Study on comorbid pattern in hypertension patients managed by Shanghai family doctors based on electronic health records
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摘要:
目的 分析上海市家庭医生在管高血压患者多病情况和共病模式，为高血压患者精准管理提供理论依据。 方法 基于慢性病一体化管理系统，选取上海市虹口区2016年10月—2023年12月的99 531例家庭医生在管高血压患者诊疗数据，通过Apriori算法和聚类分析，探索多病共存情况和共病模式，并使用Web图可视化慢性病间的非随机关联。 结果 上海市家庭医生在管高血压患者共病的比例为93.93%(92 201例)，女性高于男性、高年龄组高于低年龄组(P＜0.001)。高血压共病数量集中在2~6种，占总数的76.00%(74 602例)；关联挖掘得到12条强关联规则，高血压患者中脑卒中、肾脏疾病、心脏病、糖尿病、慢性肺部疾病、关节炎或风湿病处于主要地位。其主要的多重共病模式共有51 710人，该模式病发生比例较高的前3位为心脏病50 185人(97.05%), 关节炎或风湿病36 250人(70.10%)和慢性肺部疾病31 590人(61.09%)。 结论 本研究提示对社区纳管高血压群体加强整合型慢性病管理指导的重要性，为高血压社区管理考核指标的改善、共病组合治疗和合并症健康管理提供了参考。 Abstract:Objective To analyze the multimorbidity and comorbidity patterns among hypertensive patients managed by family doctors in Shanghai, and to provide a theoretical basis for the precise management of hypertensive patients. Methods Based on the chronic disease integration management system, this study included 99 531 hypertensive patients managed by family doctors in Hongkou District, Shanghai, from October 2016 to December 2023. The Apriori algorithm and cluster analysis were used to explore the multimorbidity and comorbidity patterns, while the Web graph was used to visualize the non-random associations among chronic diseases. Results The proportion of hypertensive patients managed by family doctors in Shanghai was 93.93% (92 201 cases), with higher rates observed in women and older age groups (P < 0.001). A total of 76.00% (74 602 cases) patients had 2 to 6 comorbid conditions. Association rule mining showed that 12 strong association rules, primarily involving stroke, kidney disease, heart disease, diabetes disease, chronic lung disease, arthritis or rheumatism. There were 51 710 people in the main comorbidity pattern, and the top 3 patterns with higher incidence were: heart disease 50 185 people (97.05%), arthritis or rheumatism 36 250 people (70.10%), and chronic lung disease 31 590 people (61.09%). Conclusion The study highlights the importance of strengthening integrated chronic disease management for the community-based hypertension group. The study provides a reference for the improvement of assessment indicators in community management of hypertension, combination treatment of comorbidities and health management of comorbidities. -
Key words:
- Hypertension /
- Association rules /
- Multimorbidity coexistence /
- Comorbidity pattern
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图 1 高血压患者3种共病模式Web图
注：节点大小表示某病患病人数多少，连接线段粗细程度反应关联强弱，红色线段表示负相关，蓝青色线段表示正相关。A为心脑血管疾病伴多重共病Web图，B为多重共病Web图，C为糖尿病、心脏病伴慢性肺部疾病Web图。
Figure 1. Web plot of 3 comorbid patterns in hypertensive patients
表 1 不同年龄、性别高血压患者共病情况比较[例(%)]
Table 1. Comparison of comorbid conditions in hypertensive patients of different ages and gender[cases(%)]
项目 合计 仅患高血压 高血压多病共存 χ2值 P值 性别 男性 45 075 3 449(7.65) 41 626(92.35) 365.843 < 0.001 女性 53 083 2 508(4.72) 50 575(95.28) 年龄(岁) 18~60 6 525 1 382(11.18) 5 143(78.82) 3 542.406 < 0.001 60~75 54 132 3 671(5.67) 50 461(93.33) >75 37 501 904(2.41) 36 597(97.59) 
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表 2 2016年2月—2023年12月上海市虹口区高血压患者共病种类情况
Table 2. Type of comorbidity in hypertensive patients in Hongkou District, Shanghai from February 2016 to December 2023
患高血压以外的慢病数量 人数(%) 0 5 957(6.07) 1 13 534(13.79) 2 17 674(18.01) 3 18 842(19.20) 4 17 017(17.34) 5 13 207(13.45) 6 7 862(8.01) 7 3 054(3.11) 8 866(0.88) 9 141(0.14) 10 4(0.00) 合计 98 158(100.00)
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表 3 高血压患者与其他慢病共病关联规则挖掘结果
Table 3. Mining results of association rules for comorbidity of other chronic diseases in hypertensive patients
前项集 后项集 支持度(%) 置信度(%) 提升度 肾脏疾病 心脏病 20.47 92.38 1.17 脑卒中 心脏病 34.79 93.59 1.18 糖尿病 心脏病 44.48 85.63 1.08 慢性肺部疾病 心脏病 47.50 88.45 1.12 关节炎或风湿病 心脏病 48.79 89.36 1.13 脑卒中and糖尿病 心脏病 22.58 95.52 1.21 脑卒中and慢性肺部疾病 心脏病 24.78 96.57 1.22 脑卒中and关节炎或风湿病 心脏病 25.67 96.70 1.22 糖尿病and慢性肺部疾病 心脏病 28.89 92.55 1.17 糖尿病and关节炎或风湿病 心脏病 29.84 93.23 1.18 慢性肺部疾病and关节炎或风湿病 心脏病 34.24 93.69 1.18 糖尿病and慢性肺部疾病and关节炎或风湿病 心脏病 22.07 95.98 1.21
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表 4 高血压人群共病模式[例(%)]
Table 4. Patterns of comorbidity in the hypertensive population[cases(%)]
疾病种类 心脑血管疾病伴多重共病(n=13 161) 多重共病(n=51 710) 糖尿病、心脏病伴慢性肺部疾病(n=33 287) 血脂异常 214(1.63) 107(0.21) 1(0.00) 糖尿病 10 451(79.40) 29 830(57.69) 10 700(32.14) 恶性肿瘤 846(6.43) 1 154(2.23) 467(1.40) 慢性肺部疾病 13 072(99.32) 31 590(61.09) 8 054(24.20) 肝脏疾病 3 336(25.35) 3 802(7.35) 657(1.97) 心脏病 13 161(99.99) 50 185(97.05) 14 301(42.96) 脑卒中 12 001(91.18) 23 148(44.77) 1 336(4.01) 肾脏疾病 9 909(75.28) 10 221(19.77) 1 621(4.87) 胃部疾病 313(2.38) 160(0.31) 71(0.21) 情感及精神问题 630(4.79) 899(1.74) 38(0.11) 记忆相关疾病 2 060(15.65) 1 901(3.68) 99(0.30) 关节炎或风湿病 12 798(97.23) 36 250(70.10) 4 552(13.68) 哮喘 3 749(28.48) 2 271(4.39) 343(1.03)
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[1] CAMOY D, TRAN J, ZOTTOLI M, et al. Association between cardiometabolic disease multimorbidity and all-cause mortality in 2 million women and men registered in UK general practices[J]. BMC Med, 2021, 19(1): 258. DOI: 10.1186/s12916-021-02126-x. [2] SKOU S T, MAIR F S, FORTIN M, et al. Multimorbidity[J]. Nat Rev Dis Primers, 2022, 8(1): 48. DOI: 10.1038/s41572-022-00376-4. [3] 姚元龙, 史威力, 冯娴, 等. 老年共病的研究管理策略[J]. 中华全科医学, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574YAO Y L, SHI W L, FENG X, et al. Research management strategies for multimorbidity in elderly patients[J]. Chinese Journal of General Practice, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574 [4] HO I S, AZCOAGA_LORENZO A, AKBARI A, et al. Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies[J]. Lancet Public Health, 2021, 6(8): e587-e597. [5] 郑晓, 田峰, 陈一鸣, 等. 2002—2022年我国多重慢病领域研究热点及演进趋势分析[J]. 中国全科医学, 2023, 26(21): 2567-2573.ZHENG X, TIAN F, CHEN Y M, et al. Research Hotspots and Evolutionary Trends on Multimorbidity in China from 2002 to 2022[J]. Chinese General Practice, 2023, 26(21): 2567-2573. [6] 徐婷玲, 周脉耕, 刘江美, 等. 1990年与2019年中国居民归因于高血压的死亡负担分析[J]. 中国慢性病预防与控制, 2022, 30(5): 327-331, 335.XU T L, ZHOU M G, LIU J M, et al. Death burden attributable to hypertension in 1990 and 2019 in China[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2022, 30(5): 327-331, 335. [7] 中国高血压防治指南修订委员会, 高血压联盟(中国), 中国医疗保健国际交流促进会高血压病学分会, 等. 中国高血压防治指南(2024年修订版)[J]. 中华高血压杂志(中英文), 2024, 32(7): 603-700.China Hypertension Prevention and Treatment Guidelines Revision Committee, Hypertension Alliance (China), China Association for the Promotion of International Exchanges in Health Care Hypertension Branch, et al. Chinese Guidelines for Prevention and Treatment of hypertension (2024 revision)[J]. Chinese Journal of Hypertension, 2024, 32(7): 603-700. [8] NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants[J]. Lancet, 2021, 398(10304): 957-980. [9] 陈维尔, 邱艳, 潘晓华, 等. 高血压共病糖尿病患者服药依从性调查及影响因素分析[J]. 中华全科医学, 2024, 22(4): 601-604. doi: 10.16766/j.cnki.issn.1674-4152.003460CHEN W E, QIU Y, PAN X H, et al. Analysis of medication adherence and influencing factors in hypertensive patients combined with diabetes mellitus[J]. Chinese Journal of General Practice, 2024, 22(4): 601-604. doi: 10.16766/j.cnki.issn.1674-4152.003460 [10] FAN Z Y, YANG Y, ZHANG C H, et al. Prevalence and patterns of comorbidity among middle-aged and elderly people in China: a cross-sectional study based on CHARLS data[J]. Int J Gen Med, 2021, 14: 1449-1455. [11] 张梦琦. 基于Apriori算法的关联规则分析[D]. 大连: 大连理工大学, 2021.ZHANG M Q. Association rule Analysis Based on Apriori Algorithm[D]. Dalian: Dalian University of Technology, 2021. [12] LAUDER L, MAHFOUD F, AZIZI M, et al. Hypertension management in patients with cardiovascular comorbidities[J]. Eur Heart J, 2023, 44(23): 2066-2077. [13] 崔曼, 王娟, 邓淼, 等. 高血压共病模式和社会参与交互作用对中国中老年人抑郁症状的影响[J]. 卫生研究, 2024, 53(5): 694-700.CUI M, WANG J, DENG M, et al. Interaction of hypertensive comorbidity patterns and social participation on depressive symptoms[J]. Journal of Hygiene Research, 2024, 53(5): 694-700. [14] 彭德荣, 陈晨, 喻梦珠, 等. 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[J]. 中华全科医学, 2023, 21(6): 907-910. doi: 10.16766/j.cnki.issn.1674-4152.003012PENG D R, CHEN C, YU M Z, et al. Data mining-based analysis of comorbidity status and association rules of hypertensive patients in the community[J]. Chinese Journal of General Practice, 2023, 21(6): 907-910. doi: 10.16766/j.cnki.issn.1674-4152.003012 [15] 李翔, 严同, 许樟荣. 糖尿病和高血压[J]. 中华糖尿病杂志, 2021, 13(7): 740-745.LI X, YAN T, XU Z R. Diabetes and hypertension[J]. Chinese Journal of Diabetes, 2021, 13(7): 740-745. [16] KUAN V, DENAXAS S, PATALAY P, et al. Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study[J]. Lancet Digit Health, 2023, 5(1): e16-e27. -
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