Mujica-Mota R E, Roberts M, Abel G, Elliott M, Lyratzopoulos G, Roland M, Campbell J
Institute of Health Research, University of Exeter Medical School, Salmon Pool Lane, Exeter, EX2 4SG, UK,
Qual Life Res. 2015 Apr;24(4):909-18. doi: 10.1007/s11136-014-0820-7. Epub 2014 Oct 26.
There is limited evidence about the impact of specific patterns of multi-morbidity on health-related quality of life (HRQoL) from large samples of adult subjects.
We used data from the English General Practice Patient Survey 2011-2012. We defined multi-morbidity as the presence of two or more of 12 self-reported conditions or another (unspecified) long-term health problem. We investigated differences in HRQoL (EQ-5D scores) associated with combinations of these conditions after adjusting for age, gender, ethnicity, socio-economic deprivation and the presence of a recent illness or injury. Analyses were based on 831,537 responses from patients aged 18 years or older in 8,254 primary care practices in England.
Of respondents, 23 % reported two or more chronic conditions (ranging from 7 % of those under 45 years of age to 51 % of those 65 years or older). Multi-morbidity was more common among women, White individuals and respondents from socio-economically deprived areas. Neurological problems, mental health problems, arthritis and long-term back problem were associated with the greatest HRQoL deficits. The presence of three or more conditions was commonly associated with greater reduction in quality of life than that implied by the sum of the differences associated with the individual conditions. The decline in quality of life associated with an additional condition in people with two and three physical conditions was less for older people than for younger people. Multi-morbidity was associated with a substantially worse HRQoL in diabetes than in other long-term conditions. With the exception of neurological conditions, the presence of a comorbid mental health problem had a more adverse effect on HRQoL than any single comorbid physical condition.
Patients with multi-morbid diabetes, arthritis, neurological, or long-term mental health problems have significantly lower quality of life than other people. People with long-term health conditions require integrated mental and physical healthcare services.
关于特定多种疾病模式对成年受试者大样本健康相关生活质量（HRQoL）影响的证据有限。
我们使用了2011 - 2012年英国全科医疗患者调查的数据。我们将多种疾病定义为存在12种自我报告疾病中的两种或更多种，或另一种（未明确说明的）长期健康问题。在调整年龄、性别、种族、社会经济剥夺以及近期疾病或损伤的存在情况后，我们调查了与这些疾病组合相关的HRQoL（EQ - 5D评分）差异。分析基于英格兰8254家初级医疗诊所中18岁及以上患者的831537份回复。
在受访者中，23%报告患有两种或更多慢性疾病（45岁以下人群中为7%，65岁及以上人群中为51%）。多种疾病在女性、白人个体以及社会经济贫困地区的受访者中更为常见。神经问题、心理健康问题、关节炎和长期背部问题与最大的HRQoL缺陷相关。三种或更多疾病的存在通常与生活质量的更大降低相关，其降低程度大于与个体疾病相关差异之和所暗示的程度。在患有两种和三种身体疾病的人群中，与额外一种疾病相关的生活质量下降在老年人中比在年轻人中要小。与其他长期疾病相比，多种疾病在糖尿病患者中与更差的HRQoL显著相关。除神经疾病外，共病心理健康问题对HRQoL的不利影响比任何单一共病身体疾病都更大。
患有多种疾病的糖尿病、关节炎、神经或长期心理健康问题患者的生活质量明显低于其他人。患有长期健康问题的人需要综合的身心医疗服务。
