Johnston Marjorie C, Black Corrinda, Mercer Stewart W, Prescott Gordon J, Crilly Michael A
Aberdeen Centre for Health Data Science, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
Aberdeen Centre for Health Data Science, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK.
BMJ Open. 2020 May 5;10(5):e033622. doi: 10.1136/bmjopen-2019-033622.
Multimorbidity is the coexistence of two or more health conditions in an individual. Multimorbidity in younger adults is increasingly recognised as an important challenge. We assessed the prevalence of secondary care multimorbidity in mid-life and its association with premature mortality over 15 years of follow-up, in the Aberdeen Children of the 1950s (ACONF) cohort.
A prospective cohort study using linked electronic health and mortality records. Scottish ACONF participants were linked to their Scottish Morbidity Record hospital episode data and mortality records. Multimorbidity was defined as two or more conditions and was assessed using healthcare records in 2001 when the participants were aged between 45 and 51 years. The association between multimorbidity and mortality over 15 years of follow-up (to ages 60-66 years) was assessed using Cox proportional hazards regression. There was also adjustment for key covariates: age, gender, social class at birth, intelligence at age 7, secondary school type, educational attainment, alcohol, smoking, body mass index and adult social class.
Of 9625 participants (51% males), 3% had multimorbidity. The death rate per 1000 person-years was 28.4 (95% CI 23.2 to 34.8) in those with multimorbidity and 5.7 (95% CI 5.3 to 6.1) in those without. In relation to the reference group of those with no multimorbidity, those with multimorbidity had a mortality HR of 4.5 (95% CI 3.4 to 6.0) over 15 years and this association remained when fully adjusted for the covariates (HR 2.5 (95% CI 1.5 to 4.0)).
Multimorbidity prevalence was 3% in mid-life when measured using secondary care administrative data. Multimorbidity in mid-life was associated with premature mortality.
多重疾病指个体同时存在两种或更多健康状况。年轻人中的多重疾病日益被视为一项重大挑战。我们在20世纪50年代阿伯丁儿童（ACONF）队列中，评估了中年人群二级医疗多重疾病的患病率及其与15年随访期过早死亡率的关联。
一项前瞻性队列研究，使用关联的电子健康和死亡率记录。苏格兰ACONF参与者与其苏格兰发病率记录的医院就诊数据和死亡率记录相链接。多重疾病定义为两种或更多状况，并在2001年参与者年龄在45至51岁时使用医疗记录进行评估。使用Cox比例风险回归评估15年随访期（至60 - 66岁）内多重疾病与死亡率之间的关联。还对关键协变量进行了调整：年龄、性别、出生时的社会阶层、7岁时的智力、中学类型、教育程度、饮酒、吸烟、体重指数和成人社会阶层。
在9625名参与者（51%为男性）中，3%患有多重疾病。患有多重疾病者每1000人年的死亡率为28.4（95%置信区间23.2至34.8），无多重疾病者为5.7（95%置信区间5.3至6.1）。与无多重疾病的参照组相比，患有多重疾病者在15年内的死亡风险比为4.5（95%置信区间3.4至6.0），在对协变量进行完全调整后，这种关联仍然存在（风险比2.5（95%置信区间1.5至4.0））。
使用二级医疗管理数据测量时，中年人群多重疾病患病率为3%。中年时的多重疾病与过早死亡相关。
