School of Public Health, The University of Queensland, Australia.
School of Public Health, The University of Queensland, Australia.
Maturitas. 2018 Mar;109:53-62. doi: 10.1016/j.maturitas.2017.12.004. Epub 2017 Dec 6.
There is substantial multimorbidity at mid-life but little is known about the strength of evidence on multimorbidity and health-related quality of life (HrQoL) at mid-life. This review addresses this gap, focusing on studies of the general population. PubMed, Web of Science, Embase and APA PsycNET databases were screened on 6 March 2017 for original research on multimorbidity and HrQoL in adults aged 40-65 years from the general population. Studies focused on index conditions, using single-item HrQoL measures, unlikely to represent the general population (e.g. primary care), and papers that were not in the English language were excluded. A narrative synthesis was presented due to heterogeneity in the measurement of multimorbidity. Of the 2557 articles, 83 underwent full text screening and 8 were included in the review. Included studies were of moderate to high quality and no exclusions were made on the basis of quality or bias. Multimorbidity was associated with poorer HrQoL at mid-life. Two cross-sectional studies found that adults with multimorbidity at early mid-life reported poorer HrQoL than adults with multimorbidity at late mid-life, while another found the reverse. Two distinct disease clusters were identified: mental health conditions and cardiovascular disease (CVD). Those in the mental health cluster reported poorer HrQoL than those in the CVD cluster, women more so than men. Limitations of the selected studies include lack of longitudinal evidence, use of self-reported conditions and no assessment of disease severity. Multimorbidity is associated with poor HrQoL at mid-life at the population level, with some evidence of differences in association with age and disease cluster and sparse evidence on sex differences. Longitudinal research using a weighted disease severity index and multimorbidity trajectories is needed to strengthen the evidence base.
中年人存在大量的共病现象，但对于中年人共病与健康相关的生活质量（HrQoL）之间的证据强度知之甚少。本综述针对这一空白，重点关注一般人群的研究。2017 年 3 月 6 日，我们在 PubMed、Web of Science、Embase 和 APA PsycNET 数据库中筛选了关于一般人群中 40-65 岁成年人共病和 HrQoL 的原始研究。研究重点是索引疾病，使用单一的 HrQoL 测量指标，不太可能代表一般人群（例如初级保健），并且不包括非英语语言的论文。由于共病的测量存在异质性，因此采用叙述性综合方法。在 2557 篇文章中，有 83 篇进行了全文筛选，有 8 篇被纳入综述。纳入的研究质量中等偏上，没有根据质量或偏倚进行排除。共病与中年人较差的 HrQoL 相关。两项横断面研究发现，早期中年有共病的成年人报告的 HrQoL 比晚期中年有共病的成年人差，而另一项研究则发现相反的结果。确定了两个不同的疾病群集：心理健康状况和心血管疾病（CVD）。心理健康群集中的人报告的 HrQoL 比心血管疾病群集差，女性比男性更差。选定研究的局限性包括缺乏纵向证据、使用自我报告的疾病以及未评估疾病严重程度。共病与中年人整体的较差的 HrQoL 相关，与年龄和疾病群集的相关性存在一些差异的证据，而关于性别差异的证据则很少。需要使用加权疾病严重程度指数和共病轨迹的纵向研究来加强证据基础。
