Wong Martin C S, Liu Jing, Zhou Shenglai, Li Shiwei, Su Xuefen, Wang Harry H X, Chung Roger Y N, Yip Benjamin H K, Wong Samuel Y S, Lau Joseph T F
School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.
Research Centre for Healthcare Management, School of Economics and Management, Tsinghua University, Beijing, China.
Int J Cardiol. 2014 Dec 15;177(2):477-82. doi: 10.1016/j.ijcard.2014.09.103. Epub 2014 Sep 28.
Multimorbidity, defined as the presence of two or more chronic conditions, leads to a substantial public health burden. This study evaluated its association with adherence with cardiovascular medications in a Chinese population. A proportional stratified sampling was adopted to draw a representative sample of residents living in Henan Province, China. Interviewer-administered surveys were conducted by trained researchers. The outcomes included the number of chronic medical conditions, adherence with long-term medications (MMAS-8), and depressive symptoms (CESD-20). Binary logistic regression analysis was conducted to evaluate if medication adherence was associated with the presence of multimorbidity. From a total of 3866 completed surveys, the proportion of subjects having 0, 1 and ≥2 chronic conditions was 62.6%, 23.8% and 13.5%, respectively. Among 27.6% who were taking chronic medications, 66.6% had poor medication adherence (MMAS-8 score≤6). From binary logistic regression analysis, subjects with poor medication adherence were significantly associated with multimorbidity (adjusted odds ratio [AOR]: 1.35, 95% C.I. 1.02-1.78, p=0.037). Other associated factors included older age (AOR=1.04, 95% C.I. 1.03-1.05, p<0.001), smoking (AOR=1.63, 95% C.I. 1.16-2.30, p=0.005), family history of hypertension (AOR=1.51, 95% C.I. 1.19-1.93, p=0.001), and fair to poor self-perceived health status (AOR=2.15, 95% C.I. 1.69-2.74, p<0.001). Using medication adherence as the outcome variable, multimorbidity was significantly associated with poor drug adherence (AOR=1.34, 95% C.I. 1.02-1.77, p=0.037). Multimorbidity was associated with poorer medication adherence. This implies the need for closer monitoring of the medication taking behavior among those with multiple chronic conditions.
多种慢性病（定义为存在两种或更多种慢性病）会导致巨大的公共卫生负担。本研究评估了其与中国人群心血管药物依从性的关联。采用按比例分层抽样方法，在中国河南省抽取具有代表性的居民样本。由经过培训的研究人员进行面对面访谈式调查。研究结果包括慢性病数量、长期药物治疗依从性（MMAS-8量表）和抑郁症状（CESD-20量表）。采用二元逻辑回归分析来评估药物治疗依从性是否与多种慢性病的存在相关。在总共3866份完成的调查问卷中，患有0种、1种和≥2种慢性病的受试者比例分别为62.6%、23.8%和13.5%。在服用慢性病药物的27.6%受试者中，66.6%的药物治疗依从性较差（MMAS-8评分≤6）。二元逻辑回归分析结果显示，药物治疗依从性差的受试者与多种慢性病显著相关（调整优势比[AOR]：1.35，95%置信区间1.02 - 1.78，p = 0.037）。其他相关因素包括年龄较大（AOR = 1.04，95%置信区间1.03 - 1.05，p < 0.001）、吸烟（AOR = 1.63，95%置信区间1.16 - 2.30，p = 0.005）、高血压家族史（AOR = 1.51，95%置信区间1.19 - 1.93，p = 0.001）以及自我感觉健康状况一般至较差（AOR = 2.15，95%置信区间1.69 - 2.74，p < 0.001）。以药物治疗依从性作为结果变量时，多种慢性病与药物依从性差显著相关（AOR = 1.34，95%置信区间1.02 - 1.77，p = 0.037）。多种慢性病与较差的药物治疗依从性相关。这意味着需要对患有多种慢性病的人群的用药行为进行更密切的监测。
