Lee Todd A, Pickard A Simon, Bartle Brian, Weiss Kevin B
Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL 60141, USA.
Ann Epidemiol. 2007 May;17(5):380-4. doi: 10.1016/j.annepidem.2007.01.033.
Diseases are often described and studied in isolation, yet there is increasing recognition of the complex interrelatedness of diseases and treatments in patients with multiple chronic diseases. Our objective was to describe the impact of selected diseases involving chronic inflammation (chronic obstructive pulmonary disease [COPD], osteoarthritis, and rheumatoid arthritis) on mortality.
We identified a cohort aged 55 to 64 years with one or more chronic conditions. Clusters of mutually exclusive disease combinations were created. Five-year all-cause mortality was determined and the relative risk (RR) of mortality was estimated when COPD, osteoarthritis, and rheumatoid arthritis were added to clusters.
In 741,847 persons the 5-year mortality rates were lowest among persons with one condition and increased with more chronic conditions. The presence of osteoarthritis in a cluster was an exception where the risk was lower compared with that cluster without osteoarthritis: COPD (RR = 0.73 [95% confidence interval (CI), 0.65, 0.81]); ischemic heart disease (0.63 [0.52, 0.76]); hypertension (0.77 [0.71, 0.83]); dementia (0.63 [0.42, 0.93]); depression (0.65 [0.50, 0.84]); hypertension plus diabetes (0.85 [0.77, 0.93]); and ischemic heart disease plus hypertension (0.83 [0.73, 0.94]).
The association between osteoarthritis and lower rates of mortality is notable and replicating these findings to explore causal relationships is important.
疾病通常是孤立地被描述和研究的，但人们越来越认识到多种慢性病患者中疾病与治疗之间存在复杂的相互关联性。我们的目标是描述某些涉及慢性炎症的疾病（慢性阻塞性肺疾病[COPD]、骨关节炎和类风湿关节炎）对死亡率的影响。
我们确定了一个年龄在55至64岁之间患有一种或多种慢性病的队列。创建了相互排斥的疾病组合集群。确定了五年全因死亡率，并估计了将COPD、骨关节炎和类风湿关节炎添加到集群中时的死亡相对风险（RR）。
在741,847人中，五年死亡率在患有一种疾病的人群中最低，并随着慢性病数量的增加而上升。骨关节炎出现在集群中是一个例外，与没有骨关节炎的集群相比风险较低：COPD（RR = 0.73[95%置信区间（CI），0.65，0.81]）；缺血性心脏病（0.63[0.52，0.76]）；高血压（0.77[0.71，0.83]）；痴呆（0.63[0.42,0.93]）；抑郁症（0.65[0.50，0.84]）；高血压加糖尿病（0.85[0.77，0.93]）；以及缺血性心脏病加高血压（0.83[0.73，0.94]）。
骨关节炎与较低死亡率之间的关联值得注意，重复这些发现以探索因果关系很重要。
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