Tesis

Faktor risiko kematian akibat penyakit kardiovaskular pada jemaah haji Indonesia = The mortality risk due to cardiovascular disease in Indonesian hajj pilgrims.

Latar Belakang : Penyakit kardiovaskular sebagai salah satu masalah kesehatan pada jemaah haji Indonesia dan penyebab tertinggi kematian jemaah haji dalam 3 tahun terakhir. Jemaah haji Indonesia sebagian besar pada stratifikasi risiko kesehatan tinggi. Beberapa faktor risiko diprediksi berhubungan dengan kematian jemaah haji akibat penyakit kardiovaskular. Saat ini belum dikembangkan model prediksi risiko kematian akibat penyakit kardiovaskular pada jemaah haji Indonesia. Tujuan: Mengetahui besaran masalah penyakit kardiovaskular, faktor risiko yang berpengaruh pada kematian jemaah haji serta model skoring risiko kematian jemaah haji Indonesia akibat penyakit kardiovaskular. Metode: Penelitian observasional dengan desain kasus kontrol. Data didapatkan melalui Pusat Kesehatan Haji Departemen Kesehatan Republik Indonesia. Dilakukan penelitian terhadap 876 jemaah haji. Variabel yang berhubungan dengan kematian jemaah haji antara lain usia, jenis kelamin, indeks massa tubuh, kebiasaan merokok, diabetes mellitus, hipertensi, dislipidemia, gagal ginjal, gagal jantung, penyakit jantung koroner, penyakit paru obstruksi kronik, waktu keberangkatan jemaah. Dilakukan analisis untuk menentukan faktor risiko yang berpengaruh terhadap kematian serta membuat skor prediksi dan penentuan cut off point berdasarkan nilai sensitivitas dan spesifisitas yang optimal untuk mengestimasi risiko mortalitas. Hasil: Proporsi kematian akibat penyakit kardiovaskular adalah 49,2 % dari seluruh jemaah haji Indonesia tahun 2017. Faktor risiko yang berhubungan dengan kematian jemaah haji antara lain; Usia lebih dari 70 tahun dengan OR 5,321 (IK 95%: 3,727-7,597), penyakit jantung koroner dengan OR 4,236 (IK 95% : 1,29213,882), hipertensi dengan OR 3,673 (IK 95% :2,555-5,280), diabetes mellitus dengan OR 3,422 (IK 95%: 2,108-5,553), dislipidemia dengan OR 2,067 (IK 95%: 1,366-3,129), indeks massa tubuh overweight dengan OR 0,571 (IK 95%: 0,3850,848) , indeks massa tubuh obesitas dengan OR 0,239 (IK 95%: 0,134-0,425). Probabilitas risiko kematian akibat penyakit kardiovaskular adalah risiko ringan dengan skor < 5 (19,47%), probabilitas sedang skor 6-9 (62,94%) dan probabilitas tinggi skor > 10 (83,3%). Simpulan: Proporsi kematian akibat penyakit kardiovaskular pada jemaah haji Indonesia tahun 2017 adalah 49,2%. Faktor risiko kardiovaskular antara lain; usia tua, hipertensi, diabetes mellitus, penyakit jantung koroner, dislipidemia. Nilai skor > 10 dapat memprediksi risiko mortalitas dengan propabilitas 88,53 %.
Kata Kunci: Jemaah haji, kematian, kardiovaskular, model skor mortalitas


Background: Cardiovascular disease has been one of the health problems in Indonesian hajj pilgrims and the cause of the highest mortality number of hajj pilgrims in the last three years. Most of Indonesian hajj pilgrims lie in the high health risk stratification. Several risk factors have been predicted to be related to the death of hajj pilgrims due to cardiovascular disease. However, until today a mortality risk prediction model due to cardiovascular disease in Indonesian hajj pilgrims has not been developed. Objective: To discover the weight of the cardiovascular disease problem, the risk factors causing the death of hajj pilgrims, and to develop the mortality risk scoring model of Indonesian hajj pilgrims due to cardiovascular disease. Method: This research is an observational study with a control case design. Data were obtained from the Hajj Health Center of the Health Ministry of the Republic of Indonesia. The research was conducted on 876 hajj pilgrims. The variables connected with the death of hajj pilgrims, among others, are age, sex, body mass index, smoking habit, diabetes mellitus, hypertension, dyslipidemia, liver failure, heart failure, coronary heart disease, chronic obstruction lung disease, the departure time of pilgrims. An analysis was conducted to determine the risk factor causing the mortality and to make a prediction score and a cut-off point based on the optimal value of sensitivity and specificity to estimate the mortality risk. Results: The mortality proportion due to cardiovascular disease was 49.2% of all Indonesian hajj pilgrims in 2017. The risk factors related to the mortality of hajj pilgrims were age above 70 years old with OR 5.321 (CI 95% : 3.727-7.579); coronary heart disease with OR 4.236 (CI 95% : 1.292-13.882); hypertension with OR 3.673 (CI 95% : 2.555-5.280); diabetes mellitus with OR 3.422 (CI 95% : 2.108-5.553); dyslipidemia with OR 2.067 (CI 95% : 1.366-3.129); overweight body mass index with OR 0.571 (CI 95% ; 0.385-0.848); obese body mass index with OR 0.239 (CI 95% : 0.134-0.425). The mortality risk probability due to cardiovascular disease is a low risk with the score < 5 (19.47%), the medium probability is with the score 6-9 (62.94%), and the high probability is with the score > 10 (83.3%). Conclusion: The mortality proportion due to cardiovascular disease in Indonesian hajj pilgrims in 2017 was 49.2%. The risk factors of the cardiovascular disease, among others, are old age, hypertension, diabetes mellitus, coronary heart disease, dyslipidemia. The score ≥ 10 can predict the mortality risk with the probability of 88.53%.
Keywords: Hajj pilgrims, mortality, cardiovascular, mortality risk scoring model