Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany.
BMC Health Serv Res. 2012 Apr 3;12:89. doi: 10.1186/1472-6963-12-89.
Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern.
The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses.
Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status.
Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups.
ISRCTN89818205.
多病共存是老年人中一种负担重、患病率高的现象。我们之前的研究表明，多病共存可以分为以下两种模式：1）焦虑、抑郁、躯体形式障碍和疼痛；2）心血管和代谢疾病。然而，目前尚不清楚这些模式受患者特征的影响程度如何。本文旨在分析社会人口统计学变量，特别是社会经济地位与一般多病共存以及每种多病共存模式的关系。
MultiCare 队列研究是一项多中心、前瞻性、观察性队列研究，纳入了 3189 名年龄在 65 岁以上的多患者，这些患者是从 158 家全科医生诊所中随机选择的。数据通过全科医生访谈和全面的患者访谈收集。通过基于戈沃距离的热甲板插补法对发病率和其他变量中的缺失值进行了插补。采用多水平混合效应线性回归分析，分析患者特征与慢性疾病数量的关系。
一般多病共存与年龄（每年增加 0.07 种慢性疾病）、性别（女性减少 0.27 种疾病）、教育（中、高水平教育减少 0.26 种疾病，低水平教育减少 0.29 种疾病）和收入（每对数单位减少 0.27 种疾病）相关。心血管和代谢疾病模式也表现出类似的相关性，性别系数更高（女性减少 1.29 种疾病），而躯体形式障碍和疼痛模式内的多病共存与性别相关（女性增加 0.79 种疾病），但与年龄或社会经济地位无关。
本研究证实，多病共存患者的发病负担与年龄、性别和患者的社会经济地位有关，但居住安排和婚姻状况没有影响。我们还表明，患者特征的影响取决于所涉及的多病共存模式，即至少存在两种类型的老年多病共存患者。首先，有一种主要患有心血管和代谢疾病的患者，这些患者通常为男性，年龄较大，社会经济地位较低。其次，有一种主要患有躯体形式障碍和疼痛相关疾病的患者，这些患者通常为女性，在年龄和社会经济群体中分布均匀。
ISRCTN89818205。
