多病共存——不仅仅是老年人的问题。来自澳大利亚生物医学研究的结果。
Multimorbidity - not just an older person's issue. Results from an Australian biomedical study.
机构信息
Population Research & Outcome Studies, South Australian Department of Health, Adelaide, Australia.
出版信息
BMC Public Health. 2010 Nov 22;10:718. doi: 10.1186/1471-2458-10-718.
BACKGROUND
Multimorbidity, the simultaneous occurrence of two or more chronic conditions, is usually associated with older persons. This research assessed multimorbidity across a range of ages so that planners are informed and appropriate prevention programs, management strategies and health service/health care planning can be implemented.
METHODS
Multimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling.
RESULTS
Overall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status.
CONCLUSIONS
Multimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies.
背景
多种慢性疾病同时存在（通常称为共病）通常与老年人相关。本研究评估了不同年龄段的共病情况，以便为规划者提供信息，并实施适当的预防计划、管理策略和卫生服务/医疗保健规划。
方法
通过对一项主要的生物医学队列研究（北阿德莱德健康研究）中收集的数据，在三个年龄组中评估了共病情况。通过临床检查确定了糖尿病、哮喘和慢性阻塞性肺疾病，通过自我报告（曾被医生告知）确定了心血管疾病、骨质疏松症、关节炎和心理健康。包括高血压和高胆固醇（通过生物医学评估）、卫生服务利用、生活质量和药物使用（与政府记录相关联）在内的一系列人口统计学、社会、风险和保护因素都被纳入了多变量模型中。
结果
在 20-39 岁年龄组中，共有 4.4%的人患有共病，40-59 岁年龄组中有 15.0%的人患有共病，60 岁及以上年龄组中有 39.2%的人患有共病（占总数的 17.1%）。在患有共病的人群中，有 42.1%的人年龄小于 60 岁。在最终的逻辑回归模型中，纳入了三个年龄组的各种变量，包括家庭结构、婚姻状况、教育程度、出生地、吸烟状况、肥胖测量值、药物使用、卫生服务利用和整体健康状况。
结论
共病不仅与老年人相关，还需要在更广泛的年龄范围内提供灵活的护理管理支持系统、适当的指南和护理协调计划。健康素养和多药治疗等问题也是需要考虑的重要因素。未来需要进行研究，评估整个生命过程中的共病情况、预防并发症，并评估适当的自我护理策略。
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