慢性病与药物在青年和成年人群中的共病模式和多药联用：使用因子分析研究慢性疾病与药物之间的系统关联。
Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis.
机构信息
CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain.
出版信息
PLoS One. 2019 Feb 6;14(2):e0210701. doi: 10.1371/journal.pone.0210701. eCollection 2019.
OBJECTIVES
The objective was to identify the systematic associations among chronic diseases and drugs in the form of patterns and to describe and clinically interpret the constituted patterns with a focus on exploring the existence of potential drug-drug and drug-disease interactions and prescribing cascades.
METHODS
This observational, cross-sectional study used the demographic and clinical information from electronic medical databases and the pharmacy billing records of all users of the public health system of the Spanish region of Aragon in 2015. An exploratory factor analysis was conducted based on the tetra-choric correlations among the diagnoses of chronic diseases and the dispensed drugs in 887,572 patients aged ≤65 years. The analysis was stratified by age and sex. To name the constituted patterns, assess their clinical nature, and identify potential interactions among diseases and drugs, the associations found in each pattern were independently reviewed by two pharmacists and two doctors and tested against the literature and the information reported in the technical medicinal forms.
RESULTS
Six multimorbidity-polypharmacy patterns were found in this large-scale population study, named as respiratory, mental health, cardiometabolic, endocrinological, osteometabolic, and mechanical-pain. The nature of the patterns in terms of diseases and drugs differed by sex and age and became more complex as age advanced.
CONCLUSIONS
The six clinically sound multimorbidity-polypharmacy patterns described in this non-elderly population confirmed the existence of systematic associations among chronic diseases and medications, and revealed some unexpected associations suggesting the prescribing cascade phenomenon as a potential underlying factor. These findings may help to broaden the focus and orient the early identification of potential interactions when caring for multimorbid patients at high risk of adverse health outcomes due to polypharmacy.
目的
旨在识别慢性病与药物之间存在的系统关联模式，并描述和临床解读这些模式，重点探索潜在的药物-药物和药物-疾病相互作用以及处方传递现象。
方法
本观察性、横断面研究利用了 2015 年西班牙阿拉贡地区公共卫生系统中所有≤65 岁患者的人口统计学和临床信息以及药房配药记录。对 887572 例患者的慢性病诊断和配药药物之间的四对相关系数进行了探索性因子分析。分析按年龄和性别分层。为了给所构成的模式命名、评估其临床性质以及识别疾病和药物之间的潜在相互作用，由两名药剂师和两名医生对每个模式中发现的关联进行独立审查，并与文献和技术药物说明书中报告的信息进行对比。
结果
在这项大规模的人群研究中发现了六种共病-多药治疗模式，分别命名为呼吸系统、心理健康、心血管代谢、内分泌、骨代谢和机械-疼痛。从疾病和药物方面来看，这些模式的性质因性别和年龄而异，且随着年龄的增长而变得更加复杂。
结论
在非老年人群中描述的这六种临床合理的共病-多药治疗模式证实了慢性病和药物之间存在系统关联，并揭示了一些意想不到的关联，提示处方传递现象可能是潜在的影响因素。这些发现可能有助于拓宽关注范围，并在高风险多药治疗共病患者的治疗中，为早期识别潜在相互作用提供方向，以避免因多药治疗而导致不良健康后果。
Zotero 插件