Department of Epidemiology and Biostatistics, Centre for Studies in Family Medicine.
Department of Family Medicine, Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Br J Gen Pract. 2019 Aug 29;69(686):e647-e656. doi: 10.3399/bjgp19X704657. Print 2019 Sep.
Multimorbidity is a complex issue in modern medicine and a more nuanced understanding of how this phenomenon occurs over time is needed.
To determine the prevalence, characteristics, and patterns of patients living with multimorbidity, specifically the unique combinations (unordered patterns) and unique permutations (ordered patterns) of multimorbidity in primary care.
A retrospective cohort analysis of the prospectively collected data from 1990 to 2013 from the Canadian Primary Care Sentinel Surveillance Network electronic medical record database.
Adult primary care patients who were aged ≥18 years at their first recorded encounter were followed over time. A list of 20 chronic condition categories was used to detect multimorbidity. Computational analyses were conducted using the Multimorbidity Cluster Analysis Tool to identify all combinations and permutations.
Multimorbidity, defined as two or more and three or more chronic conditions, was prevalent among adult primary care patients and most of these patients were aged <65 years. Among female patients with two or more chronic conditions, 6075 combinations and 14 891 permutations were detected. Among male patients with three or more chronic conditions, 4296 combinations and 9716 permutations were detected. While specific patterns were identified, combinations and permutations became increasingly rare as the total number of chronic conditions and patient age increased.
This research confirms that multimorbidity is common in primary care and provides empirical evidence that clinical management requires a tailored, patient-centred approach. While the prevalence of multimorbidity was found to increase with increasing patient age, the largest proportion of patients with multimorbidity in this study were aged <65 years.
多病共存是现代医学中的一个复杂问题，需要更深入地了解这种现象随时间推移是如何发生的。
确定患有多病共存的患者的患病率、特征和模式，特别是在初级保健中多病共存的独特组合（无序模式）和独特排列（有序模式）。
这是一项对 1990 年至 2013 年期间加拿大初级保健监测网络电子病历数据库中前瞻性收集的数据进行的回顾性队列分析。
对首次就诊时年龄≥18 岁的成年初级保健患者进行随访。使用 20 种慢性疾病类别列表来检测多病共存。使用多病共存聚类分析工具进行计算分析，以识别所有组合和排列。
定义为两种或两种以上和三种或三种以上慢性疾病的多病共存在成年初级保健患者中很常见，大多数患者年龄<65 岁。在患有两种或两种以上慢性疾病的女性患者中，检测到 6075 种组合和 14891 种排列。在患有三种或三种以上慢性疾病的男性患者中，检测到 4296 种组合和 9716 种排列。虽然确定了特定的模式，但随着慢性疾病总数和患者年龄的增加，组合和排列变得越来越罕见。
这项研究证实多病共存在初级保健中很常见，并提供了经验证据，表明临床管理需要量身定制、以患者为中心的方法。虽然多病共存的患病率随着患者年龄的增加而增加，但在这项研究中，患有多病共存的患者最大比例是年龄<65 岁。
