Macinko James, Andrade Flavia C D, Nunes Bruno P, Guanais Frederico C
UCLA Fielding School of Public Health, Los Angeles, California, United States of America.
University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America.
Rev Panam Salud Publica. 2019 Jan 25;43:e8. doi: 10.26633/RPSP.2019.8. eCollection 2019.
To describe patterns of multimorbidity in six diverse Latin American and Caribbean countries, examine its effects on primary care experiences, and assess its influence on reported overall health care assessments.
Cross-sectional data are from the Inter-American Development Bank's international primary care survey, conducted in 2013/2014, and represent the adult populations of Brazil, Colombia, El Salvador, Jamaica, Mexico and Panama. Robust Poisson regression models were used to estimate the extent to which those with multimorbidity receive adequate and appropriate primary care, have confidence in managing their health condition, and are able to afford needed medical care.
The prevalence of multimorbidity ranged from 17.5% in Colombia to 37.3% in Jamaica. Most of the examined conditions occur along with others, with diabetes and heart disease being the two problems most associated with other conditions. The proportions of adults with high out-of-pocket payments, problems paying their medical bills, seeing multiple doctors, and being in only fair/poor health were higher among those with greater levels of multimorbidity and poorer primary care experiences. Multimorbidity and difficulties with primary care were positively associated with trouble paying for medical care and managing one's conditions. Nonetheless, adults with multimorbidity were more likely to have received lifestyle advice and to be up to date with preventive exams.
Multimorbidity is reported frequently. Providing adequate care for the growing number of such patients is a major challenge facing most health systems, which will require considerable strengthening of primary care along with financial protection for those most in need.
描述六个不同的拉丁美洲和加勒比国家的共病模式，研究其对初级保健体验的影响，并评估其对所报告的整体医疗保健评估的影响。
横断面数据来自美洲开发银行2013/2014年进行的国际初级保健调查，代表巴西、哥伦比亚、萨尔瓦多、牙买加、墨西哥和巴拿马的成年人口。稳健的泊松回归模型用于估计患有多种疾病的人获得充分和适当的初级保健、对管理自己的健康状况有信心以及能够负担所需医疗护理的程度。
共病患病率从哥伦比亚的17.5%到牙买加的37.3%不等。大多数所检查的疾病与其他疾病同时发生，糖尿病和心脏病是与其他疾病最相关的两个问题。在共病程度较高且初级保健体验较差的人群中，自付费用高、支付医疗账单有问题、看多个医生以及健康状况仅为一般/较差的成年人比例更高。共病和初级保健困难与支付医疗费用和管理自身疾病的困难呈正相关。尽管如此，患有多种疾病的成年人更有可能接受过生活方式建议并进行过最新的预防性检查。
共病报告频繁。为越来越多的此类患者提供充分的护理是大多数卫生系统面临的一项重大挑战，这将需要大力加强初级保健，并为最需要的人提供财务保护。
