shanghai from January 2018 to December 2020 were collected, and the coexistence of multiple diseases among hypertensive patients of different genders and ages was analyzed. The association rule analysis of comorbidity combination was performed with Apriori algorithm to find out the key diseases of hypertensive patients with multiple diseases. Results The prevalence of comorbidity among hypertensive patients in the Shanghai community was 88.1% (34 311/38 961), which was much higher than that in the general elderly population. The prevalence of comorbidity in female hypertensive patients was higher than that in male hypertensive patients, and the prevalence of comorbidity in the high age group was higher than that in the low age group (both P < 0.001). The distribution of the total number of diseases is scattered, and there are differences between different age groups. The low age group mainly had 2-4 comorbidities, and the high age group mainly had more than 4. The results of the association rule analysis showed that two comorbidities generated eight strong association rules, the first is "hypertension and chronic ischemic heart disease"; Three comorbidities generated nine strong association rules, the first is "chronic ischemic heart disease and cerebrovascular disease and hypertension"; And four comorbidities generated three strong association rules, the first is "chronic ischemic heart disease and hyperlipidemia, cerebrovascular disease and hypertension". Conclusions The coexistence of multiple diseases in Shanghai community hypertensive patients should not be ignored, and the contraindications, interactions and multiple drug use should be considered. In particular, the prevention of hypertension comorbidity in young and middle-aged people is particularly important, which requires early warning, quasi evaluation and precise intervention. Management of comorbidities should include clinical-related conditions such as chronic ischemic heart disease, cerebrovascular disease and hyperlipemia, as well as other systemic comorbidities such as chronic functional bowel disease and chronic obstructive pulmonary disease.
- Hypertension /
- Correlation analysis /
- Multiple diseases coexist /
- Data mining /
- Community management

HTML全文

图 1 2018—2020年上海市某社区高血压患者共病种类数量情况

Figure 1. Number of comorbidities of hypertension patients in a community in Shanghai from 2018 to 2020

下载: 全尺寸图片幻灯片

图 2 共病高血压患者的病种关联分析网络图

Figure 2. Network diagram of disease association analysis in patients with comorbidities hypertension

下载: 全尺寸图片幻灯片

表 1 2018—2020年上海市某社区高血压患者基本情况[例(%)]

Table 1. Basic situation of hypertension patients in a community in Shanghai from 2018 to 2020[cases(%)]

年龄组	男性	女性	合计
18~60岁	4 364(25.4)	4 761(21.9)	9 125(23.4)
61~75岁	8 811(51.2)	10 593(48.7)	19 404(49.8)
75岁以上	4 020(23.4)	6 412(29.5)	10 432(26.8)
合计	17 195(100.0)	21 766(100.0)	38 961(100.0)

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表 2 2018—2020年上海市某社区高血压患者共病情况

Table 2. Comorbidities of hypertension patients in a community in Shanghai from 2018 to 2020

项目	例数	多病共存[例(%)]	χ²值	P值
性别
男性	17 195	14 739(85.7)	161.474	＜0.001
女性	21 766	19 572(90.0)
年龄
18~60岁	9 125	7 242(79.4)	1 033.421	＜0.001
61~75岁	19 404	17 251(88.9)
75岁以上	10 432	9 818(94.1)
合计	38 961	34 311(88.1)

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表 3 2018—2020年上海市某社区高血压患者共病病种数量分布及特征[例(%)]

Table 3. The number distribution and characteristics of co-morbidities of hypertension patients in a community in Shanghai from 2018 to 2020 [cases(%)]

项目	例数	2~4种	4种以上	χ²值	P值
性别				371.198	＜0.001
男性	14 739	6 675(45.3)	8 064(54.7)
女性	19 572	6 854(35.0)	12 718(65.0)
年龄
18~60岁	7 242	4 291(59.3)	2 951(40.7)	1 859.503	＜0.001
61~75岁	17 251	6 610(38.3)	10 641(61.7)
75岁以上	9 818	2 628(26.8)	7 190(73.2)
合计	34 311	13 529(39.4)	20 782(60.6)

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表 4 2种共病的高血压患者的病种关联分析规则(%)

Table 4. The rule of disease association analysis in two kinds of hypertension patients with comorbidities (%)

关联规则	支持度	置信度
高血压and慢性缺血性心脏病	59.2	100.0
高血压and脑血管	49.4	100.0
高血压and关节骨骼疾病	45.1	100.0
高血压and慢性阻塞性肺疾病	42.9	100.0
高血压and高脂血症	42.1	100.0
高血压and慢性功能性肠疾患	35.6	100.0
高血压and慢性胃十二指肠炎症	34.3	100.0
高血压and糖尿病	30.6	100.0

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表 5 3种共病的高血压患者的病种关联分析规则(%)

Table 5. The rule of disease association analysis in 3 kinds of hypertension patients with comorbidities (%)

关联规则	支持度	置信度
慢性缺血性心脏病and脑血管and高血压	49.4	80.4
慢性缺血性心脏病and高脂血症and高血压	42.1	80.3
慢性缺血性心脏病and慢性功能性肠疾患and高血压	34.6	80.9
高血压and关节骨骼疾病and慢性缺血性心脏病	34.5	100.0
慢性缺血性心脏病and慢性胃十二指肠炎症and高血压	34.3	80.6
高血压and慢性阻塞性肺疾病and慢性缺血性心脏病	33.7	100.0
高血压and关节骨骼疾病and脑血管	31.6	100.0
高血压and高脂血症and脑血管	30.9	100.0

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表 6 4种共病的高血压患者的病种关联分析规则(%)

Table 6. The rule of disease association analysis in 4 kinds of hypertension patients with comorbidities (%)

关联规则	支持度	置信度
慢性缺血性心脏病and高脂血症and脑血管and高血压	40.9	88.3
慢性缺血性心脏病and关节骨骼疾病and脑血管and高血压	31.6	88.1
慢性缺血性心脏病and慢性阻塞性肺疾病and脑血管and高血压	30.2	88.5

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参考文献(17)

[1]	周晓丽, 刘曼玲, 焦艳会. 多种慢性病管理模式在社区老年高血压患者中的综合应用与评价[J]. 中华全科医学, 2020, 18(3): 449-453. doi: 10.16766/j.cnki.issn.1674-4152.001270 ZHOU X L, LIU M L, JIAO Y H. Comprehensive application and evaluation of multiple chronic disease management models in elderly patients with hypertension in community[J]. Chinese Journal of General Practice, 2020, 18(3): 449-453. doi: 10.16766/j.cnki.issn.1674-4152.001270
[2]	刘晓芬, 何莹, 魏柯雯, 等. 北京市房山区成人常见慢性病流行特征及控制现状调查[J]. 中国慢性病预防与控制, 2019, 27(8): 605-607. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201908012.htm LIU X F, HE Y, WEI K W, et al. Epidemiological characteristics and control status of adult common chronic diseases in Fangshan District, Beijing[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2019, 27(8): 605-607. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201908012.htm
[3]	戴付敏, 刘思雨, 张希. 社区居家多病共存老年人的非正式照料研究进展[J]. 中华全科医学, 2020, 18(3): 471-475. doi: 10.16766/j.cnki.issn.1674-4152.001276 DAI F M, LIU S Y, ZHANG X. Research Progress on informal care of the elderly living with multiple disease in a community home[J]. Chinese Journal of General Practice, 2020, 18(3): 471-475. doi: 10.16766/j.cnki.issn.1674-4152.001276
[4]	国家心血管病中心, 国家基本公共卫生服务项目基层高血压管理办公室, 国家基层高血压管理专家委员会, 等. 国家基层高血压防治管理指南2020版[J]. 中国医学前沿杂志(电子版), 2021, 13(4): 26-37. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202309001.htm The National Essential Public Health Service Program Office for Management of Hypertension in Primary Health Care, National Center for Cardiovascular Diseases, National Committee on Hypertension Management in Primary Health Care, et al. National clinical practice guidelines on the management of hypertension in primary health care in China (2020)[J]. Chinese Journal of the Frontiers of Medical Science (Electronic Version), 2021, 13(4): 26-37. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202309001.htm
[5]	胡世莲, 王静, 程翠, 等. 中国居民慢性病的流行病学趋势分析[J]. 中国临床保健杂志, 2020, 23(3): 289-294. doi: 10.3969/J.issn.1672-6790.2020.03.001 HU S L, WANG J, CHENG C, et al. Epidemiological analysis of chronic diseases in Chinese residents[J]. Chinese Journal of Clinical Healthcare, 2020, 23(3): 289-294. doi: 10.3969/J.issn.1672-6790.2020.03.001
[6]	张琪, 金玲玲, 田秀梅, 等. 南京市玄武区老年人慢性病共病现状及其影响因素[J]. 职业与健康, 2020, 36(11): 1496-1499. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK202011016.htm ZHANG Q, JIN L L, TIAN X M, et al. Prevalence and influencing factors of comorbidity of chronic diseases among elderly People in Xuanwu District of Nanjing City[J]. Occupation and Health, 2020, 36(11): 1496-1499. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK202011016.htm
[7]	孙丹丹, 黄蓉, 索靖东, 等. 中国老年人慢性病共病对其健康状况的影响[J]. 武汉大学学报(医学版), 2022, 43(2): 302-306. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYK202202026.htm SUN D D, HUANG R, SUO J D, et al. Influence of multiple chronic conditions on the health status of the elderly in China[J]. Journal of Wuhan University (Medical Edition), 2022, 43(2): 302-306. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYK202202026.htm
[8]	冯祥, 华召来, 周琴, 等. 某市中老年居民主要慢性病患病现况及共病模式分析[J]. 现代预防医学, 2019, 46(20): 3728-3731 https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201920019.htm FENG X, HUA Z L, ZHOU Q, et al. Analysis of status and comorbid patterns of major chronic diseases among middle-aged and elderly residents in a city[J]. Modern Preventive Medicine, 2019, 46(20): 3728-3731 https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201920019.htm
[9]	王梅杰, 周翔, 李亚杰, 等. 2010—2019年中国中老年人慢性病共病患病率的Meta分析[J]. 中国全科医学, 2021, 24(16): 2085-2091. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202116017.htm WANG M J, ZHOU X, LI Y J, et al. Prevalence rate of multiple chronic conditions in middle-aged and elderly Chinese people from 2010 to 2019: a meta-analysis[J]. Chinese General Practice, 2021, 24(16): 2085-2091. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202116017.htm
[10]	金福碧, 郑和昕, 林玲萍, 等. 老年住院患者多重用药调查分析与对策[J]. 浙江中医药大学学报, 2012, 36(12): 1360-1363. https://www.cnki.com.cn/Article/CJFDTOTAL-BHON201212037.htm JIN F B, ZHENG H X, LIN L P, et al. Investigation and strategies for poly-pharmacy in the hospitalized senile patients[J]. Journal of Zhejiang Chinese Medical University, 2012, 36(12): 1360-1363. https://www.cnki.com.cn/Article/CJFDTOTAL-BHON201212037.htm
[11]	MUHLACK D C, HOPPE L K, WEBERPALSA J, et al. The association of potentially inappropriate medication at older age with cardiovascular events and overall mortality: a systematic review and meta-analysis of cohort studies[J]. J Am Med Dir Assoc, 2017, 18(3): 211-220.
[12]	付丽英. 社区老年人慢性病共病及其对卫生服务利用的影响[D]. 开封: 河南大学, 2019. FU L Y. Chronic disease comorbidity and its influence on health service utilization in elderly people in community[D]. Kaifeng: Henan University, 2019.
[13]	张家泳, 丛守婧, 麦勇强, 等. 广东省中山市中老年人慢性病共病现状调查及流行病学分析[J]. 现代医药卫生, 2018, 34(9): 1320-1323. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201809014.htm ZHANG J Y, CONG S J, MAI Y Q, et al. Investigation and epidemiology analysis of chronic disease common diseases in elderly people in Zhongshan city[J]. Journal of Modern Medicine & Health, 2018, 34(9): 1320-1323. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201809014.htm
[14]	《心肺血管病杂志》编辑部. 中国心血管健康与疾病报告2019[J]. 心肺血管病杂志, 2020, 39(10): 1157-1162. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202332001.htm Journal of Cardiovascular and Pulmonary Diseases Editorial Department. Annual report on cardiovascular health and diseases in CHINA 2019[J]. Journal of Cardiovascular and Pulmonary Diseases, 2020, 39(10): 1157-1162. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202332001.htm
[15]	甘勇, 杨婷婷, 杨宇迪, 等. 基于系统基模的慢性病主要危险因素分析及对策研究[J]. 中华全科医学, 2019, 17(12): 2046-2050, 2054. doi: 10.16766/j.cnki.issn.1674-4152.001124 GAN Y, YANG T T, YANG Y D, et al. Analysis of main risk factors and countermeasures of chronic diseases based on systems archetypes[J]. Chinese Journal of General Practice, 2019, 17(12): 2046-2050, 2054. doi: 10.16766/j.cnki.issn.1674-4152.001124
[16]	孙文岩, 王思源, 吴菲, 等. 上海市35岁及以上居民高血压、糖尿病共病流行现状分析[J]. 上海预防医学, 2021, 33(7): 559-565. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI202107002.htm SUN W Y, WANG S Y, WU F, et al. Epidemic status of patients with hypertension and diabetes among adults aged 35 years and older in Shanghai[J]. Shanghai Journal of Preventive Medicine, 2021, 33(7): 559-565. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI202107002.htm
[17]	汪迎春, 张瑜, 曹梅, 等. 阻塞性睡眠呼吸暂停低通气综合征合并高血压患者皮质下觉醒反应与糖代谢相关性研究[J]. 中华全科医学, 2018, 16(8): 1261-1263, 1333. doi: 10.16766/j.cnki.issn.1674-4152.000346 WANG Y C, ZHANG Y, CAO M, et al. Relationship between subcortical arousal and glucose metabolism in patients with obstructive sleep apnea hypopnea syndrome and hypertension[J]. Chinese Journal of General Practice, 2018, 16(8): 1261-1263, 1333. doi: 10.16766/j.cnki.issn.1674-4152.000346