Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Intern Emerg Med. 2020 Oct;15(7):1207-1217. doi: 10.1007/s11739-020-02306-2. Epub 2020 Mar 16.
Multimorbidity is frequent and represents a significant burden for patients and healthcare systems. However, there are limited data on the most common combinations of comorbidities in multimorbid patients. We aimed to describe and quantify the most common combinations of comorbidities in multimorbid medical inpatients. We used a large retrospective cohort of adults discharged from the medical department of 11 hospitals across 3 countries (USA, Switzerland, and Israel) between 2010 and 2011. Diseases were classified into acute versus chronic. Chronic diseases were grouped into clinically meaningful categories of comorbidities. We identified the most prevalent combinations of comorbidities and compared the observed and expected prevalence of the combinations. We assessed the distribution of acute and chronic diseases and the median number of body systems in relationship to the total number of diseases. Eighty-six percent (n = 126,828/147,806) of the patients were multimorbid (≥ 2 chronic diseases), with a median of five chronic diseases; 13% of the patients had ≥ 10 chronic diseases. Among the most frequent combinations of comorbidities, the most prevalent comorbidity was chronic heart disease. Other high prevalent comorbidities included mood disorders, arthropathy and arthritis, and esophageal disorders. The ratio of chronic versus acute diseases was approximately 2:1. Multimorbidity affected almost 90% of patients, with a median of five chronic diseases. Over 10% had ≥ 10 chronic diseases. This identification and quantification of frequent combinations of comorbidities among multimorbid medical inpatients may increase awareness of what should be taken into account when treating such patients, a growth in the need for special care considerations.
多发病是指患者同时患有两种或两种以上的慢性疾病，它十分常见，给患者和医疗系统带来了沉重负担。然而，目前有关多发病患者最常见的合并症组合的数据有限。本研究旨在描述和量化多发病成年住院患者最常见的合并症组合，并定量分析。我们使用了一个来自美国、瑞士和以色列 11 家医院的医学科 2010 年至 2011 年期间出院的成年人的大型回顾性队列。疾病分为急性和慢性。慢性疾病分为有临床意义的合并症类别。我们确定了最常见的合并症组合，并比较了观察到的和预期的组合的流行率。我们评估了急性和慢性疾病的分布以及与疾病总数相关的身体系统中位数数量。86%（n=126828/147806）的患者患有多发病（≥2 种慢性疾病），中位数为 5 种慢性疾病；13%的患者患有≥10 种慢性疾病。在最常见的合并症组合中，最常见的合并症是慢性心脏病。其他高发的合并症包括情绪障碍、关节病和关节炎以及食管疾病。慢性疾病与急性疾病的比例约为 2:1。多发病几乎影响了 90%的患者，中位数为 5 种慢性疾病。超过 10%的患者患有≥10 种慢性疾病。这种对多发病成年住院患者常见合并症组合的识别和量化可能会提高治疗这些患者时应考虑的因素的意识，同时也会增加对特殊护理需求的关注。
