基于区域医疗大数据的慢性肾脏病患者贫血患病及治疗情况调查

柴扬帆; 林鸿波; 丁国辉; 王晋伟; 王怀玉; 彭苏元; 高碧霞; 邓心未; 孔桂兰; 包蓓艳; 张路霞

Abstract

柴扬帆,林鸿波,丁国辉,王晋伟,王怀玉,彭苏元,高碧霞,邓心未,孔桂兰,包蓓艳,张路霞.基于区域医疗大数据的慢性肾脏病患者贫血患病及治疗情况调查[J].Chinese journal of Epidemiology,2023,44(7):1046-1053

基于区域医疗大数据的慢性肾脏病患者贫血患病及治疗情况调查

Prevalence and treatment of anemia in chronic kidney disease patients based on regional medical big data

Received:December 01, 2022

DOI：10.3760/cma.j.cn112338-20221201-01028

KeyWord: 慢性肾脏病贫血流行病学研究电子健康档案

English Key Word: Chronic kidney disease Anemia Epidemiologic study Electronic health record

FundProject:教育部人文社科基金（22YJA630036）；北京市自然科学基金（7212201）；浙江省自然科学基金（LZ22F020014）；北京大学医学部-密歇根大学医学院转化医学与临床研究联合研究所项目（BMU2020JI011）；北大百度基金（2020BD005，2019BD017）

Author Name	Affiliation	E-mail
Chai Yangfan	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China National Institute of Health Data Science, Peking University, Beijing 100191, China
Lin Hongbo	Yinzhou District Center for Disease Control and Prevention of Ningbo, Ningbo 315199, China
Ding Guohui	School of Computer Science, Shenyang Aerospace University, Shenyang 110136, China
Wang Jinwei	Department of Nephrology, Peking University First Hospital, Beijing 100034, China
Wang Huaiyu	National Institute of Health Data Science, Peking University, Beijing 100191, China
Peng Suyuan	National Institute of Health Data Science, Peking University, Beijing 100191, China
Gao Bixia	Department of Nephrology, Peking University First Hospital, Beijing 100034, China
Deng Xinwei	Department of Nephrology, Peking University First Hospital, Beijing 100034, China
Kong Guilan	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China National Institute of Health Data Science, Peking University, Beijing 100191, China	guilan.kong@hsc.pku.edu.cn
Bao Beiyan	Ningbo Urology and Nephrology Hospital, Ningbo 315100, China	baobeiyan2007@sina.com
Zhang Luxia	National Institute of Health Data Science, Peking University, Beijing 100191, China Department of Nephrology, Peking University First Hospital, Beijing 100034, China

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Abstract:

目的分析慢性肾脏病（CKD）患者的贫血患病率、影响因素及治疗情况。方法采用描述性统计分析方法分析2012-2018年宁波市鄞州区域健康信息平台中CKD患者贫血患病情况及贫血患病后12个月内接受治疗的情况；采用多因素logistic回归模型分析CKD患者贫血患病的影响因素。结果共纳入52 619例新发CKD患者，有15 639例（29.72%）CKD患者存在贫血，其中女性贫血患者10 178例（31.87%），男性贫血患者5 461例（26.41%），女性CKD患者贫血患病率高于男性，差异有统计学意义（P<0.001）。贫血患病率随着CKD分期的进展而增加（趋势检验P<0.001），由1期的24.77%增长至5期的69.42%。多因素logistic回归分析显示，CKD贫血患病主要的影响因素有性别（女性：aOR=1.57，95%CI：1.50~1.63）、CKD分期（2期：aOR=1.10，95％CI：1.04~1.16；3期：aOR=2.28，95%CI：2.12~2.44；4期：aOR=4.49，95%CI：3.79~5.32；5期：aOR=6.31，95%CI：4.74~8.39）、年龄（18~30岁：aOR=2.40，95%CI：2.24~2.57；61~75岁：aOR=1.35，95%CI：1.28~1.42；≥76岁：aOR=2.37，95%CI：2.20~2.55）、BMI（<18.5 kg/m²：aOR=1.29，95%CI：1.18~1.41；23.0~24.9 kg/m²：aOR=0.79，95%CI：0.75~0.83；≥25.0 kg/m²：aOR=0.70，95%CI：0.66~0.74）、腹型肥胖（aOR=0.91，95%CI：0.86~0.96）、慢性阻塞性肺疾病（aOR=1.15，95%CI：1.09~1.22）、恶性肿瘤（aOR=3.03，95%CI：2.84~3.23）、心力衰竭（aOR=1.44，95%CI：1.35~1.54）及心肌梗死（aOR=1.54，95%CI：1.16~2.04）。有12.03%的3~5期CKD贫血患者在12个月内接受了铁剂治疗，4.78%的患者接受了红细胞生成刺激剂（ESA）治疗。结论宁波市鄞州区CKD患者贫血患病率较高，铁剂及ESA治疗率偏低，应加强CKD患者的贫血管理与治疗。

English Abstract:

Objective To assess the prevalence, risk factors and treatment of anemia in patients with chronic kidney disease (CKD). Methods A descriptive method was used to analyze the prevalence and treatment of anemia in CKD patients based on regional health data in Yinzhou District of Ningbo during 2012-2018. The multivariate logistic regression analysis was used to identify independent influence factors of anemia in the CKD patients. Results In 52 619 CKD patients, 15 639 suffered from by anemia (29.72%), in whom 5 461 were men (26.41%) and 10 178 were women (31.87%), and anemia prevalence was higher in women than in men, the difference was significant (P<0.001). The prevalence of anemia increased with stage of CKD (24.77% in stage 1 vs. 69.42% in stage 5, trend χ² test P<0.001). Multivariate logistic regression analysis revealed that being women (aOR=1.57, 95%CI:1.50-1.63), CKD stage (stage 2:aOR=1.10, 95%CI:1.04-1.16;stage 3:aOR=2.28,95%CI:2.12-2.44;stage 4:aOR=4.49,95%CI:3.79-5.32;stage 5:aOR=6.31,95%CI:4.74-8.39), age (18-30 years old: aOR=2.40,95%CI:2.24-2.57, 61-75 years old: aOR=1.35,95%CI:1.28-1.42, ≥ 76 years old: aOR=2.37,95%CI:2.20-2.55), BMI (<18.5 kg/m²:aOR=1.29,95%CI:1.18-1.41;23.0-24.9 kg/m²:aOR=0.79,95%CI:0.75-0.83; ≥ 25.0 kg/m²:aOR=0.70,95%CI:0.66-0.74), abdominal obesity (aOR=0.91, 95%CI:0.86-0.96), chronic obstructive pulmonary disease (aOR=1.15, 95%CI:1.09-1.22), cancer (aOR=3.03, 95%CI:2.84-3.23), heart failure (aOR=1.44, 95%CI:1.35-1.54) and myocardial infarction (aOR=1.54, 95%CI:1.16-2.04) were independent risk factors of anemia in CKD patients. Among stage 3-5 CKD patients with anemia, 12.03% received iron therapy, and 4.78% received treatment with erythropoiesis-stimulating agent (ESA) within 12 months after anemia was diagnosed. Conclusions The prevalence of anemia in CKD patients was high in Yinzhou. However, the treatment rate of iron therapy and ESA were low. More attention should be paid to the anemia management and treatment in CKD patients.

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