Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Ontario, Canada.
PLoS One. 2020 Feb 20;15(2):e0229160. doi: 10.1371/journal.pone.0229160. eCollection 2020.
It is unknown if the relationship between multimorbidity and disability differs by combinations of chronic conditions. The objective of our study was to elucidate how joint effect of different combinations of chronic conditions impact the five year risk of functional disability at the population level.
Participants ≥65 years from the Canadian Study of Health and Aging were assessed for functional disability measured using activities of daily living (ADL) and instrumental ADL (IADL), and the presence of conditions in five disease domains; cardiometabolic, neurological, sensory, musculoskeletal, and respiratory. Logistic regression was used to assess the relationship between each disease domain and incident ADL and IADL measured at five years of follow up and population attributable risk (PAR) was modeled for diseases domains that were significantly associated with disability. Results were stratified by sex and age (65-74 years, ≥75 years).
There were 6272 participants free of ADL disability and 4571 participants free from IADL disability at baseline. For incident ADL, the greatest PAR values were 21.3 (9.8-32.8) for the cardiometabolic domain in males 65-74 years, 22.7 (4.7-40.8) for the musculoskeletal domain for females aged 65-74 years, and 11.2 (2.8-19.7) for the musculoskeletal domain in males ≥75 years. The PAR for the musculoskeletal, sensory, and neurological domains were similar in females ≥75 years(9.3-9.9). PAR values were lower but followed similar patterns for IADL disability.
The chronic disease domains which most strongly predicted incident ADLs and IADLs did not account for the greatest amount of disability at the population level.
多病症与残疾之间的关系是否因慢性病的组合而不同尚不清楚。本研究的目的是阐明不同慢性疾病组合的联合效应对人群水平的功能性残疾五年风险的影响。
来自加拿大老龄化健康研究的≥65 岁的参与者接受了评估，以评估使用日常生活活动（ADL）和工具性日常生活活动（IADL）测量的功能性残疾以及五个疾病领域（心血管代谢、神经、感觉、肌肉骨骼和呼吸）中存在的疾病情况。使用逻辑回归评估每个疾病领域与五年随访时 ADL 和 IADL 之间的关系，并对与残疾显著相关的疾病领域进行人群归因风险（PAR）建模。结果按性别和年龄（65-74 岁，≥75 岁）进行分层。
在基线时，有 6272 名参与者无 ADL 残疾，4571 名参与者无 IADL 残疾。对于新发 ADL，65-74 岁男性中心血管代谢疾病领域的最大 PAR 值为 21.3（9.8-32.8），65-74 岁女性中肌肉骨骼疾病领域的最大 PAR 值为 22.7（4.7-40.8），≥75 岁男性中肌肉骨骼疾病领域的最大 PAR 值为 11.2（2.8-19.7）。≥75 岁女性中肌肉骨骼、感觉和神经疾病领域的 PAR 值相似（9.3-9.9）。PAR 值较低，但对于 IADL 残疾，其模式也相似。
在人群水平上，预测新发 ADL 和 IADL 的最强慢性疾病领域并不能解释最大程度的残疾。
