Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study

González-Henares, Maria Antònia; Clúa-Espuny, Josep Lluís; Lorman-Carbo, Blanca; Fernández-Sáez, José; Queralt-Tomas, Lluisa; Muria-Subirats, Eulalia; Ballesta-Ors, Juan; Gil-Guillen, Jose Vicente

doi:10.1007/s12325-019-01206-y

Cited by 4 publications

(4 citation statements)

References 42 publications

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“…The results of the present study indicate a higher incidence of ICH in an emerging and vulnerable population subgroup, such as CCPs, than in both general and elderly populations. Data on time trends for ICH in the general population indicate no significant changes in the incidence of ICH over the last two decades [6,15], but the incidence density of ICH was 5to-60-fold higher than that observed in the general population, both within the study area and worldwide (Table 6) [6,[16][17][18][19][20][21][22][23][24]. Comparisons between studies are difficult due to several interacting and overlapping emerging risk factors and aetiologies, new imaging techniques, demographic changes, comorbidities and associated treatments, different target populations, and the lack of a standardized methodology for data recording and exploitation, which makes it impossible to make adjustments to the incidences for different series of patients.…”

Section: Discussionmentioning

confidence: 86%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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Background Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). Methods This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex. Results 161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127–174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88–6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11–2.35], and cardiovascular disease [OR 1.48 IC95% 1.05–2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89–0.97] and negative predictive value [0.98 (CI95% 0.83–1.12)]. Conclusions In the CCP subgroup the incidence density of ICH was 5–60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH. Trial registration This study was retrospectively registered in ClinicalTrials.gov (NCT03247049) on August 11/2017.

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Section: Discussionmentioning

confidence: 86%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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“…Literature comparison remains difficult since there is a lack of ICH incidence studies in populations with high multimorbidity and complexity, such as the GMA-4. In our study area, two studies conducted with complex chronic patients [ 14 , 15 ] showed a greater incidence of ICH.…”

Section: Discussionmentioning

confidence: 89%

“…Recent studies from our setting show that complex chronic patients are a high-risk group for ICH, with ICH incidences from 5 to 60 times higher than the general population. Notably, the HAS-BLED has shown high sensitivity in this subgroup of population for the identification of individuals at high risk of ICH [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Adjusted Morbidity Groups and Intracerebral Haemorrhage: A Retrospective Primary Care Cohort Study

Lorman-Carbo

Clúa-Espuny

Muria-Subirats

et al. 2021

IJERPH

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Background: Intracerebral haemorrhage rates are increasing among highly complex, elderly patients. The main objective of this study was to identify modifiable risk factors of intracerebral haemorrhage. Methods: Multicentre, retrospective, community-based cohort study was conducted, including patients in the Adjusted Morbidity Group 4 with no history of intracerebral haemorrhage. Cases were obtained from electronic clinical records of the Catalan Institute of Health and were followed up for five years. The primary outcome was the occurrence of intracerebral haemorrhage during the study period. Demographic, clinical and pharmacological variables were included. Logistic regression analyses were carried out to detect prognostic variables for intracerebral haemorrhage. Results: 4686 subjects were included; 170 (3.6%) suffered an intracerebral haemorrhage (85.8/10,000 person–year [95% CI 85.4 to 86.2]). The HAS-BLED score for intracerebral haemorrhage risk detection obtained the best AUC (0.7) when used in the highest complexity level (cut-off point ≥3). Associated independent risk factors were age ≥80 years, high complexity and use of antiplatelet agents. Conclusions: The Adjusted Morbidity Group 4 is associated with a high risk of intracerebral haemorrhage, particularly for highly complex patients and the use of antiplatelet agents. The risk of bleeding in these patients must be closely monitored.

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“…Understanding the change trend of chronic diseases with age is a critical way to control them. In the former researches, morbidity and mortality are the mostly used indicators to measure the diseases [ 3 – 6 ]. But after Global Burden of Disease Study 2010 (GBD study 2010) published the measurement of Disabled Adjusted Life Years (DALYs) of 291 diseases and injuries, DALYs become a novel indicator to evaluate the chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

Trajectories of middle-aged and elderly people’s chronic diseases Disability Adjusted Life Years (DALYs): cohort, socio-economic status and gender disparities

Zhang

Tang

Liang

et al. 2021

Int J Equity Health

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Background The accelerated aging trend brought great chronic diseases burdens. Disabled Adjusted Life Years (DALYs) is a novel way to measure the chronic diseases burden. This study aimed to explore the cohort, socioeconomic status (SES), and gender disparities of the DALYs trajectories. Methods A total of 15,062 participants (55,740 observations) comes from China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. Mixed growth curve model was adopted to predict the DALYS trajectories in 45–90 years old people influenced by different birth cohorts and SES. Results We find significant cohort, SES (resident place, education level and income) disparities differences in the chronic diseases DALYs. For individuals of earlier cohort, DALYs are developed in a late age but grow fast with age but reversed for most recent cohorts. Living in urban, having higher SES level will decrease the growth rate with age, but converges for most recent cohorts. Meanwhile, DALYs disparities of resident place and education level show gender differentials that those for female are narrowed across cohort but for male are not. Conclusions The cohort effects on chronic diseases DALYs are accumulated with China’s unique social, and political settings. There are large inequalities in early experiences, SES and DALYs. Efforts of reducing these inequalities must focus on the lower SES individuals and those living in rural areas, which greatly benefit individuals from recent cohorts.

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Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study

Cited by 4 publications

References 42 publications

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Adjusted Morbidity Groups and Intracerebral Haemorrhage: A Retrospective Primary Care Cohort Study

Trajectories of middle-aged and elderly people’s chronic diseases Disability Adjusted Life Years (DALYs): cohort, socio-economic status and gender disparities

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