无家可归和突然死亡的发生率和原因:来自POST SCD研究的数据
Leila Haghighat1, Satvik Ramakrishna2, James W Salazar1
1Division of Cardiology, Department of Medicine, University of California, San Francisco.
JAMA internal medicine
|October 23, 2023
概括
旧金山的无家可归者经历的突发死亡率明显高,通常是由于过量服用等非心脏原因,以及潜在的可预防心律失常原因.
科学领域:
- 公共卫生 公共卫生
- 心脏病学 心脏病学
- 法医病理学 法医病理学
背景情况:
- 无家可归是一个主要的公共卫生问题,旧金山拥有大量的无家可归人口.
- 无家可归的人面临着显著减少的预期寿命,而过早死亡的原因在很大程度上是未知的.
- 突然死亡 (SCD) 是一般人群早期死亡的一个重要因素,但它在无家可归的人群中的特殊作用需要调查.
研究的目的:
- 为了比较旧金山县住房和没有住房的个人之间突然死亡 (SCD) 的发生率和原因.
- 确定在无家可归人口中导致SCD的特定风险因素和潜在病理.
主要方法:
- 一项队列研究利用了死后心脏突然死亡系统调查 (POST SCD) 研究的数据.
- 包括2011年至2018年在旧金山县连续发生的医院外心脏骤停死亡 (18-90岁) 的情况.
- 尸体解剖,毒理学分析和医疗记录审查对于符合世界卫生组织假定SCD标准的病例.
主要成果:
- 总共分析了868个假定的SCD,其中151个 (17.4%) 发生在无家可归的个人中.
- 无家可归的人患SCD的比率显著更高 (IRR,16.2),并且在死亡时年轻.
- 非心脏病原因,特别是过量服用,在没有住所的人群中 (63.6%) 与住所的人群 (37.7%) 相比更为普遍.
- 节律失常的原因,可能可以用除器治疗,在无家可归的人群中 (31.8%) 比住房的人群 (58.6%) 更常见.
结论:
- 无家可归与旧金山县突然死亡风险增加密切相关.
- 无家可归者突然死亡的原因各不相同,包括非心脏事件 (如过量服用) 的比例较高,以及可能可预防的心律失常原因.
- 调查结果强调,迫切需要针对性公共卫生干预和无家可归人口的可获得医疗护理,以减少过早死亡率.
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