Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.
BMC Public Health. 2013 Mar 21;13:251. doi: 10.1186/1471-2458-13-251.
Health surveys (HS) are a well-established methodology for measuring the health status of a population. The relative merit of using information based on HS versus electronic health records (EHR) to measure multimorbidity has not been established. Our study had two objectives: 1) to measure and compare the prevalence and distribution of multimorbidity in HS and EHR data, and 2) to test specific hypotheses about potential differences between HS and EHR reporting of diseases with a symptoms-based diagnosis and those requiring diagnostic testing.
Cross-sectional study using data from a periodic HS conducted by the Catalan government and from EHR covering 80% of the Catalan population aged 15 years and older. We determined the prevalence of 27 selected health conditions in both data sources, calculated the prevalence and distribution of multimorbidity (defined as the presence of ≥2 of the selected conditions), and determined multimorbidity patterns. We tested two hypotheses: a) health conditions requiring diagnostic tests for their diagnosis and management would be more prevalent in the EHR; and b) symptoms-based health problems would be more prevalent in the HS data.
We analysed 15,926 HS interviews and 1,597,258 EHRs. The profile of the EHR sample was 52% women, average age 47 years (standard deviation: 18.8), and 68% having at least one of the selected health conditions, the 3 most prevalent being hypertension (20%), depression or anxiety (16%) and mental disorders (15%). Multimorbidity was higher in HS than in EHR data (60% vs. 43%, respectively, for ages 15-75+, P <0.001, and 91% vs. 83% in participants aged ≥65 years, P <0.001). The most prevalent multimorbidity cluster was cardiovascular. Circulation disorders (other than varicose veins), chronic allergies, neck pain, haemorrhoids, migraine or frequent headaches and chronic constipation were more prevalent in the HS. Most symptomatic conditions (71%) had a higher prevalence in the HS, while less than a third of conditions requiring diagnostic tests were more prevalent in EHR.
Prevalence of multimorbidity varies depending on age and the source of information. The prevalence of self-reported multimorbidity was significantly higher in HS data among younger patients; prevalence was similar in both data sources for elderly patients. Self-report appears to be more sensitive to identifying symptoms-based conditions. A comprehensive approach to the study of multimorbidity should take into account the patient perspective.
健康调查（HS）是一种测量人群健康状况的成熟方法。使用基于 HS 的信息与电子健康记录（EHR）来衡量多种疾病的相对优势尚未确定。我们的研究有两个目标：1）测量和比较 HS 和 EHR 数据中多种疾病的患病率和分布情况，2）测试关于基于症状的诊断和需要诊断测试的疾病的 HS 和 EHR 报告之间可能存在差异的具体假设。
使用加泰罗尼亚政府进行的定期 HS 和涵盖 80%年龄在 15 岁及以上的加泰罗尼亚人口的 EHR 的数据进行横断面研究。我们确定了这两种数据源中 27 种选定健康状况的患病率，计算了多种疾病的患病率和分布情况（定义为存在≥2 种选定情况），并确定了多种疾病模式。我们测试了两个假设：a）需要诊断测试来诊断和管理的疾病在 EHR 中更为普遍；b）基于症状的健康问题在 HS 数据中更为普遍。
我们分析了 15926 次 HS 访谈和 1597258 次 EHR。EHR 样本的特征为 52%的女性，平均年龄 47 岁（标准差：18.8），68%的人至少有一种选定的健康状况，前三种最常见的是高血压（20%）、抑郁或焦虑（16%）和精神障碍（15%）。HS 中的多种疾病患病率高于 EHR 数据（分别为 60%和 43%，年龄在 15-75+，P <0.001，年龄在≥65 岁的参与者中分别为 91%和 83%，P <0.001）。最常见的多种疾病模式是心血管疾病。HS 中更常见的循环系统疾病（静脉曲张除外）、慢性过敏、颈部疼痛、痔疮、偏头痛或频繁头痛和慢性便秘。在 HS 中，大多数有症状的疾病（71%）的患病率更高，而需要诊断测试的疾病不到三分之一的患病率更高。
多种疾病的患病率因年龄和信息来源而异。在年轻患者中，HS 数据中的自我报告多种疾病的患病率明显更高；在老年患者中，两种数据源的患病率相似。自我报告似乎更能敏感地识别基于症状的疾病。对多种疾病的研究应综合考虑患者的角度。
