美国人多种疾病患病趋势，1988-2014 年。
Multimorbidity Trends in United States Adults, 1988-2014.
机构信息
From Department of Family Medicine, West Virginia University, Morgantown, WV (DEK, JX, CSP).
出版信息
J Am Board Fam Med. 2018 Jul-Aug;31(4):503-513. doi: 10.3122/jabfm.2018.04.180008.
IMPORTANCE
The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing primary care.
OBJECTIVE
The purpose of this study was to determine the prevalence of multi-morbidity and to document changes in prevalence during the last 25 years.
DESIGN/SETTING: Cross-sectional study using multiple years (1988-2014) of the National Health and Nutrition Examination Survey (NHANES) were analyzed.
SETTING
Multiple years (1988 to 2014) of the National Health and Nutrition Examination Survey (NHANES) from the United States were analyzed.
PARTICIPANTS
Noninstitutionalized adults.
MAIN OUTCOMES AND MEASURES
Number of chronic conditions per individual analyzed by age, race, gender, and socioeconomic factors.
RESULTS
A total of 57,303 individuals were surveyed regarding the presence of multi-morbidity in separate surveys spanning 1988-2014. The overall current prevalence in 2013-2014 of >2 morbidities was 59.6% (95% CI 58.1%-61.1%), 38.5% had 3 or more, and 22.7% had 4 or more morbidities, which was significantly higher than in 1988 (45.7%, 95% CI 43.5%-47.8%, with >2 morbidities). Among individuals with 2 or more morbidities, 54.1% have obesity compared to 41.9% in 1988. Among adults age >65, prevalence was 91.8% for 2 or more morbidities. Whites and Blacks had significantly higher prevalence (59.2% and 60.1%) than Hispanic or "other" race (45.0%, < .0001). Women (58.4%) had more current multi-morbidities (>2) than men (55.9%, = .01).
CONCLUSIONS AND RELEVANCE
Multimorbidity is common and has been increasing over the last 25 years. This finding has implications for public health policy and anticipated health costs for the coming years.
重要性
一个患者同时存在多种疾病（多种疾病）是基层医疗面临的一个关键挑战。
目的
本研究旨在确定多种疾病的患病率，并记录过去 25 年期间患病率的变化。
设计/设置：使用多项年份（1988-2014 年）的全国健康和营养检查调查（NHANES）进行横断面研究。
地点
来自美国的多项年份（1988 年至 2014 年）的全国健康和营养检查调查（NHANES）进行分析。
参与者
非机构化成年人。
主要结果和措施
按年龄、种族、性别和社会经济因素分析每个个体的慢性疾病数量。
结果
在 1988 年至 2014 年期间进行的单独调查中，共有 57303 人接受了关于多种疾病存在情况的调查。2013-2014 年当前存在>2 种疾病的总体患病率为 59.6%（95%CI 58.1%-61.1%），38.5%有 3 种或更多，22.7%有 4 种或更多疾病，明显高于 1988 年（45.7%，95%CI 43.5%-47.8%，有>2 种疾病）。在有 2 种或更多疾病的个体中，54.1%患有肥胖症，而 1988 年为 41.9%。在年龄>65 岁的成年人中，有 2 种或更多疾病的患病率为 91.8%。白人（59.2%）和黑人（60.1%）的患病率明显高于西班牙裔或“其他”种族（45.0%，<.0001）。女性（58.4%）的当前多发性疾病（>2 种）多于男性（55.9%，=.01）。
结论和相关性
多种疾病很常见，并且在过去 25 年中一直在增加。这一发现对未来几年的公共卫生政策和预期医疗费用具有重要意义。
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