Lee Todd A, Shields Alexandra E, Vogeli Christine, Gibson Teresa B, Woong-Sohn Min, Marder William D, Blumenthal David, Weiss Kevin B
Center for Management of Complex Chronic Care, Hines VA Hospital, P. O. Box 5000, (151-H), Hines, IL, 60141, USA.
J Gen Intern Med. 2007 Dec;22 Suppl 3(Suppl 3):403-7. doi: 10.1007/s11606-007-0277-2.
Among patients with multiple chronic conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with multiple chronic conditions, much less is known about the mortality rate associated with specific combinations of multiple diseases.
Measure the mortality rate in combinations of 11 chronic conditions.
Cohort study of veteran health care users.
Veterans between 55 and 64 years that used Veterans Health Administration health care services between October 1999 and September 2000.
Patients were identified as having one or more of the following: COPD, diabetes, hypertension, rheumatoid arthritis, osteoarthritis, asthma, depression, ischemic heart disease, dementia, stroke, and cancer. Mutually exclusive combinations of disease based on these conditions were created, and 5-year mortality rates were determined.
There were 741,847 persons included. The number in each group by a count of conditions was: none = 217,944 (29.34%); 1 = 221,111 (29.8%); 2 = 175,228 (23.6%); 3 = 86,447 (11.7%); and 4+ = 41,117 (5.5%). The 5-year mortality rate by the number of conditions was: none = 4.1%; 1 = 6.0%; 2 = 7.8%; 3 = 11.2%; 4+ = 16.7%. Among combinations with the same number of conditions, there was significant variability in mortality rates.
Patients with multiple chronic conditions have higher mortality rates. Because there was significant variation in mortality across clusters with the same number of conditions, when studying patients with multiple coexisting illnesses, it is important to understand not only that several conditions may be present but that specific conditions can differentially impact the risk of mortality.
在患有多种慢性病的患者中，人们越来越认识到疾病之间复杂的相互关联性。以往的研究主要关注多种慢性病的患病率和经济负担，而对于多种疾病特定组合的死亡率了解较少。
测量11种慢性病组合的死亡率。
对退伍军人医疗保健使用者的队列研究。
1999年10月至2000年9月期间使用退伍军人健康管理局医疗保健服务的55至64岁退伍军人。
确定患者患有以下一种或多种疾病：慢性阻塞性肺疾病（COPD）、糖尿病、高血压、类风湿性关节炎、骨关节炎、哮喘、抑郁症、缺血性心脏病、痴呆症、中风和癌症。基于这些疾病创建了相互排斥的疾病组合，并确定了5年死亡率。
共纳入741,847人。按疾病数量分组的人数分别为：无疾病 = 217,944人（29.34%）；1种疾病 = 221,111人（29.8%）；2种疾病 = 175,228人（23.6%）；3种疾病 = 86,447人（11.7%）；4种及以上疾病 = 41,117人（5.5%）。按疾病数量划分的5年死亡率分别为：无疾病 = 4.1%；1种疾病 = 6.0%；2种疾病 = 7.8%；3种疾病 = 11.2%；4种及以上疾病 = 16.7%。在疾病数量相同的组合中，死亡率存在显著差异。
患有多种慢性病的患者死亡率较高。由于疾病数量相同的组群之间死亡率存在显著差异，因此在研究患有多种共存疾病的患者时，不仅要了解可能存在几种疾病，而且要了解特定疾病对死亡风险的不同影响，这一点很重要。
