Rzewuska Magdalena, de Azevedo-Marques João Mazzoncini, Coxon Domenica, Zanetti Maria Lúcia, Zanetti Ana Carolina Guidorizzi, Franco Laercio Joel, Santos Jair Lício Ferreira
Community Health Postgraduate Program, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Department of Social Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
PLoS One. 2017 Feb 9;12(2):e0171813. doi: 10.1371/journal.pone.0171813. eCollection 2017.
Middle-income countries are facing a growing challenge of adequate health care provision for people with multimorbidity. The objectives of this study were to explore the distribution of multimorbidity and to identify patterns of multimorbidity in the Brazilian general adult population. Data from 60202 adults, aged ≥18 years that completed the individual questionnaire of the National Health Survey 2013 (Portuguese: "Pesquisa Nacional de Saúde"-"PNS") was used. We defined multimorbidity as the presence of two or more chronic conditions, including self-reported diagnoses and responses to the 9-item Patient Health Questionnaire for depression. Multivariate Poisson regression analyses were used to explore relationship between multimorbidity and demographic factors. Exploratory tetrachoric factor analysis was performed to identify multimorbidity patterns. 24.2% (95% CI 23.5-24.9) of the study population were multimorbid, with prevalence rate ratios being significantly higher in women, older people and those with lowest educational level. Multimorbidity occurred earlier in women than in men, with half of the women and men aged 55-59 years and 65-69 years, respectively, were multimorbid. The absolute number of people with multimorbidity was approximately 2.5-fold higher in people younger than 65 years than older counterparts (9920 vs 3945). Prevalence rate ratios of any mental health disorder significantly increased with the number of physical conditions. 46.7% of the persons were assigned to at least one of three identified patterns of multimorbidity, including: "cardio-metabolic", "musculoskeletal-mental" and "respiratory" disorders. Multimorbidity in Brazil is as common as in more affluent countries. Women in Brazil develop diseases at younger ages than men. Our findings can inform a national action plan to prevent multimorbidity, reduce its burden and align health-care services more closely with patients' needs.
中等收入国家在为患有多种疾病的人群提供充足医疗保健方面面临着日益严峻的挑战。本研究的目的是探讨多种疾病的分布情况，并确定巴西成年普通人群中多种疾病的模式。我们使用了来自60202名年龄≥18岁成年人的数据，这些人完成了2013年全国健康调查（葡萄牙语：“Pesquisa Nacional de Saúde”-“PNS”）的个人问卷。我们将多种疾病定义为存在两种或更多慢性疾病，包括自我报告的诊断以及对9项抑郁患者健康问卷的回答。采用多变量泊松回归分析来探讨多种疾病与人口统计学因素之间的关系。进行探索性四分相关因子分析以确定多种疾病模式。24.2%（95%置信区间23.5 - 24.9）的研究人群患有多种疾病，女性、老年人以及教育水平最低的人群的患病率比值显著更高。女性患多种疾病的时间比男性更早，分别有一半的女性和男性在55 - 59岁和65 - 69岁时患有多种疾病。年龄小于65岁的人群中患有多种疾病的绝对人数比年龄较大的人群高出约2.5倍（9920对3945）。任何精神健康障碍的患病率比值随着身体疾病数量的增加而显著上升。46.7%的人被归类为至少三种已确定的多种疾病模式中的一种，包括：“心血管代谢”、“肌肉骨骼 - 精神”和“呼吸”疾病。巴西的多种疾病情况与更富裕国家一样普遍。巴西女性比男性更早患病。我们的研究结果可为预防多种疾病、减轻其负担以及使医疗服务更紧密地符合患者需求的国家行动计划提供参考。
