Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia.
School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
PLoS One. 2018 Aug 14;13(8):e0201496. doi: 10.1371/journal.pone.0201496. eCollection 2018.
Hospitalisation for atherothrombotic disease (ATD) is expected to rise in coming decades. However, increasingly, associated comorbidities impose challenges in managing patients and deciding appropriate secondary prevention. We investigated the prevalence and pattern of multimorbidity (presence of two or more chronic conditions) in Aboriginal and non-Aboriginal Western Australian residents with ATDs.
We used population-based de-identified linked administrative health data from 1 January 2000 to 30 June 2014 to identify a cohort of patients aged 25-59 years admitted to Western Australian hospitals with a discharge diagnosis of ATD. The prevalence of common chronic diseases in these patients was estimated and the patterns of comorbidities and multimorbidities empirically explored using two different approaches: identification of the most commonly occurring pairs and triplets of comorbid diseases, and through latent class analysis (LCA). Half of the cohort had multimorbidity, although this was much higher in Aboriginal people (Aboriginal: 79.2% vs. non-Aboriginal: 39.3%). Only a quarter were without any documented comorbidities. Hypertension, diabetes, alcohol abuse disorders and acid peptic diseases were the leading comorbidities in the major comorbid combinations across both Aboriginal and non-Aboriginal cohorts. The LCA identified four and six distinct clinically meaningful classes of multimorbidity for Aboriginal and non-Aboriginal patients, respectively. Out of the six groups in non-Aboriginal patients, four were similar to the groups identified in Aboriginal patients. The largest proportion of patients (33% in Aboriginal and 66% in non-Aboriginal) was assigned to the "minimally diseased" (or relatively healthy) group, with most patients having less than two conditions. Other groups showed variability in degree and pattern of multimorbidity.
Multimorbidity is common in ATD patients and the comorbidities tend to interact and cluster together. Physicians need to consider these in their clinical practice. Different treatment and secondary prevention strategies are likely to be useful for management in these cluster groups.
未来几十年，动脉血栓栓塞性疾病（atherothrombotic disease，ATD）的住院率预计将会上升。然而，与 ATD 相关的合并症越来越多，这给患者的管理和适当的二级预防带来了挑战。我们调查了西澳大利亚州有 ATD 的土著和非土著居民中多种合并症（存在两种或多种慢性疾病）的流行率和模式。
我们使用了 2000 年 1 月 1 日至 2014 年 6 月 30 日基于人群的去识别链接的行政健康数据，以确定在西澳大利亚州医院住院并诊断为 ATD 的 25-59 岁患者队列。我们估计了这些患者常见慢性疾病的流行率，并通过两种不同的方法对合并症的模式进行了实证研究：识别最常见的合并症对和三联症，以及使用潜在类别分析（latent class analysis，LCA）。该队列的一半患者有多种合并症，但在土著人群中，这一比例要高得多（土著：79.2%比非土著：39.3%）。只有四分之一的患者没有任何记录的合并症。高血压、糖尿病、酒精滥用障碍和胃酸相关疾病是两个族群主要合并症组合中的主要合并症。LCA 为土著和非土著患者分别确定了四个和六个不同的具有临床意义的多种合并症类别。在非土著患者的六个组中，有四个与土著患者的组相似。最大比例的患者（土著患者为 33%，非土著患者为 66%）被分到“患病最少”（或相对健康）的组中，大多数患者只有不到两种疾病。其他组的多种合并症程度和模式存在差异。
多种合并症在 ATD 患者中很常见，合并症往往相互作用并聚集在一起。医生在临床实践中需要考虑到这些情况。对于这些聚类群体，不同的治疗和二级预防策略可能会更有助于管理。
