Laura Rosella (
Kathy Kornas is a research officer at the Dalla Lana School of Public Health, University of Toronto.
Health Aff (Millwood). 2018 Mar;37(3):464-472. doi: 10.1377/hlthaff.2017.1150.
With falling mortality rates for several diseases, patients are living longer with complex multimorbidities. We explored the burden of multimorbidity at the time of death, how it varies by socioeconomic status, and trends over time in Ontario, Canada. We calculated the proportions of decedents with varying degrees of multimorbidity and types of conditions at death, and we analyzed the trend from 1994 to 2013 in the number of conditions at the time of death. The prevalence of multimorbidity at death increased from 79.6 percent in 1994 to 95.3 percent in 2013. An upward trend in the number of conditions per person at death was observed for all chronic conditions except chronic coronary syndrome, congestive heart failure, and stroke. Chronic respiratory diseases and diabetes were disproportionately represented in low-income and deprived neighborhoods. The trend toward greater multimorbidity burden over time and the existence of steep socioeconomic gradients underscore the importance of integrated health care planning for preventing and managing multiple complex conditions.
随着多种疾病死亡率的下降，患者的寿命越来越长，同时伴有多种复杂的合并症。我们探讨了在加拿大安大略省，死亡时多种合并症的负担，以及它如何随社会经济地位而变化，以及随时间的变化趋势。我们计算了不同程度的多种合并症和死亡时各种疾病类型的死者比例，并分析了 1994 年至 2013 年死亡时疾病数量的趋势。死亡时多种合并症的患病率从 1994 年的 79.6%上升到 2013 年的 95.3%。除慢性冠状动脉综合征、充血性心力衰竭和中风外，所有慢性疾病的人均疾病数量都呈上升趋势。慢性呼吸道疾病和糖尿病在低收入和贫困社区中比例过高。随着时间的推移，多种合并症负担加重的趋势以及社会经济地位的陡峭梯度表明，需要进行综合卫生保健规划，以预防和管理多种复杂疾病。
