Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
Popul Health Metr. 2011 Sep 1;9(1):51. doi: 10.1186/1478-7954-9-51.
The high prevalence of chronic diseases in Western countries implies that the presence of multiple chronic diseases within one person is common. Especially at older ages, when the likelihood of having a chronic disease increases, the co-occurrence of distinct diseases will be encountered more frequently. The aim of this study was to estimate the age-specific prevalence of multimorbidity in the general population. In particular, we investigate to what extent specific pairs of diseases cluster within people and how this deviates from what is to be expected under the assumption of the independent occurrence of diseases (i.e., sheer coincidence).
We used data from a Dutch health survey to estimate the prevalence of pairs of chronic diseases specified by age. Diseases we focused on were diabetes, myocardial infarction, stroke, and cancer. Multinomial P-splines were fitted to the data to model the relation between age and disease status (single versus two diseases). To assess to what extent co-occurrence cannot be explained by independent occurrence, we estimated observed/expected co-occurrence ratios using predictions of the fitted regression models.
Prevalence increased with age for all disease pairs. For all disease pairs, prevalence at most ages was much higher than is to be expected on the basis of coincidence. Observed/expected ratios of disease combinations decreased with age.
Common chronic diseases co-occur in one individual more frequently than is due to chance. In monitoring the occurrence of diseases among the population at large, such multimorbidity is insufficiently taken into account.
西方国家慢性病的高患病率意味着一个人同时患有多种慢性病的情况很常见。特别是在年龄较大的人群中，随着患慢性病的可能性增加，不同疾病的同时发生会更加频繁。本研究旨在估计一般人群中多种疾病的特定年龄患病率。具体而言，我们研究了特定的疾病对在人群中聚集的程度，以及这种聚集程度与假设疾病独立发生（即纯粹的巧合）时预期的程度有何不同。
我们使用荷兰健康调查的数据来估计特定年龄的慢性疾病对的患病率。我们关注的疾病是糖尿病、心肌梗死、中风和癌症。使用多项 P 样条对数据进行拟合，以模拟年龄与疾病状态（单一疾病与两种疾病）之间的关系。为了评估疾病同时发生的程度不能用独立发生来解释的程度，我们使用拟合回归模型的预测来估计观察到的/预期的同时发生比。
所有疾病对的患病率都随年龄增长而增加。在大多数年龄段，所有疾病对的患病率都远高于基于巧合的预期。疾病组合的观察到的/预期的比值随年龄的增长而降低。
常见的慢性病在个体中同时发生的频率高于偶然发生的频率。在监测人群中疾病的发生时，这种多重疾病的情况没有得到充分考虑。
