Calderón-Larrañaga Amaia, Vetrano Davide L, Onder Graziano, Gimeno-Feliu Luis A, Coscollar-Santaliestra Carlos, Carfí Angelo, Pisciotta Maria S, Angleman Sara, Melis René J F, Santoni Giola, Mangialasche Francesca, Rizzuto Debora, Welmer Anna-Karin, Bernabei Roberto, Prados-Torres Alexandra, Marengoni Alessandra, Fratiglioni Laura
Aging Research Center, NVS Department, Karolinska Institutet, Stockholm University, Sweden.
EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC-ISCIII, Spain.
J Gerontol A Biol Sci Med Sci. 2017 Oct 1;72(10):1417-1423. doi: 10.1093/gerona/glw233.
Although the definition of multimorbidity as "the simultaneous presence of two or more chronic diseases" is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity.
Based on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register.
A disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had ≥2 of these 60 disease categories, 73.2% had ≥3, and 55.8% had ≥4.
This operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.
尽管“同时存在两种或更多种慢性病”这一多重疾病的定义已得到广泛认可，但其操作化定义尚未达成共识。本研究旨在提供一份由临床驱动的慢性病综合清单，用于衡量多重疾病时纳入考量。
基于慢性病的共识定义，一个国际多学科团队将国际疾病分类第10版（ICD - 10）中的所有四位数字级编码分类为是否为慢性病。随后，慢性ICD - 10编码根据临床标准被归为更广泛的类别。最后，我们通过将该分类应用于瑞典 Kungsholmen地区老年与护理国家研究（SNAC - K）中的老年人，并使用瑞典国家患者登记处的住院数据，展示了概念验证。
如果一种疾病或状况持续时间较长，并且（a）导致残留残疾或生活质量恶化，或者（b）需要长期护理、治疗或康复，则被视为慢性病。在将此定义应用于老年人群体后，识别出918个慢性ICD - 10编码，并将其归为60个慢性病类别。在SNAC - K中，88.6%的人患有这60种疾病类别中的≥2种，73.2%的人患有≥3种，55.8%的人患有≥4种。
这种多重疾病的操作化测量方法，可使用临床数据或行政数据或两者结合来实施，可能有助于其监测和国际比较。一旦经过验证，它可能推动多重疾病概念和理论方面的发展与演变，最终实现更好的护理。
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