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Article(id=1321169852853769132, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169839390053177, articleNumber=null, orderNo=null, doi=10.11847/zgggws1144537, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1711296000000, receivedDateStr=2024-03-25, revisedDate=1725292800000, revisedDateStr=2024-09-03, acceptedDate=1736956800000, acceptedDateStr=2025-01-16, onlineDate=1792921039069, onlineDateStr=2026-10-25, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921039069, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921039069, creator=13701087609, updateTime=1792921039069, updator=13701087609, issue=Issue{id=1321169839390053177, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='6', pageStart='641', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='1749484800000', pubDateStr='2025-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921035859, creator='13701087609', updateTime=1792921035859, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=711, endPage=715, ext={EN=ArticleExt(id=1321169853730378671, articleId=1321169852853769132, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Association analysis of chronic disease comorbidity combinations in elderly inpatients in Shenzhen city from 2017 to 2022: an analysis based on medical records data, columnId=1321169853617132462, journalTitle=Chinese Journal of Public Health, columnName=Special Report – Promoting Older Adult Health Knowledge and Enhancing Health Literacy, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the prevalence and common comorbidity patterns of chronic diseases among elderly inpatients in Shenzhen city, Guangdong province, from 2017 to 2022, and to provide scientific evidence for the development of comorbidity management and prevention strategies.

Methods

Data from the discharge summaries of 410 814 inpatients aged 65 years and older from 142 primary and higher-level hospitals in Shenzhen city between January 1, 2017, and December 31, 2022, were collected. Frequency combination analysis was used to identify common chronic disease comorbidity combinations, and association rule analysis was used to identify common non-random disease combinations.

Results

Among the 410 814 elderly inpatients in Shenzhen city from 2017 to 2022, 387 020 (94.21%) had chronic disease comorbidities. Hypertension was the most prevalent chronic disease (59.14%), accounting for 97.79% of the comorbidity composition. The most common two- and three-disease combinations were “hypertension + stroke” (106 005 cases, 25.80%) and “hypertension + peripheral artery disease + stroke” (55 343 cases, 13.47%), respectively. The top 20 two- and three-disease combinations mainly consisted of hypertension, stroke, ischemic heart disease, heart failure, peripheral artery disease, dyslipidemia, and type 2 diabetes, with cardiovascular diseases predominating, followed by metabolic diseases. Association rule analysis showed that among the top 20 rules, the rule “(refractive errors and accommodation disorders) => (cataract)” had the highest lift value of 6.128. The remaining association rules all involved cardiovascular and cerebrovascular diseases, with the rule “(chronic ischemic heart disease, hypertension, peripheral artery disease) => (heart failure)” having a lift value of 3.082.

Conclusions

The prevalence of chronic disease comorbidities among elderly inpatients in Shenzhen city is high. Cardiovascular diseases dominate the two- and three-disease combinations. Cataracts and cardiovascular and cerebrovascular diseases are the main non-random comorbidity association patterns.

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WU Liqun, E-mail:
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目的

了解2017—2022年广东省深圳市老年住院患者的慢性病共病现状及常见的关联组合，为慢性病共病管理和防控措施的制定提供科学依据。

方法

收集2017年1月1日—2022年12月31日深圳市142家一级及以上非中医类医院410 814例≥65岁老年住院患者的病案首页数据，使用频率组合分析常见的慢性病共病疾病组合，并采用关联规则分析常见的非随机疾病组合。

结果

2017—2022年深圳市410 814例老年住院患者中，患慢性病共病者387 020例，慢性病共病患病比例为94.21%；高血压是深圳市老年住院患者患病率最高的慢性病，患病率为59.14%，其共病构成比为97.79%；最常见的二元和三元疾病组合分别为“高血压+脑卒中”和“高血压+外周动脉疾病+脑卒中”，分别为106 005和55 343例，分别占老年住院患者的25.80%和13.47%；排名前20位的二元和三元疾病组合主要由高血压、脑卒中、缺血性心脏病、心力衰竭、外周动脉病、血脂异常、2型糖尿病等疾病组成，其中心血管疾病占主导，其次为代谢性疾病；关联规则分析结果显示，在排名前20位的规则中，规则“（屈光和调节障碍）=>（白内障）”的提升度最高为6.128，其余的关联规则均涉及心脑血管疾病，其中规则（慢性缺血性心脏病，高血压，外周动脉疾病）=>（心力衰竭）的提升度为3.082。

结论

深圳市老年住院患者的慢性病共病现状严重，二元和三元疾病组合中心血管疾病占主导，白内障和心脑血管疾病是主要的非随机共病关联模式。

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黎艳娜（1996—），中级，硕士，研究方向：卫生管理

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伍丽群，E-mail：
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Perspectives in Health Information Management, 2021, 18(3): 1h., articleTitle=null, refAbstract=null), Reference(id=1321169858281198564, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169852853769132, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=13, rfOrder=12, authorNames=null, journalName=null, refType=null, unstructuredReference=Wang Y H, Huang C, Tseng Y L, et al. Refractive error and eye health: an umbrella review of meta-analyses[J]. Frontiers in Medicine, 2021, 8: 759767., articleTitle=null, refAbstract=null), Reference(id=1321169858646103013, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169852853769132, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=14, rfOrder=13, authorNames=null, journalName=null, refType=null, unstructuredReference=Teo K K, Rafiq T. Cardiovascular risk factors and prevention: a perspective from developing countries[J]. Canadian Journal of Cardiology, 2021, 37(5): 733-743., articleTitle=null, refAbstract=null), Reference(id=1321169858734183399, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169852853769132, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=15, rfOrder=14, authorNames=null, journalName=null, refType=null, unstructuredReference=Joseph J J, Deedwania P, Acharya T, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association[J]. Circulation, 2022, 145(9): e722-e759., articleTitle=null, refAbstract=null), Reference(id=1321169859052950504, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169852853769132, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=16, rfOrder=15, authorNames=null, journalName=null, refType=null, unstructuredReference=胡大一. 中国血脂异常与动脉粥样硬化性心血管疾病防控的新证据和新指南[J]. 中华心血管病杂志, 2016, 44(10): 826-827., articleTitle=null, refAbstract=null), Reference(id=1321169859124253673, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169852853769132, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=17, rfOrder=16, authorNames=null, journalName=null, refType=null, unstructuredReference=Signorelli S S, Marino E, Scuto S, et al. Pathophysiology of Peripheral Arterial Disease (PAD): a review on oxidative disorders[J]. International Journal of Molecular Sciences, 2020, 21(12): 4393., articleTitle=null, refAbstract=null), Reference(id=1321169859199751146, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169852853769132, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=18, rfOrder=17, authorNames=null, journalName=null, refType=null, unstructuredReference=Fuchs F D, Whelton P K. High blood pressure and cardiovascular disease[J]. 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Top 20 two-way and three-way comorbidity combinations of chronic diseases in elderly inpatients in Shenzhen city

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排名二元疾病组合三元疾病组合
组合例数%组合例数%
1高血压+脑卒中106 00525.80高血压+外周动脉疾病+脑卒中55 34313.47
2高血压+外周动脉疾病89 57021.80慢性缺血性心脏病+高血压+外周动脉疾病44 24110.77
3慢性缺血性心脏病+高血压83 45820.32慢性缺血性心脏病+心力衰竭+高血压43 07610.49
4高血压+2型糖尿病78 67719.15慢性缺血性心脏病+高血压+脑卒中42 22210.28
5外周动脉疾病+脑卒中69 39816.89高血压+脑卒中+2型糖尿病39 5549.63
6高血压+血脂异常61 04014.86高血压+血脂异常+脑卒中34 7888.47
7慢性缺血性心脏病+外周动脉疾病57 51714.00高血压+外周动脉疾病+2型糖尿病33 8938.25
8慢性缺血性心脏病+心力衰竭55 91713.61慢性缺血性心脏病+高血压+2型糖尿病32 8818.00
9心力衰竭+高血压55 08113.41高血压+血脂异常+外周动脉疾病32 7827.98
10慢性缺血性心脏病+脑卒中51 45312.52慢性缺血性心脏病+外周动脉疾病+脑卒中32 5057.91
11脑卒中+2型糖尿病46 99011.44慢性缺血性心脏病+心力衰竭+外周动脉疾病30 0867.32
12血脂异常+脑卒中43 23410.52心力衰竭+高血压+外周动脉疾病29 3437.14
13血脂异常+外周动脉疾病42 61310.37心力衰竭+高血压+脑卒中28 7977.01
14外周动脉疾病+2型糖尿病41 88910.20慢性缺血性心脏病+高血压+血脂异常27 8166.77
15慢性缺血性心脏病+2型糖尿病39 7779.68慢性缺血性心脏病+心力衰竭+脑卒中27 3766.66
16白内障+高血压38 0379.26血脂异常+外周动脉疾病+脑卒中26 1476.36
17高血压+嘌呤和嘧啶代谢紊乱36 8658.97外周动脉疾病+脑卒中+2型糖尿病25 9516.32
18高血压+肾衰竭36 6878.93高血压+血脂异常+2型糖尿病25 5706.22
19心力衰竭+外周动脉疾病36 4528.87慢性缺血性心脏病+血脂异常+外周动脉疾病21 9635.35
20慢性缺血性心脏病+血脂异常35 4758.64心力衰竭+高血压+2型糖尿病21 9245.34
), ArticleFig(id=1321169856804803538, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169852853769132, language=CN, label=表1, caption=

深圳市老年住院患者慢性病共病患病前20位二元和三元疾病组合

, figureFileSmall=null, figureFileBig=null, tableContent=
排名二元疾病组合三元疾病组合
组合例数%组合例数%
1高血压+脑卒中106 00525.80高血压+外周动脉疾病+脑卒中55 34313.47
2高血压+外周动脉疾病89 57021.80慢性缺血性心脏病+高血压+外周动脉疾病44 24110.77
3慢性缺血性心脏病+高血压83 45820.32慢性缺血性心脏病+心力衰竭+高血压43 07610.49
4高血压+2型糖尿病78 67719.15慢性缺血性心脏病+高血压+脑卒中42 22210.28
5外周动脉疾病+脑卒中69 39816.89高血压+脑卒中+2型糖尿病39 5549.63
6高血压+血脂异常61 04014.86高血压+血脂异常+脑卒中34 7888.47
7慢性缺血性心脏病+外周动脉疾病57 51714.00高血压+外周动脉疾病+2型糖尿病33 8938.25
8慢性缺血性心脏病+心力衰竭55 91713.61慢性缺血性心脏病+高血压+2型糖尿病32 8818.00
9心力衰竭+高血压55 08113.41高血压+血脂异常+外周动脉疾病32 7827.98
10慢性缺血性心脏病+脑卒中51 45312.52慢性缺血性心脏病+外周动脉疾病+脑卒中32 5057.91
11脑卒中+2型糖尿病46 99011.44慢性缺血性心脏病+心力衰竭+外周动脉疾病30 0867.32
12血脂异常+脑卒中43 23410.52心力衰竭+高血压+外周动脉疾病29 3437.14
13血脂异常+外周动脉疾病42 61310.37心力衰竭+高血压+脑卒中28 7977.01
14外周动脉疾病+2型糖尿病41 88910.20慢性缺血性心脏病+高血压+血脂异常27 8166.77
15慢性缺血性心脏病+2型糖尿病39 7779.68慢性缺血性心脏病+心力衰竭+脑卒中27 3766.66
16白内障+高血压38 0379.26血脂异常+外周动脉疾病+脑卒中26 1476.36
17高血压+嘌呤和嘧啶代谢紊乱36 8658.97外周动脉疾病+脑卒中+2型糖尿病25 9516.32
18高血压+肾衰竭36 6878.93高血压+血脂异常+2型糖尿病25 5706.22
19心力衰竭+外周动脉疾病36 4528.87慢性缺血性心脏病+血脂异常+外周动脉疾病21 9635.35
20慢性缺血性心脏病+血脂异常35 4758.64心力衰竭+高血压+2型糖尿病21 9245.34
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Support, confidence, and lift of the top 20 comorbidity association rules for chronic diseases in elderly inpatients in Shenzhen city

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排名关联规则支持度置信度提升度
1（屈光和调节障碍）=>（白内障）0.0630.9296.128
2（慢性缺血性心脏病,高血压,外周动脉疾病）=>（心力衰竭）0.0600.5543.082
3（慢性缺血性心脏病,高血压, 脑卒中）=>（心力衰竭）0.0560.5473.041
4（心力衰竭,高血压,外周动脉疾病）=>（慢性缺血性心脏病）0.0600.8353.022
5（慢性缺血性心脏病, 2型糖尿病）=>（心力衰竭）0.0530.5433.021
6（心力衰竭, 2型糖尿病）=>（慢性缺血性心脏病）0.0530.8303.003
7（心力衰竭,外周动脉疾病）=>（慢性缺血性心脏病）0.0730.8252.985
8（慢性缺血性心脏病, 脑卒中）=>（心力衰竭）0.0670.5322.959
9（慢性缺血性心脏病,外周动脉疾病=>（心力衰竭）0.0730.5232.909
10（心力衰竭,高血压, 脑卒中）=>（慢性缺血性心脏病）0.0560.8022.900
11（慢性缺血性心脏病,高血压）=>（心力衰竭）0.1050.5162.870
12（心力衰竭, 脑卒中）=>（慢性缺血性心脏病）0.0670.7912.862
13（心力衰竭,高血压）=>（慢性缺血性心脏病）0.1050.7822.829
14（心力衰竭）=>（慢性缺血性心脏病）0.1360.7572.738
15（慢性缺血性心脏病,高血压,脑卒中）=>（外周动脉疾病）0.0670.6472.100
16（慢性缺血性心脏病,脑卒中）=>（外周动脉疾病）0.0790.6322.050
17（心力衰竭,脑卒中）=>（外周动脉疾病）0.0530.6272.034
18（高血压,血脂异常,脑卒中）=>（外周动脉疾病）0.0530.6242.024
19（慢性缺血性心脏病,血脂异常）=>（外周动脉疾病）0.0530.6192.009
20（血脂异常,脑卒中）=>（外周动脉疾病）0.0640.6051.963
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深圳市老年住院患者提升度前20位慢性病共病关联规则支持度、置信度和提升度

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排名关联规则支持度置信度提升度
1（屈光和调节障碍）=>（白内障）0.0630.9296.128
2（慢性缺血性心脏病,高血压,外周动脉疾病）=>（心力衰竭）0.0600.5543.082
3（慢性缺血性心脏病,高血压, 脑卒中）=>（心力衰竭）0.0560.5473.041
4（心力衰竭,高血压,外周动脉疾病）=>（慢性缺血性心脏病）0.0600.8353.022
5（慢性缺血性心脏病, 2型糖尿病）=>（心力衰竭）0.0530.5433.021
6（心力衰竭, 2型糖尿病）=>（慢性缺血性心脏病）0.0530.8303.003
7（心力衰竭,外周动脉疾病）=>（慢性缺血性心脏病）0.0730.8252.985
8（慢性缺血性心脏病, 脑卒中）=>（心力衰竭）0.0670.5322.959
9（慢性缺血性心脏病,外周动脉疾病=>（心力衰竭）0.0730.5232.909
10（心力衰竭,高血压, 脑卒中）=>（慢性缺血性心脏病）0.0560.8022.900
11（慢性缺血性心脏病,高血压）=>（心力衰竭）0.1050.5162.870
12（心力衰竭, 脑卒中）=>（慢性缺血性心脏病）0.0670.7912.862
13（心力衰竭,高血压）=>（慢性缺血性心脏病）0.1050.7822.829
14（心力衰竭）=>（慢性缺血性心脏病）0.1360.7572.738
15（慢性缺血性心脏病,高血压,脑卒中）=>（外周动脉疾病）0.0670.6472.100
16（慢性缺血性心脏病,脑卒中）=>（外周动脉疾病）0.0790.6322.050
17（心力衰竭,脑卒中）=>（外周动脉疾病）0.0530.6272.034
18（高血压,血脂异常,脑卒中）=>（外周动脉疾病）0.0530.6242.024
19（慢性缺血性心脏病,血脂异常）=>（外周动脉疾病）0.0530.6192.009
20（血脂异常,脑卒中）=>（外周动脉疾病）0.0640.6051.963
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2017—2022年深圳市老年住院患者慢性病共病疾病组合关联分析
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黎艳娜 , 杜芳 , 伍丽群 *, *
中国公共卫生 | 专题报道——宣传普及老年健康知识，提高老年人健康素养 2025,41(6): 711-715
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中国公共卫生 |专题报道——宣传普及老年健康知识，提高老年人健康素养 2025 , 41 (6) : 711 -715
2017—2022年深圳市老年住院患者慢性病共病疾病组合关联分析
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黎艳娜, 杜芳, 伍丽群*, *
作者信息
  • 深圳市卫生健康发展研究和数据管理中心，深圳 518028
通讯作者:
伍丽群，E-mail：
作者简介:

黎艳娜（1996—），中级，硕士，研究方向：卫生管理

Association analysis of chronic disease comorbidity combinations in elderly inpatients in Shenzhen city from 2017 to 2022: an analysis based on medical records data
Yanna LI, Fang DU, Liqun WU
Affiliations
  • Shenzhen Health Development Research and Data Management Center, Shenzhen 518028, China
    • Corresponding Author:
    WU Liqun, E-mail:
出版时间: 2025-06-10 doi: 10.11847/zgggws1144537
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摘要
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目的

了解2017—2022年广东省深圳市老年住院患者的慢性病共病现状及常见的关联组合，为慢性病共病管理和防控措施的制定提供科学依据。

方法

收集2017年1月1日—2022年12月31日深圳市142家一级及以上非中医类医院410 814例≥65岁老年住院患者的病案首页数据，使用频率组合分析常见的慢性病共病疾病组合，并采用关联规则分析常见的非随机疾病组合。

结果

2017—2022年深圳市410 814例老年住院患者中，患慢性病共病者387 020例，慢性病共病患病比例为94.21%；高血压是深圳市老年住院患者患病率最高的慢性病，患病率为59.14%，其共病构成比为97.79%；最常见的二元和三元疾病组合分别为“高血压+脑卒中”和“高血压+外周动脉疾病+脑卒中”，分别为106 005和55 343例，分别占老年住院患者的25.80%和13.47%；排名前20位的二元和三元疾病组合主要由高血压、脑卒中、缺血性心脏病、心力衰竭、外周动脉病、血脂异常、2型糖尿病等疾病组成，其中心血管疾病占主导，其次为代谢性疾病；关联规则分析结果显示，在排名前20位的规则中，规则“（屈光和调节障碍）=>（白内障）”的提升度最高为6.128，其余的关联规则均涉及心脑血管疾病，其中规则（慢性缺血性心脏病，高血压，外周动脉疾病）=>（心力衰竭）的提升度为3.082。

结论

深圳市老年住院患者的慢性病共病现状严重，二元和三元疾病组合中心血管疾病占主导，白内障和心脑血管疾病是主要的非随机共病关联模式。

慢性病共病  /  疾病组合  /  关联分析  /  老年住院患者  /  深圳市
Objective

To investigate the prevalence and common comorbidity patterns of chronic diseases among elderly inpatients in Shenzhen city, Guangdong province, from 2017 to 2022, and to provide scientific evidence for the development of comorbidity management and prevention strategies.

Methods

Data from the discharge summaries of 410 814 inpatients aged 65 years and older from 142 primary and higher-level hospitals in Shenzhen city between January 1, 2017, and December 31, 2022, were collected. Frequency combination analysis was used to identify common chronic disease comorbidity combinations, and association rule analysis was used to identify common non-random disease combinations.

Results

Among the 410 814 elderly inpatients in Shenzhen city from 2017 to 2022, 387 020 (94.21%) had chronic disease comorbidities. Hypertension was the most prevalent chronic disease (59.14%), accounting for 97.79% of the comorbidity composition. The most common two- and three-disease combinations were “hypertension + stroke” (106 005 cases, 25.80%) and “hypertension + peripheral artery disease + stroke” (55 343 cases, 13.47%), respectively. The top 20 two- and three-disease combinations mainly consisted of hypertension, stroke, ischemic heart disease, heart failure, peripheral artery disease, dyslipidemia, and type 2 diabetes, with cardiovascular diseases predominating, followed by metabolic diseases. Association rule analysis showed that among the top 20 rules, the rule “(refractive errors and accommodation disorders) => (cataract)” had the highest lift value of 6.128. The remaining association rules all involved cardiovascular and cerebrovascular diseases, with the rule “(chronic ischemic heart disease, hypertension, peripheral artery disease) => (heart failure)” having a lift value of 3.082.

Conclusions

The prevalence of chronic disease comorbidities among elderly inpatients in Shenzhen city is high. Cardiovascular diseases dominate the two- and three-disease combinations. Cataracts and cardiovascular and cerebrovascular diseases are the main non-random comorbidity association patterns.

chronic disease comorbidity  /  disease combinations  /  association analysis  /  elderly inpatients  /  Shenzhen city
黎艳娜, 杜芳, 伍丽群. 2017—2022年深圳市老年住院患者慢性病共病疾病组合关联分析. 中国公共卫生, 2025 , 41 (6) : 711 -715 . DOI: 10.11847/zgggws1144537
Yanna LI, Fang DU, Liqun WU. Association analysis of chronic disease comorbidity combinations in elderly inpatients in Shenzhen city from 2017 to 2022: an analysis based on medical records data[J]. Chinese Journal of Public Health, 2025 , 41 (6) : 711 -715 . DOI: 10.11847/zgggws1144537
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慢性病共病是指同时患有≥2种慢性病的情况[1]，随着全球人口老龄化的加剧，慢性病患者急剧增加，慢性病共病患病率急速上升，成为全球卫生领域的一项重要挑战[2]。研究表明，慢性病共病患者会面临更多的过早死亡、身体功能和社会适应能力下降、生活质量降低、心理和精神状态不佳的风险以及更多的医疗服务需求、不良药物反应、复杂治疗方案、失能和残疾的风险[3–5]。而了解特定人群的共病模式，确定常见的聚集疾病，对以患者为中心导向的疾病预防、诊断、治疗和预后策略均具有重要意义[1]。为了解2017—2022年广东省深圳市老年住院患者的慢性病共病现状及常见的关联组合，为慢性病共病管理和防控措施的制定提供科学依据，本研究收集2017年1月1日—2022年12月31日深圳市142家一级及以上医院410 814例≥65岁老年住院患者的病案首页数据，使用频率组合分析常见的慢性病共病疾病组合，并采用关联规则分析常见的非随机疾病组合。结果报告如下。
1　资料与方法
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1.1　资料来源
收集2017年1月1日—2022年12月31日深圳市142家一级及以上非中医类医院410 814例≥65岁老年住院患者的病案首页数据，内容包括患者ID、患者唯一识别码、性别、年龄、民族、婚姻状况、疾病主要诊断和次要诊断编码和出院方式等。根据患者唯一识别码将2017—2022年老年住院患者出院人次数合并为老年住院患者出院人数，疾病根据主要诊断和次要诊断编码去重后叠加，性别、年龄、民族和婚姻状况选择调查期间初次住院状态，出院方式选择为终末状态。慢性病指患有持续≥1年且需要持续医疗或限制日常生活活动或两者兼而有之的病症，参考2019年全球疾病负担研究（Global Burden of Disease 2019, GBD 2019）中关于伤残和死亡原因的慢性病目录[6]以及国家卫生健康委办公厅发布的224个病种临床路径（2019年版）中的慢性病[7]，结合第十版国际疾病分类编码（ICD-10，Classification of Diseases and Related Health Problems 10th Revision）[8]和相应的疾病出院人数，本研究最终确定了248种重要的慢性病。本研究所使用的数据来自清华-深圳健康生态队列项目，具体为病案首页数据，并已通过清华大学万科公共卫生与健康学院伦理委员会审查批准（批号：20230065）。
1.2　统计分析
应用R 4.3.1进行统计分析。常见的随机二元和三元疾病组合根据疾病共现频次进行统计，非随机的慢性病共现关系则使用Apriori关联规则算法进行挖掘。Apriori算法是一种用于挖掘频繁项集和关联规则的经典算法，该方法不仅考虑疾病组合出现的频率，而且还分析这些组合是否超出了随机概率的范围，即这些组合是否存在某种特定的关联模式。本研究采用支持度、置信度和提升度3个Apriori算法的常用评价指标选择模型。其中，支持度衡量某一疾病组合在所有疾病组合病例中出现的频率，用于发现哪些疾病组合值得进一步分析；置信度衡量在出现疾病A的条件下，疾病B同时出现的概率，反映规则的强度或可信度；提升度衡量疾病A与B之间的关联强度，提升度>1表示疾病A与B之间存在正相关关系，提升度为1表示疾病A与B之间无关联，提升度<1表示疾病A与B之间存在负相关关系。本研究将支持度设置为>0.05、置信度>0.5，对248种慢性病进行分析，共挖掘出92条关联规则。
2　结　果
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2.1　老年住院患者一般情况
深圳市410 814例老年住院患者中，男性206 597例（50.29%），女性204 217例（49.71%）；年龄65～74岁258 786例（62.99%），≥75岁152 028例（37.01%）；汉族404 335例（98.42%），其他民族6 479例（1.58%）；婚姻状况未婚2 168例（0.53%），已婚364 475例（88.72%），离异/丧偶44 171例（10.75%）；出院方式非死亡390 113例（94.96%），死亡20 701例（5.04%）。
2.2　2017—2022年深圳市老年住院患者慢性病共病情况
2017—2022年深圳市410 814例老年住院患者中，患慢性病共病者387 020例，慢性病共病患病比例为94.21%。深圳市老年住院患者患病率前20位的慢性病依次为高血压[59.14%（242 940/410 814）]、脑卒中[33.94%（139 427/410 814）]、外周动脉疾病[30.81%（126 591/410 814）]、慢性缺血性心脏病[27.65%（113 574/410 814）]、2型糖尿病[25.89%（106 378/410 814）]、血脂异常[20.99%（86 245/410 814）]、心力衰竭[17.98%（73 868/410 814）]、白内障[15.16%（62 265/410 814）]、慢性阻塞性肺疾病[14.55%（59 770/410 814）]、胃炎和十二指肠炎[13.48%（55 364/410 814）]、前列腺增生[13.09%（53 778/410 814）]、胆石症[12.40%（50 952/410 814）]、嘌呤和嘧啶代谢紊乱[12.03%（49 415/410 814）]、肾衰竭[11.57%（47 539/410 814）]、脊椎病[11.53%（47 355/410 814）]、甲状腺疾病[11.48%（47 159/410 814）]、脂肪肝[10.99%（45 136/410 814）]、尿石症[10.40%（42 715/410 814）]、骨质疏松症[9.63%（39 564/410 814）]和颈椎间盘疾患[8.60%（35 335/410 814）]，共病构成比依次为97.99%（238 060/242 940）、99.18%（138 280/139 427）、99.60%（126 083/126 591）、99.66%（113 193/113 574）、98.92%（105 227/106 378）、99.49%（85 805/86 245）、99.88%（73 782/73 868）、98.83%（61 539/62 265）、98.29%（58 748/59 770）、98.66%（54 620/55 364）、98.95%（53 211/53 778）、98.58%（50 229/50 952）、99.67%（49 254/49 415）、99.72%（47 408/47 539）、99.12%（46 936/47 355）、99.10%（46 734/47 159）、99.66%（44 981/45 136）、99.01%（42 294/42 715）、95.43%（37 757/39 564）和99.21%（35 056/35 335）。
2.3　深圳市老年住院患者慢性病共病主要随机二元和三元疾病组合（表1）
居于深圳市老年住院患者慢性病共病患病首位的二元疾病组合和三元疾病组合分别为“高血压+脑卒中”和“高血压+外周动脉疾病+脑卒中”，患病比例分别为25.80%（106 005/410 814）和13.47%（55 343/410 814）；前20为二元和三元疾病组合主要由高血压、脑卒中、缺血性心脏病、心力衰竭、外周动脉病、血脂异常和2型糖尿病疾病组成，其中心脑血管疾病占主导，其次为代谢性疾病。
2.4　深圳市老年住院患者慢性病共病主要非随机关联疾病模式（表2）
本研究挖掘出的提升度前20位关联规则中，最常见的疾病为慢性缺血性心脏病，出现在16条规则中；其次分别为心力衰竭、外周动脉疾病和脑卒中，分别出现在14、10和9条规则中。规则“（屈光和调节障碍）=>（白内障）”的提升度最高，提示有92.9%的屈光和调节障碍老年住院患者同时患有白内障，屈光和调节障碍与白内障具有较强的关联。其他的关联规则均涉及到心脑血管疾病，形成由高血压、2型糖尿病、血脂异常、脑卒中、外周动脉疾病、心力衰竭、缺血性心脏病等组成的心脑血管疾病簇团，高血压、2型糖尿病、血脂异常与心脑血管疾病均具有较强的关联，老年住院患者同时患有慢性缺血性心脏病、高血压和外周动脉疾病，其发生心力衰竭的概率增加3.082倍。
3　讨　论
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近年来，随着老龄化进程的加速，慢性病患者增加，慢性病共病患病率急速上升，成为全球公共卫生领域的一项重要挑战。本研究结果显示，深圳市≥65岁老年住院患者慢性病共病患病比例达94.21%，与其他研究结果基本一致[9–10]，表明老年住院患者多种慢性病共存的现象非常普遍。其中，高血压为深圳市老年住院患者患有的最主要慢性病，患病率为59.14%，其共病构成比为97.79%；其他患病排名前20位的慢性病共病构成比大多数>98%，其中心力衰竭和肾衰竭的共病构成比接近100%，提示管理和预防这些疾病对于改善老年人的健康和减少住院情况至关重要。
根据频次进行统计的二元和三元疾病组合主要以心脑血管疾病（高血压、脑卒中、外周动脉疾病、慢性缺血性心脏病、心力衰竭）为主导，反映出老年人群中心血管疾病的易感性。研究表明心血管疾病风险随年龄的增长而显著增加，且心血管疾病明显影响老年人的身体健康、生活质量和死亡率[11]，因此预防和管理老年人群心血管疾病十分重要。本研究中，“高血压+脑卒中”和“高血压+外周动脉疾病+脑卒中”为最常见的二元和三元疾病组合，患病比例分别为25.80%和13.47%，其他常见的二元疾病组合还有“高血压+外周动脉疾病” “慢性缺血性心脏病+高血压” “高血压+2型糖尿病”等，常见的三元组合还有“慢性缺血性心脏病+高血压+外周动脉疾病” “慢性缺血性心脏病+心力衰竭+高血压” “慢性缺血性心脏病+高血压+脑卒中”等。其中，高血压在多种疾病组合中普遍存在，由于长期的高血压可导致动脉硬化、血流动力学改变、内皮功能障碍，从而增加了脑卒中、外周动脉疾病、慢性缺血性心脏病等疾病的患病风险，因此控制血压可以有效预防上述慢性病的发生，改善整体健康状况。
其次为代谢性疾病（2型糖尿病、甲状腺疾病、脂肪肝、血脂异常、嘌呤紊乱）。基于关联规则算法的非随机疾病组合发现，老年住院患者形成明显的心脑血管关联模式和白内障关联模式。此外，本研究还采用Apriori算法探讨了深圳市老年住院患者中慢性病的非随机关联规则，这与之前的二元和三元疾病组合分析有所不同。Apriori算法的应用可以更准确地识别慢性病之间的关联，而非仅仅基于共同出现的频率，这些关联规则的发现有助于理解慢性疾病的共病机制，并为临床治疗提供指导[12]。本研究关联规则分析结果显示，深圳市老年住院患者的疾病关联主要发现2种模式：第1种是屈光和调节障碍（近视或远视）与白内障之间的强关联，Wang等[13]研究亦发现近视与核性白内障、后囊下白内障和开角型青光眼患病均相关；第2种是心脑血管疾病的强关联，以慢性缺血性心脏病、外周动脉疾病和心力衰竭为关联规则的后项。这些规则涉及高血压、2型糖尿病和血脂异常，提示在老年人群中进行生活方式干预以及血压、血糖和血脂控制的重要性，研究表明控制血压、血糖和血脂可明显降低心血管疾病的发生率[14]。2型糖尿病主要与缺血性心脏病和心力衰竭关联，可能是2型糖尿病为动脉粥样硬化性心血管疾病的危险因素之一，胰岛素抵抗和高血糖均会促进心脑血管疾病和心力衰竭[15]。血脂异常主要与外周动脉疾病和慢性缺血性心脏病关联，可能是长期的总胆固醇水平过高会增加外周动脉疾病发病风险，低密度脂蛋白胆固醇是动脉粥样硬化性心血管疾病的主要致病成分，而动脉粥样硬化则是外周动脉疾病发展的主要原因[16–17]。高血压关联规则中出现的频率较高，与多种心脑血管疾病均有关联，包括慢性缺血性心脏病、脑卒中、心力衰竭和外周动脉疾病，这可能与高血压为多种心脑血管疾病发生的主要危险因素有关，如冠状动脉疾病、充血性心力衰竭、脑血管疾病和外周动脉疾病等[18]。
综上所述，深圳市老年住院患者的慢性病共病现状严重，二元和三元疾病组合中心血管疾病占主导，白内障和心脑血管疾病是主要的非随机共病关联模式。本研究的优点是纳入了410 814例老年住院患者的病历数据，具有较大的样本量，在一定程度保证了研究结果的稳定性，且采用病案首页数据以及疾病诊断均使用ICD-10编码进行分类，有效避免了提取诊断信息导致的误差。但本研究仍存在一定的局限性，如本研究为回顾性研究，可以发现疾病之间的关联关系，但2种疾病之间可能存在其他潜在的混杂因素，无法进行因果关系的推断，因此在今后的研究中可针对关联性强的疾病进行深入研究，以更好地理解其之间的交互作用和潜在的因果关系。

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2025年第41卷第6期
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doi: 10.11847/zgggws1144537
  • 接收时间：2024-03-25
  • 首发时间：2026-10-25
  • 出版时间：2025-06-10
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  • 收稿日期：2024-03-25
  • 修回日期：2024-09-03
  • 录用日期：2025-01-16
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    深圳市卫生健康发展研究和数据管理中心，深圳 518028

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2种不同金属材料的力学参数
科
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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