Shang Xianwen, Peng Wei, Hill Edward, Szoeke Cassandra, He Mingguang, Zhang Lei
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
Front Public Health. 2020 Aug 18;8:404. doi: 10.3389/fpubh.2020.00404. eCollection 2020.
Determining the incidence, progression, and patterns of multimorbidity are important for the prevention, management, and treatment of concurrence of multiple conditions. This study aimed to analyze major multimorbidity patterns and the association of the onset of a primary condition or combinations of a primary and a secondary condition with the progression to subsequent conditions. We included 53,867 participants aged 45-64 years from the 45 and Up Study who were free of 10 predefined chronic conditions at baseline (2006-2009). The incidence of multimorbidity (coexistence of ≥2, ≥3, and ≥4 conditions) was identified using the claims database until December 31, 2016. The primary, secondary, tertiary, and quaternary condition for each participant was defined according to its temporal order of onset. During a mean 9-years follow-up, the cumulative incidence of primary, secondary, tertiary, and quaternary conditions was 49.6, 23.7, 9.0, and 2.9%, respectively. The time to develop a subsequent condition decreased with the accumulation of conditions ( < 0.0001). Two concurrent cardiometabolic disorders (CMDs, 30.4%) and CMDs clustered with musculoskeletal disorders (15.2%), mental disorders (13.5%), asthma (12.0%), or cancer (8.7%) were the five most common multimorbidity patterns. CMDs tended to occur prior to mental or musculoskeletal disorders but after the onset of cancers or asthma. Compared with all participants who developed cancer as a primary condition, individuals who experienced mental disorders/neurodegenerative disorders and a comorbidity as cardiovascular disease, hypertension, dyslipidemia, diabetes, asthma, or osteoarthritis were 3.36-10.87 times more likely to develop cancer as a tertiary condition. Individuals with neurodegenerative disorders and a comorbidity as hypertension, dyslipidemia, osteoarthritis, or asthma were 5.14-14.15 times more likely to develop mental disorders as a tertiary condition. A high incidence of multimorbidity in middle-aged adults was observed and CMDs were most commonly seen in multimorbidity patterns. There may be accelerated aging after a primary condition occurs. Our findings also reveal a potential preventative window to obviate the development of secondary or tertiary conditions.
确定多种疾病并存的发病率、进展情况及模式对于多种疾病并发的预防、管理和治疗至关重要。本研究旨在分析主要的多种疾病并存模式，以及原发性疾病或原发性与继发性疾病组合的发病与后续疾病进展之间的关联。我们纳入了来自“45岁及以上研究”的53867名年龄在45 - 64岁之间的参与者，他们在基线期（2006 - 2009年）没有10种预先定义的慢性疾病。使用索赔数据库确定截至2016年12月31日多种疾病并存（≥2种、≥3种和≥4种疾病并存）的发病率。根据发病的时间顺序确定每位参与者的原发性、继发性、 tertiary和quaternary疾病。在平均9年的随访期间，原发性、继发性、 tertiary和quaternary疾病的累积发病率分别为49.6%、23.7%、9.0%和2.9%。随着疾病的累积，发展为后续疾病的时间缩短（<0.0001）。两种并存的心脏代谢疾病（CMDs，30.4%）以及与肌肉骨骼疾病（15.2%）共同出现的CMDs、与精神疾病（13.5%）共同出现的CMDs、与哮喘（12.0%）共同出现的CMDs或与癌症（8.7%）共同出现的CMDs是五种最常见的多种疾病并存模式。CMDs往往在精神或肌肉骨骼疾病之前出现，但在癌症或哮喘发病之后出现。与所有以癌症作为原发性疾病发病的参与者相比，患有精神疾病/神经退行性疾病且合并心血管疾病、高血压、血脂异常、糖尿病、哮喘或骨关节炎的个体发展为癌症作为 tertiary疾病的可能性高3.36 - 10.87倍。患有神经退行性疾病且合并高血压、血脂异常、骨关节炎或哮喘的个体发展为精神疾病作为 tertiary疾病的可能性高5.14 - 14.15倍。观察到中年成年人中多种疾病并存的发病率较高，且CMDs在多种疾病并存模式中最为常见。原发性疾病发生后可能存在加速衰老的情况。我们的研究结果还揭示了一个潜在的预防窗口，以避免继发性或 tertiary疾病的发生。
