Juul-Larsen Helle Gybel, Christensen Line Due, Bandholm Thomas, Andersen Ove, Kallemose Thomas, Jørgensen Lillian Mørch, Petersen Janne
Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Clin Epidemiol. 2020 Feb 28;12:245-259. doi: 10.2147/CLEP.S226586. eCollection 2020.
The majority of acutely admitted older medical patients are multimorbid, receive multiple drugs, and experience a complex treatment regime. To be able to optimize treatment and care, we need more knowledge of the association between different patterns of multimorbidity and healthcare utilization and the complexity thereof. The purpose was therefore to investigate patterns of multimorbidity in a Danish national cohort of acutely hospitalized medical patients aged 65 and older and to determine the association between these multimorbid patterns with the healthcare utilization and complexity.
Longitudinal cohort study of 129,900 (53% women) patients. Latent class analysis (LCA) was used to develop patterns of multimorbidity based on 22 chronic conditions ascertained from Danish national registers. A latent class regression was used to test for differences in healthcare utilization and healthcare complexity among the patterns measured in the year leading up to the index admission.
LCA identified eight distinct multimorbid patterns. Patients belonging to multimorbid patterns including the major chronic conditions; diabetes and chronic obstructive pulmonary disease was associated with higher odds of healthcare utilization and complexity than the reference pattern ("Minimal chronic conditions"). The pattern with the highest number of chronic conditions did not show the highest healthcare utilization nor complexity.
Our study showed that chronic conditions cluster together and that these patterns differ in healthcare utilization and complexity. Patterns of multimorbidity have the potential to be used in epidemiological studies of healthcare planning but should be confirmed in other population-based studies.
大多数急性入院的老年内科患者患有多种疾病，服用多种药物，并经历复杂的治疗方案。为了能够优化治疗和护理，我们需要更多地了解不同的多病共存模式与医疗保健利用之间的关联及其复杂性。因此，本研究旨在调查丹麦一个65岁及以上急性住院内科患者全国队列中的多病共存模式，并确定这些多病共存模式与医疗保健利用及复杂性之间的关联。
对129,900名患者（53%为女性）进行纵向队列研究。基于从丹麦国家登记册中确定的22种慢性病，采用潜在类别分析（LCA）来确定多病共存模式。使用潜在类别回归来检验在索引入院前一年所测量的不同模式之间在医疗保健利用和医疗保健复杂性方面的差异。
LCA确定了八种不同的多病共存模式。属于包括主要慢性病（糖尿病和慢性阻塞性肺疾病）在内的多病共存模式的患者，与参照模式（“最少慢性病”）相比，医疗保健利用和复杂性的几率更高。慢性病数量最多的模式并未表现出最高的医疗保健利用率和复杂性。
我们的研究表明，慢性病会聚集在一起，并且这些模式在医疗保健利用和复杂性方面存在差异。多病共存模式有可能用于医疗保健规划的流行病学研究，但应在其他基于人群的研究中得到证实。
