Marengoni Alessandra, Angleman Sara, Fratiglioni Laura
J Comorb. 2011 Dec 27;1:11-18. doi: 10.15256/joc.2011.1.3. eCollection 2011.
The prevalence of chronic diseases has increased with population ageing, and research has attempted to elucidate the correlation between chronic diseases and disability. However, most studies in older populations have focused on the effect of single disabling conditions, even though most older adults have more than one chronic disease (multimorbidity).
The aims of this study were to evaluate the association of disability with disease, in terms of multimorbidity and specified pairs of diseases, in a population-based study of older adults. Materials and Methods: Using the Kungsholmen Project, we estimated the prevalence of disability by the number of chronic diseases, disease status by organ systems, and in specific pairs of chronic conditions, in a Swedish population (=1,099; ≥77 years). Disability was defined as need of assistance in at least one activity of daily living (Katz index).
Functional disability was seen in 17.9% of participants. It increased as the number of chronic diseases increased. The prevalence of disability varied greatly amongst specific pairs of diseases: from 6.7% in persons affected by hypertension and atrial fibrillation to 82.4% in persons affected by dementia and hip fracture. In multivariate logistic regression models, the disease pairs that were significantly associated with the highest increased relative odds of disability contained dementia (dementia-hip fracture, dementia-CVD, and dementia-depression).
Our findings suggest specific pairs of diseases are much more highly associated with disability than others, particularly diseases coupled with dementia. This knowledge may improve prevention of disablement and planning of resource distribution. Journal of Comorbidity 2011;1:11-18.
随着人口老龄化，慢性病的患病率有所上升，并且已有研究试图阐明慢性病与残疾之间的关联。然而，大多数针对老年人群的研究都聚焦于单一致残状况的影响，尽管大多数老年人患有不止一种慢性病（多病共存）。
在一项基于人群的老年人群研究中，从多病共存以及特定疾病组合的角度，评估残疾与疾病之间的关联。材料与方法：利用 Kungsholmen 项目，我们在瑞典人群（=1099 人；≥77 岁）中，依据慢性病数量、器官系统疾病状态以及特定慢性病组合来估算残疾患病率。残疾被定义为在至少一项日常生活活动中需要帮助（Katz 指数）。
17.9%的参与者存在功能残疾。其随着慢性病数量的增加而上升。在特定疾病组合中，残疾患病率差异极大：从患高血压和心房颤动者的 6.7%到患痴呆症和髋部骨折者的 82.4%。在多变量逻辑回归模型中，与残疾相对比值升高最为显著相关的疾病组合包含痴呆症（痴呆症 - 髋部骨折、痴呆症 - 心血管疾病、痴呆症 - 抑郁症）。
我们的研究结果表明，特定的疾病组合与残疾的关联程度比其他组合高得多，尤其是与痴呆症相关的疾病组合。这一认知可能会改善残疾预防以及资源分配规划。《共病杂志》2011 年；1：11 - 18。
