Pengpid Supa, Peltzer Karl
ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand.
Department of Research Innovation and Development, University of Limpopo, Sovenga 0727, South Africa.
Int J Environ Res Public Health. 2017 Sep 6;14(9):1019. doi: 10.3390/ijerph14091019.
The aim of this study was to explore the prevalence, pattern, and social determinants of chronic conditions multimorbidity among chronic disease primary care patients in four Greater Mekong countries (Cambodia, Myanmar, Thailand, and Vietnam). In a cross-sectional survey, chronic disease patients accessing primary care were recruited if they had been diagnosed with any of 21 chronic conditions in the past 12 months, and were interviewed with a structured questionnaire on anxiety, depression, alcohol use, tobacco use, dietary behaviour, physical activity, and quality of life. The sample included 6236 public primary care patients (32.8% men and 67.2% women), with a mean age of 53.0 years (SD = 16.8). From 21 chronic conditions, the three most common were hypertension (37.4%), depression (34.4%), and digestive diseases (32.0%). In all, 27.4% had one chronic condition, 28.6% had two, 22.4% had three, and 21.6% had four or more chronic conditions. The percentage with the highest comorbidity was depression (47.3%), hypertension (43.4%), and digestive diseases (34.1%). The highest mean multimorbidity reported was for mental illness (4.44), kidney disease (4.11), and Parkinson's disease (4.10), and the lowest multimorbidity for epilepsy (2.43) and cancer (2.80). Compared to those who had only one chronic condition, being male, older age, lower education, and lower quality of life were associated with having two and three or more chronic conditions. Multimorbidity is a prevalent problem among chronic condition primary care patients-a finding with implications for health care delivery, management, and research.
本研究旨在探讨大湄公河地区四个国家（柬埔寨、缅甸、泰国和越南）慢性病初级保健患者中慢性病共病的患病率、模式及社会决定因素。在一项横断面调查中，招募过去12个月内被诊断患有21种慢性病中任何一种的初级保健慢性病患者，并使用结构化问卷对他们进行焦虑、抑郁、饮酒、吸烟、饮食行为、身体活动和生活质量方面的访谈。样本包括6236名公立初级保健患者（男性占32.8%，女性占67.2%），平均年龄为53.0岁（标准差 = 16.8）。在21种慢性病中，最常见的三种是高血压（37.4%）、抑郁症（34.4%）和消化系统疾病（32.0%）。总体而言，27.4%的患者患有一种慢性病，28.6%的患者患有两种，22.4%的患者患有三种，21.6%的患者患有四种或更多慢性病。共病率最高的是抑郁症（47.3%）、高血压（43.4%）和消化系统疾病（34.1%）。报告的平均共病率最高的是精神疾病（4.44）、肾脏疾病（4.11）和帕金森病（4.10），最低的是癫痫（2.43）和癌症（2.80）。与仅患有一种慢性病的患者相比，男性、年龄较大、教育程度较低和生活质量较低与患有两种及三种或更多慢性病有关。共病是慢性病初级保健患者中普遍存在的问题——这一发现对医疗保健的提供、管理和研究具有重要意义。
