Williams Joni S, Egede Leonard E
Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina.
Am J Med Sci. 2016 Jul;352(1):45-52. doi: 10.1016/j.amjms.2016.03.004. Epub 2016 Mar 18.
Approximately 50% of adults have multimorbidity (MM) that is associated with greater disability, poorer quality of life (QOL) and increased psychological distress. This study assessed the association between MM and QOL, health status and functional disability in U.S. adults.
Cross-sectional study of 23,789 patients from 2011 Medical Expenditure Panel Survey was conducted. Mean scores were calculated for QOL (physical component score [PCS] and mental component score [MCS]) and proportions for functional limitation (activities of daily living [ADL]; instrumental ADL [IADL] and physical functioning). Health status was assessed by depression and serious psychological distress. Regression models evaluated associations between MM and QOL, functional health status and functional limitations, while adjusting for confounders.
Approximately 53% of 45-64-year-olds and 84% of those ≥65-years-old had MM. In adjusted models, ≥3 conditions were significantly associated with poorer outcomes-PCS QOL (β = -9.15; 95% CI: -9.69 to -8.61), MCS QOL (β = -1.98; 95% CI: -2.43 to -1.52), ADL (odds ratio [OR] = 5.80; 95% CI: 2.27-14.8), IADL (OR = 3.99; 95% CI: 2.31-6.88) and physical functioning (OR = 16.8; 95% CI: 12.0-23.6) compared with 1-2 conditions. Depression (PCS QOL: β = -4.02; 95% CI: -4.89 to -3.15; MCS QOL: β = -12.5; 95% CI: -13.2 to -10.9; ADL: OR = 2.49; 95% CI: 1.65-3.76; IADL: OR = 2.65; 95% CI: 1.88-3.72; physical functioning: OR = 2.44; 95% CI: 1.99-2.99) and serious psychological distress (PCS QOL: β = -3.16; 95% CI: -4.30 to -2.03; MCS QOL: β = -11.8; 95% CI: -12.8 to -10.8; ADL: OR = 1.57; 95% CI: 0.95-2.60; IADL: OR = 1.13; 95% CI: 0.80-1.59 and physical functioning: OR = 1.41; 95% CI: 1.11-1.78) were significantly associated with adverse outcomes.
In this nationally representative sample of U.S. adults, MM was significantly associated with poorer QOL, functional health status and physical functioning, when adjusting for relevant confounders. A holistic view of the complexities associated with MM must dictate comprehensive care.
约50%的成年人患有多种疾病（MM），这与更大的残疾、更差的生活质量（QOL）以及心理困扰增加有关。本研究评估了美国成年人中MM与QOL、健康状况和功能残疾之间的关联。
对2011年医疗支出小组调查中的23789名患者进行横断面研究。计算QOL的平均得分（身体成分得分[PCS]和心理成分得分[MCS]）以及功能受限的比例（日常生活活动[ADL]；工具性ADL[IADL]和身体功能）。通过抑郁和严重心理困扰评估健康状况。回归模型评估MM与QOL、功能健康状况和功能受限之间的关联，同时对混杂因素进行调整。
45 - 64岁人群中约53%以及65岁及以上人群中84%患有MM。在调整后的模型中，与1 - 2种疾病相比，≥3种疾病与较差的结果显著相关——PCS QOL（β = -9.15；95% CI：-9.69至-8.61）、MCS QOL（β = -1.98；95% CI：-2.43至-1.52）、ADL（优势比[OR] = 5.80；95% CI：2.27 - 14.8）、IADL（OR = 3.99；95% CI：2.31 - 6.88）和身体功能（OR = 16.8；95% CI：12.0 - 23.6）。抑郁（PCS QOL：β = -4.02；95% CI：-4.89至-3.15；MCS QOL：β = -12.5；95% CI：-13.2至-10.9；ADL：OR = 2.49；95% CI：1.65 - 3.76；IADL：OR = 2.65；95% CI：1.88 - 3.72；身体功能：OR = 2.44；95% CI：1.99 - 2.99）和严重心理困扰（PCS QOL：β = -3.16；95% CI：-4.30至-2.03；MCS QOL：β = -11.8；95% CI：-12.8至-10.8；ADL：OR = 1.57；95% CI：0.95 - 2.60；IADL：OR = 1.13；95% CI：0.80 - 1.59；身体功能：OR = 1.41；95% CI：1.11 - 1.78）与不良结果显著相关。
在这个具有全国代表性的美国成年人样本中，调整相关混杂因素后，MM与较差的QOL、功能健康状况和身体功能显著相关。必须从整体上看待与MM相关的复杂性，以指导全面护理。
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