基于医疗大数据的上海市嘉定区冠心病患者多病共存模式研究

汤鸣秋; 石建伟; 周良; 巩昕; 孙朝珺; 周鹰

doi:10.16766/j.cnki.issn.1674-4152.003531

基于医疗大数据的上海市嘉定区冠心病患者多病共存模式研究

doi: 10.16766/j.cnki.issn.1674-4152.003531

汤鸣秋¹,
石建伟²,
周良²,
巩昕³,
孙朝珺⁴,
周鹰^1, ,

1.
上海市嘉定区真新社区卫生服务中心，上海 201824
2.
上海交通大学医学院公共卫生学院，上海 200025
3.
同济大学附属东方医院心内科，上海 200120
4.
上海市静安区彭浦新村街道社区卫生服务中心，上海 200435

基金项目:

国家自然科学基金青年基金项目 72204187

上海市静安区医学科研项目 2021SQ05

详细信息

通讯作者:
周鹰，E-mail：zz0553zz@163.com

中图分类号: R541.4
计量
- 文章访问数: 313
- HTML全文浏览量: 159
- PDF下载量: 30
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-26
- 网络出版日期: 2024-07-22

Exploring comorbidity patterns in coronary heart disease patients in Jiading district of Shanghai based on medical big datasets

1.
Zhenxin Community Health Care Center of Jiading District, Shanghai 201842, China

摘要

摘要: 目的分析上海市嘉定区冠心病患者多病共存现状与模式，为冠心病多病共存精准管理提供理论依据和数据支撑。方法收集上海市嘉定区全部医疗机构2020年12月—2021年12月的192 060例冠心病患者的诊疗数据，分析其多病共存现状，通过Apriori算法进行关联规则分析，挖掘关键共病病种，通过2-STEP聚类法，探索主要疾病的共病模式。结果 192 060例冠心病患者中有166 969人存在多病共存(86.94%)。女性共病占比(98 802人，87.18%)略高于男性(68 167人，86.59%，χ²=695.555，P＜0.001)。随年龄递增共病占比显著增加，18~60岁组、61~75岁组和75岁以上组分别为18 017人(73.46%)、87 180人(86.94%)和61 772人(91.85%)，Z=-13.704，P＜0.001。多病共存以2~4种为主，高血压(支持度为71.59%)和慢性胃肠炎(支持度为49.96%)为主要共病病种。聚类分析发现5种典型共病模式：诱发因素共病、合并症共病、心血管-代谢共病、循环系统共病和多系统混合共病。结论冠心病具有高共病比例、共病人群差异化、共病病种高集中度和共病模式典型等特征，提示应根据这些典型特征，在主动健康、多重用药、延缓病程等方面研制差异化防控策略。
- 冠心病 /
- 多病共存模式 /
- 关联分析 /
- 聚类分析 /
- 医疗大数据
Abstract: Objective This study aims to explore the comorbidities associated with CHD and support its precise management. Methods Data on CHD patients from all medical institutions in Jiading District, Shanghai, from December 2020 to December 2021 were analyzed. The Apriori algorithm was used to identify key comorbidities, and 2-STEP clustering method was used to explore patterns of multimorbidity. Results Among 192 060 CHD patients, 166 969 (86.94%) exhibited comorbidities, with a higher rate in women (98 802, 87.18%) than in men (68 167, 86.59%, χ²=695.555, P < 0.001). The proportion of comorbidity increased significantly along with the age increase: 73.46% in the 18-60 age group (18 017), 86.94% in the 61-75 age group (87 180), and 91.85% in the over 75 age group (61 772, Z=-13.704, P < 0.001). CHD typically presents with 2-4 comorbidities, with hypertension (71.59%) and chronic gastroenteritis (49.96%) being the primary comorbidities identified through association rule analysis. Five distinct multimorbidity patterns were identified by 2-STEP clustering analysis: triggers, complications, cardiovascular-metabolic, circulatory system, and multi-system mixed. Conclusion CHD patients exhibit high comorbidity rates and diverse patterns of co-existing diseases, indicating the need for differentiated management strategies. These strategies should focus on proactive health measures, managing polypharmacy, and delaying progression to effectively address multimorbidity.
- Coronary heart disease /
- Multimorbidity patterns /
- Association rules /
- Clustering analysis /
- Big medical datasets

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表 1 2020年12月—2021年12月上海市嘉定区冠心病患者基本情况[例(%)]

Table 1. Basic situation of patients with coronary heart disease in Jiading District, Shanghai from December 2020 to December 2021[cases (%)]

年龄(岁)	男性	女性	合计
18~60	10 919(13.87)	13 606(12.01)	24 525(12.77)
61~75	41 467(52.67)	58 812(51.89)	100 279(52.21)
＞75	26 340(33.46)	40 916(36.10)	67 256(35.02)
合计	78 726(100.00)	113 334(100.00)	192 060(100.00)

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表 2 不同年龄、性别冠心病患者共病情况比较

Table 2. Comparison of comorbidity of coronary heart disease patients of different ages and genders

项目	例数	多病共存[例(%)]	统计量	P值
性别
男性	78 726	68 167(86.59)	695.555^a	＜0.001
女性	113 334	98 802(87.18)
年龄(岁)
18~60	24 525	18 017(73.46)	-13.704^b	＜0.001
61~75	100 279	87 180(86.94)
＞75	67 256	61 772(91.85)
注：^a为χ²值，^b为Z值。

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表 3 2020年12月—2021年12月上海市嘉定区冠心病患者共病种类情况

Table 3. Types of comorbidity of patients with coronary heart disease in Jiading District, Shanghai from December 2020 to December 2021

共病种类	例(%)
2种	46 194(27.67)
3种	47 176(28.25)
4种	36 563(21.90)
5种	22 079(13.22)
6种	10 285(6.16)
7种	3 762(2.25)
8种	828(0.50)
9种	82(0.05)
合计	166 969(100.00)

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表 4 冠心病患者的共病病种关联规则分析

Table 4. Analysis of association rules of comorbidities in patients with coronary heart disease

前项集	后项集	支持度(%)	置信度(%)
高血压	冠心病	71.59	100.0
慢性胃肠炎	冠心病	49.96	100.0
高血脂	冠心病	38.68	100.0
脑血管病	冠心病	37.06	100.0
支气管炎	冠心病	29.69	100.0
糖尿病	冠心病	28.78	100.0
慢性胃肠炎and高血压	冠心病	39.61	100.0
高血脂and高血压	冠心病	32.10	100.0
脑血管病and高血压	冠心病	30.52	100.0
糖尿病and高血压	冠心病	24.45	100.0
支气管炎and高血压	冠心病	24.25	100.0
脑血管病and慢性胃肠炎	冠心病	23.96	100.0
高血脂and慢性胃肠炎	冠心病	23.79	100.0
支气管炎and慢性胃肠炎	冠心病	20.40	100.0
高血脂and慢性胃肠炎and高血压	冠心病	20.64	100.0
脑血管病and慢性胃肠炎and高血压	冠心病	20.58	100.0

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表 5 冠心病患者的共病病种聚类分析预测变量重要性

Table 5. Importance of predictive variables in cluster analysis of comorbidity in patients with coronary heart disease

共病模式	病种构成	预测变量重要性^a	类别人数(例)	构成比(%)
诱发因素共病模式	冠心病	1.00	59 747	31.11
	高血压	0.77
合并症共病模式	冠心病	1.00	42 389	22.07
	慢性胃肠炎	0.59
心血管-代谢共病模式	冠心病	1.00	42 132	21.94
	高血压	0.99
	高血脂	0.65
	糖尿病	0.56
循环系统共病模式	冠心病	1.00	24 948	12.99
	高血压	0.81
	脑血管病	0.56
多系统混合共病模式	冠心病	1.00	22 844	11.89
	高血压	0.83
	慢性胃肠炎	0.75
	高血脂	0.65
	脑血管病	0.63
	支气管炎	0.61
	心律失常	0.51
注：^a预测变量重要性＜0.5的病种在聚类中不进行展示。

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