Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
PLoS One. 2020 Dec 11;15(12):e0243614. doi: 10.1371/journal.pone.0243614. eCollection 2020.
The limited knowledge on aetiology, epidemiology and risk factors for multimorbidity especially evident from low and middle-income countries curtail the development and implementation of sustainable healthcare models. Sri Lanka, boasting for one of South Asia's most efficient public health systems that is accessible free-of-charge by the citizens is presently transitioning from lower-middle to upper-middle-income tier. Faced with the triple burden of disease, it is imperative for Sri Lanka to incorporate an integrated model to manage multimorbidity.
A descriptive cross-sectional study was carried out in medical clinics of a tertiary care hospital and a University primary care department. Data were extracted on to a form from the clinical records of patients over the age of 20 years with at least one non-communicable disease (NCD) and analysed.
Multimorbidity was present among 64.1% of patients (n = 1600). Nearly 44.44% of the patients aged 20-35 years have a minimum of two disorders, and by the time they reach 50 years, nearly 64% of the patients have two or more non-communicable diseases. Nearly 7% of those aged over 65 years were diagnosed with four or more disorders. A fourth of the sample was affected by co-morbid diabetes mellitus and hypertension, whereas the combinations of coronary heart disease with hypertension and diabetes mellitus were also found to be significantly prevalent. A salient revelation of the binomial logistic regression analysis was that the number of disorders was positively correlated to the presence of mental disorders 7.25 (95% CI = 5.82-8.68).
Multimorbidity is highly prevalent among this population and seemingly has a detrimental effect on the psychological wellbeing of those affected. Therefore, the need for horizontal integration of all primary to tertiary care disciplines, including mental health, to manage multimorbidity by policymakers is emphasized as a priority task.
中低收入国家对多种疾病的病因学、流行病学和危险因素知之甚少，这严重限制了可持续医疗模式的制定和实施。斯里兰卡拥有南亚最有效的公共卫生系统之一，公民可免费享受该系统，目前正从中下收入国家向中上收入国家过渡。斯里兰卡面临着疾病的三重负担，因此必须采用综合模式来管理多种疾病。
在一家三级保健医院和一家大学初级保健部门的诊所进行了一项描述性的横断面研究。从 20 岁以上至少患有一种非传染性疾病（NCD）的患者的临床记录中提取数据并进行分析。
64.1%的患者（n=1600）患有多种疾病。近 44.44%的 20-35 岁患者至少有两种疾病，而到 50 岁时，近 64%的患者患有两种或两种以上的非传染性疾病。近 7%的 65 岁以上患者被诊断出患有四种或更多疾病。四分之一的样本受到共患糖尿病和高血压的影响，而高血压和糖尿病与冠心病的组合也被发现具有显著的普遍性。二项逻辑回归分析的一个显著结果是，疾病的数量与精神障碍的存在呈正相关（7.25，95%置信区间=5.82-8.68）。
这种人群中多种疾病的患病率很高，而且似乎对受影响者的心理健康产生了不利影响。因此，政策制定者强调需要将所有初级到三级保健学科横向整合，包括心理健康，以优先解决多种疾病的管理问题。
