Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Public Health, NHS Grampian, Summerfield House, Aberdeen, UK.
Eur J Public Health. 2019 Feb 1;29(1):182-189. doi: 10.1093/eurpub/cky098.
Multimorbidity, the coexistence of multiple health conditions, is a growing public health challenge. Research and intervention development are hampered by the lack of consensus regarding defining and measuring multimorbidity. The aim of this systematic review was to pool the findings of systematic reviews examining definitions and measures of multimorbidity.
Medline, Embase, PubMed and Cochrane were searched from database inception to February 2017. Two authors independently screened titles, abstracts and full texts and extracted data from the included papers. Disagreements were resolved with a third author. Reviews were quality assessed.
Of six reviews, two focussed on definitions and four on measures. Multimorbidity was commonly defined as the presence of multiple diseases or conditions, often with a cut-off of two or more. One review developed a holistic definition including biopsychosocial and somatic factors as well as disease. Reviews recommended using measures validated for the outcome of interest. Disease counts are an alternative if no validated measure exists.
To enable comparison between studies and settings, researchers and practitioners should be explicit about their choice of definition and measure. Using a cut-off of two or more conditions as part of the definition is widely adopted. Measure selection should be based on tools validated for the outcome being considered. Where there is no validated measure, or where multiple outcomes or populations are being considered, disease counts are appropriate.
多种疾病共存，即多种健康状况同时存在，是一个日益严重的公共卫生挑战。由于缺乏对多种疾病的定义和衡量的共识，研究和干预措施的发展受到了阻碍。本系统综述的目的是汇集关于多种疾病的定义和衡量标准的系统综述的结果。
从数据库建立到 2017 年 2 月，我们在 Medline、Embase、PubMed 和 Cochrane 中进行了搜索。两名作者独立筛选标题、摘要和全文，并从纳入的论文中提取数据。有分歧的地方由第三名作者解决。对综述进行了质量评估。
在 6 篇综述中，有 2 篇侧重于定义，4 篇侧重于衡量标准。多种疾病通常被定义为存在多种疾病或状况，通常以存在两种或以上疾病作为标准。有一篇综述提出了一个全面的定义，包括生物心理社会和躯体因素以及疾病。综述建议使用针对预期结果验证过的措施。如果没有验证过的措施，可以使用疾病计数作为替代。
为了使研究和研究环境之间能够进行比较，研究人员和从业者应该明确其定义和衡量标准的选择。在定义中使用两个或更多条件的标准被广泛采用。应根据正在考虑的结果验证过的工具来选择衡量标准。如果没有验证过的措施，或者需要考虑多个结果或人群，则疾病计数是合适的。
