共病的流行病学及其对医疗保健、研究和医学教育的影响：一项横断面研究。

Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

机构信息

Quality, Safety and Informatics Research Group, Population Health Sciences Division, University of Dundee, Dundee, UK.

出版信息

Lancet. 2012 Jul 7;380(9836):37-43. doi: 10.1016/S0140-6736(12)60240-2. Epub 2012 May 10.

DOI:10.1016/S0140-6736(12)60240-2

PMID:22579043

Abstract

BACKGROUND

Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation.

METHODS

In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders.

FINDINGS

42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11).

INTERPRETATION

Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas.

FUNDING

Scottish Government Chief Scientist Office.

摘要

背景

长期疾病是全球医疗体系面临的主要挑战，但医疗体系在很大程度上是针对单一疾病而不是多种疾病进行配置的。我们研究了多种疾病的分布情况，以及身体和心理健康障碍的合并症与年龄和社会经济剥夺之间的关系。

方法

在一项横断面研究中，我们从苏格兰 314 家医疗实践中注册的 1751841 人中提取了截至 2007 年 3 月 40 种疾病的数据。我们根据疾病数量、疾病类型（身体或精神）、性别、年龄和社会经济状况进行了数据分析。我们将多种疾病定义为存在两种或两种以上疾病。

结果

42.2%（95%CI 42.1-42.3）的所有患者存在一种或多种疾病，23.2%（23.08-23.21）为多种疾病患者。尽管随着年龄的增长，多种疾病的患病率显著增加，而且大多数 65 岁及以上的人都存在这种情况，但在 65 岁以下的人群中，患有多种疾病的绝对人数更高（210500 人比 194996 人）。与最富裕地区相比，生活在最贫困地区的人发病时间更早，10-15 年，社会经济贫困尤其与包括心理健康障碍在内的多种疾病有关（最贫困地区的身体和心理健康障碍的患病率为 11.0%，95%CI 10.9-11.2%，而最贫困地区为 5.9%，5.8%-6.0%）。患有心理健康障碍的人数随着身体疾病数量的增加而增加（调整后的比值比为 6.74，95%CI 6.59-6.90，5 种或更多疾病与 1.95，1.93-1.98 种疾病相比），在较贫困地区比在较富裕地区更为显著（2.28，2.21-2.32 与 1.08，1.05-1.11）。