Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HC FMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Nursing Department, Federal University of, Pelotas, RS, Brazil.
Sci Rep. 2019 Feb 20;9(1):2390. doi: 10.1038/s41598-019-39326-8.
Chronic diseases are often comorbid and present a weighty burden for communities in the 21 century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional São Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physical-mental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual- and area-level variables. Three patterns of clustering were found for women: 'irritable mood and headache', 'chronic diseases and pain', and 'substance use disorders'. Among men, the patterns were: 'chronic pain and respiratory disease', 'psychiatric disorders', and 'chronic diseases'. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.
慢性病通常并发，并给 21 世纪的社区带来沉重负担。本研究描述了一般人群中多种疾病的模式，并在巴西非老年成年人的城市样本中检查了其与个体和区域因素的关联。数据来自横断面圣保罗大都市心理健康调查，这是一项分层多阶段区域概率抽样调查。经过培训的访谈者评估了精神疾病，并询问了 1571 名居住在社区的女性和 1142 名年龄在 18 至 64 岁之间的男性的身体状况。主成分分析按性别描述了身心多种疾病的模式。随后，采用多水平回归分析对多种疾病模式进行了分析，考虑了个体和区域变量。针对女性，发现了三种聚类模式：“烦躁情绪和头痛”、“慢性疾病和疼痛”和“物质使用障碍”。对于男性，模式是：“慢性疼痛和呼吸道疾病”、“精神疾病”和“慢性疾病”。多水平分析表明多种疾病模式与个体和区域决定因素之间存在关联。我们的研究结果呼吁全球范围内改革医疗保健系统，特别是在资源匮乏的国家。在医疗保健环境中，用多种疾病模式代替单一疾病框架可以提高全科医生满足以人为本的医疗需求的能力。
