Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide 5001, Australia.
J Epidemiol Community Health. 2010 Dec;64(12):1036-42. doi: 10.1136/jech.2009.088260. Epub 2009 Oct 23.
To determine the impact of comorbid chronic diseases on mortality in older people.
Prospective cohort study (1992-2006). Associations between numbers of chronic diseases or mutually exclusive comorbid chronic diseases on mortality over 14 years, by Cox proportional hazards model adjusting for sociodemographic variables or Kaplan-Meier analyses, respectively.
Population based, Australia.
2087 randomly selected participants aged ≥65 years old, living in the community or institutions.
Participants with 3-4 or ≥5 diseases had a 25% (95% CI 1.05 to 1.5, p=0.01) and 80% (95% CI 1.5 to 2.2, p<0.0001) increased risk of mortality, respectively, by comparison with no chronic disease, after adjusting for age, sex and residential status. When cardiovascular disease (CVD), mental health problem or diabetes were comorbid with arthritis, there was a trend towards increased survival (range 8.2-9.5 years) by comparison with CVD, mental health problem or diabetes alone (survival 5.8-6.9 years). This increase in survival with arthritis as a comorbidity was negated when CVD and mental health problems or CVD and diabetes were present in disease combinations together.
Older people with ≥3 chronic diseases have increased risk of mortality, but discordant effects on survival depend on specific disease combinations. These results raise the hypothesis that patients who have an increased likelihood of opportunity for care from their physician are more likely to have comorbid diseases detected and managed.
确定共患慢性病对老年人死亡率的影响。
前瞻性队列研究（1992-2006 年）。通过 Cox 比例风险模型，调整社会人口学变量后，分别评估了患有多种慢性疾病或互斥的共患慢性疾病的患者在 14 年内的死亡率；或通过 Kaplan-Meier 分析评估。
澳大利亚，基于人群。
2087 名随机选择的年龄≥65 岁、居住在社区或机构中的参与者。
与无慢性疾病者相比，患有 3-4 种或≥5 种疾病的患者在调整年龄、性别和居住状态后，其死亡率分别增加了 25%（95%CI 1.05 至 1.5，p=0.01）和 80%（95%CI 1.5 至 2.2，p<0.0001）。当心血管疾病（CVD）、心理健康问题或糖尿病与关节炎同时存在时，与 CVD、心理健康问题或糖尿病单独存在时相比，生存趋势呈增加趋势（范围 8.2-9.5 年）。当 CVD 和心理健康问题或 CVD 和糖尿病同时存在于疾病组合中时，关节炎作为共病存在时生存增加的这种趋势就会被抵消。
患有≥3 种慢性疾病的老年人死亡率风险增加，但生存的不一致影响取决于特定的疾病组合。这些结果提出了一个假设，即那些有更多机会从医生那里获得护理的患者，其共患疾病更有可能被发现并得到管理。
