Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK.
Isr J Health Policy Res. 2015 Jan 26;4:1. doi: 10.1186/2045-4015-4-1. eCollection 2015.
The ageing of the population across developed countries and beyond has increased the importance of examining multi-morbidity. The recent paper by Arbelle et al. [Isr J of Health Policy Res. 2014;3:29] on multiple chronic conditions in Israel's Maccabi Health Care System (MHC) is a welcome and interesting contribution to the literature on this topic. They found that the prevalence of multiple chronic conditions among the MHC population rises with age, is lower for higher socioeconomic groups, and is higher than in a primary care population in Scotland studied by Barnett et al. [Lancet. 2012;380:37-43]. The difference in prevalence between the two studies is unlikely to reflect entirely, or probably even mainly, real differences in morbidity rates between the two countries. Systematic reviews have highlighted large differences in the prevalence of multi-morbidity in different studies. Although the Israeli and Scottish study used similar definitions and methods, the nature of the source data differed. It seems likely that the incentives to record the full range of patients' conditions may differ between data sources depending on the uses of the data, which may in turn depend on the country's health care financing system. If this is correct, it will complicate comparisons between different jurisdictions. It is important to consider not only the prevalence of multi-morbidity but also its costs to the health system and to wider society. Cost of illness studies can be helpful in informing decisions about prioritisation of resources. Multi-morbidity complicates such studies. The overall costs of health and social care for people with a specific condition would include costs relating to any comorbidities. To examine the marginal impact on overall costs of each condition among those with multiple conditions is likely to be complex and arguably not especially useful.
人口老龄化在发达国家和其他国家日益加剧，这使得检查多种疾病的重要性日益增加。Arbelle 等人最近在以色列 Maccabi 医疗保健系统（MHC）中对多种慢性疾病的研究[Isr J of Health Policy Res. 2014;3:29]是对该主题文献的一个受欢迎和有趣的贡献。他们发现，MHC 人群中多种慢性疾病的患病率随年龄增长而上升，在社会经济地位较高的人群中较低，高于 Barnett 等人在苏格兰初级保健人群中研究的患病率[Lancet. 2012;380:37-43]。这两项研究之间患病率的差异不太可能完全反映，甚至可能主要反映两国之间发病率的实际差异。系统评价强调了不同研究中多疾病患病率的巨大差异。尽管以色列和苏格兰的研究使用了相似的定义和方法，但源数据的性质有所不同。根据数据的用途，数据源记录患者病情全貌的激励机制可能会有所不同，而数据的用途又可能取决于国家的医疗保健融资系统。如果这是正确的，那么它将使不同司法管辖区之间的比较变得复杂。不仅要考虑多种疾病的患病率，还要考虑其对卫生系统和更广泛社会的成本。疾病负担研究可以帮助为资源优先排序决策提供信息。多种疾病使这类研究变得复杂。患有特定疾病的人在健康和社会保健方面的总体成本将包括与任何合并症相关的成本。检查多种疾病患者中每种疾病对总体成本的边际影响可能很复杂，而且可能没有特别有用。
