Nunes Bruno P, Chiavegatto Filho Alexandre D P, Pati Sanghamitra, Cruz Teixeira Doralice S, Flores Thaynã R, Camargo-Figuera Fabio A, Munhoz Tiago N, Thumé Elaine, Facchini Luiz A, Rodrigues Batista Sandro R
Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
BMJ Open. 2017 Jun 9;7(6):e015885. doi: 10.1136/bmjopen-2017-015885.
The study aims to evaluate the magnitude of multimorbidity in Brazilian adults, as well to measure their association with individual and contextual factors stratified by Brazilian states and regions.
A national-based cross-sectional study was carried out in 2013 with Brazilian adults. Multimorbidity was evaluated by a list of 22 physical and mental morbidities (based on self-reported medical diagnosis and Patient Health Questionnaire-9 for depression). The outcome was analysed taking ≥2 and ≥3 diseases as cut-off points. Factor analysis (FA) was used to identify disease patterns and multilevel models were used to test association with individual and contextual variables.
The sample comprised 60 202 individuals. Multimorbidity frequency was 22.2% (95% CI 21.5 to 22.9) for ≥2 morbidities and 10.2% (95% CI 9.7 to 10.7) for ≥3 morbidities. In the multilevel adjusted models, females, older people, those living with a partner and having less schooling presented more multiple diseases. No linear association was found according to wealth index but greater outcome frequency was found in individuals with midrange wealth index. Living in states with higher levels of education and wealthier states was associated with greater multimorbidity. Two patterns of morbidities (cardiometabolic problems and respiratory/mental/muscle-skeletal disorders) explained 92% of total variance. The relationship of disease patterns with individual and contextual variables was similar to the overall multimorbidity, with differences among Brazilian regions.
In Brazil, at least 19 million adults had multimorbidity. Frequency is similar to that found in other Low and and Middle Income Countries. Contextual and individual social inequalities were observed.
本研究旨在评估巴西成年人中多重疾病的严重程度，并衡量其与按巴西各州和地区分层的个体及背景因素之间的关联。
2013年对巴西成年人开展了一项基于全国范围的横断面研究。通过一份包含22种身心疾病的清单（基于自我报告的医学诊断和用于抑郁症的患者健康问卷-9）评估多重疾病。以≥2种和≥3种疾病为临界点分析结果。采用因子分析（FA）来识别疾病模式，并使用多水平模型来检验与个体及背景变量的关联。
样本包括60202名个体。≥2种疾病的多重疾病发生率为22.2%（95%置信区间21.5至22.9），≥3种疾病的发生率为10.2%（95%置信区间9.7至10.7）。在多水平调整模型中，女性、老年人、有伴侣者以及受教育程度较低者患多种疾病的情况更多。根据财富指数未发现线性关联，但在中等财富指数的个体中发现更高的结果发生率。生活在教育水平较高的州和较富裕的州与更高的多重疾病发生率相关。两种疾病模式（心脏代谢问题和呼吸/精神/肌肉骨骼疾病）解释了总方差的92%。疾病模式与个体及背景变量之间的关系与总体多重疾病相似，巴西各地区之间存在差异。
在巴西，至少1900万成年人患有多重疾病。发生率与其他低收入和中等收入国家相似。观察到背景和个体社会不平等现象。
