Evoluci?? de les lesions en la gent gran. Espanya 2000-2010

Abstract

Les lesions traum??tiques en la gent gran s??n un problema de salutp??blica important, donat que s??n una de les principals causes demorbiditat en aquest col??lectiu. L???estudi de la incid??ncia de lesions enla gent gran i la seva evoluci?? ofereix una visi?? parcel??lada de lasituaci??, ja que en la majoria de casos les dades que es mostren esredueixen a un ??nic mecanisme - com per exemple l???evoluci?? de leslesions per caigudes -, o a lesions en concret - com les fractures demaluc -, o d???una certa gravetat ??? com l???estudi de les lesions que hanrequerit ingr??s hospitalari.Es plantegen com objectius d???aquesta tesi estimar la incid??nciahospital??ria de lesions traum??tiques en la gent gran a Espanya, segonssexe i grup d???edat, aix?? com en els diferents grups de gravetat i tipusde mecanisme, identificar les lesions m??s habituals en les personesgrans i analitzar l???evoluci?? de la incid??ncia calculada en cada cas alllarg d???onze anys.S???ha portat a terme un estudi descriptiu. Depenent dels objectius eldisseny utilitzat ha estat transversal o de tend??ncies. La poblaci??d???estudi son les persones majors de 64 anys residents a Espanyadurant el per??ode 2000-2010.Les taxes d???incid??ncia hospital??ria s???han calculat a partir de les alteshospital??ries del Conjunt M??nim B??sic de Dades Hospital??ries(CMBDH) del Ministerio de Sanidad, Pol??ticas Sociales e Igualdad i deles dades del Padr?? Municipal d???Habitants del Instituto Nacional deEstad??stica. Els casos s??n residents majors de 64 anys amb diagn??sticprincipal de lesi?? traum??tica. L???evoluci?? de la incid??ncia s???ha analitzatutilitzant models lineals generalitzats assumint distribuci?? de Poisson ifunci?? d???enlla?? logaritme per a cada una de les variables depenents is???ha ajustat per sobredispersi??. S???ha calculat el Percentatge Anual deCanvi (APC) de la taxa a partir de l???estimaci?? del risc relatiu (RR)anual de lesi?? i el seu interval de confian??a al 95%.La incid??ncia hospital??ria de lesi?? traum??tica ??s superior en dones queen homes i augmenta amb la edat. En els ??ltims anys s???observa unatend??ncia a l???augment de la incid??ncia, sobretot a partir dels 75-80anys (grans-grans). Aquest augment ??s m??s r??pid en les persones dem??s edat. En les lesions per col??lisi?? de tr??nsit ??s en l?????nic cas en qu??s???observa un descens. Les lesions m??s habituals continuen sent lesfractures de maluc, per b?? que en el cas de les dones de menys de 75anys (grans-joves) la incid??ncia hospital??ria ha mostrat un descensimportant, i en el cas dels homes fins a aquesta edat s???ha mostratestable al llarg del per??ode. L???efecte d???aquest descens s???ha vistcontrabalan??at per l???augment important de lesions com elstraumatismes cranioencef??lics i les fractures en les extremitatssuperiors que, tot i de magnitud for??a menor que les fractures demaluc, han mostrat augments importants al llarg del per??ode.Els resultats d???aquesta tesi porten a identificar dos grans grups dinsdel col??lectiu de les persones grans, els grans-joves (fins als 75-80anys) i els grans-grans (a partir d???aquesta edat).Tot i que les fractures de maluc s??n la lesi?? amb m??s pres??ncia en totsels grups d???edat, el descens de la incid??ncia en les dones grans-jovesconjuntament amb l???increment de les fractures d???extremitats superiorsi dels traumatismes cranioencef??lics porta a que en aquest grup lesfractures de maluc perdin protagonisme. En el cas dels grans-grans,l???increment de la incid??ncia de lesi?? traum??tica s???afegeix al creixementpoblacional que est?? experimentant aquest grup d???edat en els ??ltimsanys. Aquest doble increment porta a que cada vegada siguin m??s, entermes absoluts, el nombre de persones grans-grans a tractar a nivellhospitalari. Alhora, tamb?? suposa un augment de la demanada deserveis posteriors per tal que la persona lesionada pugui assolir elm??xim nivell d???autonomia despr??s de la lesi?? que li permeti gaudird???un envelliment actiu.

Traumatic injuries in older people are a major public health problem,since they are one of the leading causes of morbidity in this agegroup. Studies of the incidence of injury and it trends among olderpeople provide only a partial insight into the situation, since in mostcases the data are limited to a single injury mechanism, such as theevolution of fall-related injuries, to specific injury types, such as hipfractures, or to injuries of a certain severity, such as those requiringhospitalization.The objectives of this thesis are to estimate the incidence of traumaticinjuries among elderly individuals that were attended at hospitals inSpain, stratified by sex and age, as well as by severity and mechanismof injury. We also identify the most common injuries in older people,and finally analyse the evolution of their incidence over a period ofeleven years.We conducted a descriptive study, using a cross-sectional orlongitudinal design, depending on the objectives. The populationstudy consists of individuals over 64 years of age who were resident inSpain between 2000 and 2010.Incidence rates were calculated using data provided by the NationalHospital Discharge Register (NHDR) from the Spanish Institute ofHealth Information (Ministerio de Sanidad, Servicios Sociales eIgualdad), and the National Institute of Statistics. Cases were Spanishresidents older than 64 years discharged from a Spanish hospital witha primary diagnosis of traumatic injury. Incidence trends wereanalysed using generalized linear models, assuming Poissondistribution and log link function for each dependent variable, andadjusting for overdispersion. The Annual Percent Change (APC) ofthe rate is computed from the estimated relative risk (RR) and its 95%confidence interval.The incidence of traumatic injuries attended at hospital is higheramong women than men, and increases with age. A positive trend inincidence has been observed in recent years, especially in individualsover 75-80 years of age, and this increase is accentuated by age.Traffic injuries are the only injury type in which we observe a decline.Hip fractures are still the most common injury type, although in thecase of individuals under 75 years, their incidence decreasedsignificantly in women and remained stable in men throughout thestudy period. The effect of this decline has been counterbalanced byan increase in the incidence of other types of injury such as headinjuries and fractures in the upper extremities.The results of this thesis allow us to identify two large groups withinthe population of older people, the elderly (up to 75-80 years) and thesuper-elderly (from this age onward).While hip fractures remain the most common injury type in all agegroups, their decrease in incidence among elderly women along withthe increase in frequency of fractures of the upper extremities and oftraumatic brain injuries means that hip fractures are losing importancein this age group. In the case of super-elderly individuals, the increase