Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015 Japan. Email:
Prev Chronic Dis. 2019 Jan 31;16:E11. doi: 10.5888/pcd16.180170.
Multimorbidity, the co-occurrence of 2 or more disorders in a patient, can complicate treatment planning and affect health outcomes. Improvements in prevention and management strategies for patients with 3 or more or more co-occurring chronic diseases requires an understanding of the epidemiology of common 3-way disease patterns and their interactions. Our study aimed to describe these common 3-way disease patterns and examine the factors associated with the co-occurrence of 3 or more diseases in elderly Japanese patients.
We included all Japanese citizens aged 75 or older living in Tokyo who used medical care between September 2013 and August 2014 (N = 1,311,116) in our analysis. The 15 most common 3-way patterns of 22 target diseases according to sex and age were identified from among all possible combinations by using an anonymized medical claims database. We examined the associations of sociodemographic characteristics and health care use with the presence of 1 or 2 co-occurring diseases and 3 or more co-occurring diseases by using multinomial logistic regression.
Approximately 65% of patients had 3 or more co-occurring diseases. The most common 3-way pattern was hypertension, coronary heart disease, and peptic ulcer disease in men (12.4%) and hypertension, dyslipidemia, and peptic ulcer disease in women (12.8%). The prevalence of 3 or more diseases was positively associated with men, patients aged 85 to 90, the use of home medical care services, the number of outpatient facilities visited, and hospital admissions.
The common 3-way disease patterns and multimorbidity factors identified in our study may facilitate the recognition of high-risk patients and support the development of clinical guidelines for multimorbidity.
多种疾病共存，即患者同时患有两种或两种以上疾病，会使治疗计划变得复杂，并影响健康结局。为了改善 3 种及以上共患慢性病患者的预防和管理策略，需要了解常见的 3 种疾病模式的流行病学及其相互作用。本研究旨在描述这些常见的 3 种疾病模式，并探讨与老年日本患者 3 种及以上疾病共患相关的因素。
我们对在 2013 年 9 月至 2014 年 8 月期间使用医疗服务的所有年龄在 75 岁及以上的东京居民（n=1311116）进行了分析。通过使用匿名医疗索赔数据库，从所有可能的组合中确定了按性别和年龄划分的 22 种目标疾病中最常见的 15 种 3 种疾病模式。我们使用多项逻辑回归分析，检查了社会人口统计学特征和医疗保健使用与 1 种或 2 种共患疾病以及 3 种或更多共患疾病的存在之间的关联。
约 65%的患者存在 3 种及以上共患疾病。最常见的 3 种疾病模式为男性中的高血压、冠心病和消化性溃疡病（12.4%），以及女性中的高血压、血脂异常和消化性溃疡病（12.8%）。3 种及以上疾病的患病率与男性、85 至 90 岁的患者、家庭医疗保健服务的使用、就诊的门诊设施数量和住院有关。
本研究中确定的常见 3 种疾病模式和多种疾病共存的因素有助于识别高危患者，并支持多种疾病临床指南的制定。
