Ferry F R, Rosato M G, Curran E J, O'Reilly D, Leavey G
Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland.
Centre for Public Health, Block A Royal Victoria Hospital, Queen's University Belfast, Belfast BT12 6BA, Northern Ireland.
J Public Health (Oxf). 2022 Mar 7;44(1):e59-e67. doi: 10.1093/pubmed/fdaa209.
Despite increasing multimorbidity across the lifespan, little is known about the co-occurrence of conditions and risk factors among younger adults. This population-based study examines multimorbidity, social determinants and associated mortality among younger and middle-age adults.
Analysis was based on the Northern Ireland population aged 25-64 years enumerated in the 2011 Census (n = 878 345), with all-cause mortality follow-up to 2014 (8659 deaths). Logistic regression was used to examine social determinants and Cox proportional hazards models in the analysis of associated mortality.
Prevalence of multimorbidity was 13.7% in females and 12.7% in males. There was a strong association between multimorbidity that included mental/cognitive illness and deprivation. Among those never married, multimorbid physical conditions were less likely [relative risk ratios (RRR) = 0.92: 95% confidence interval (CI) = 0.88, 0.95 for males; and RRR = 0.90: 0.87, 0.94 for females]. Rurality was associated with lower physical multimorbidity (RRR = 0.92: 0.89, 0.95) but higher mental/cognitive multimorbidity (RRR = 1.35: 1.12, 1.64) among females. All multimorbid categories were associated with elevated risk of mortality.
The health and economic challenges created by multimorbidity should be addressed further 'upstream'. Future multimorbidity research should include younger adults to inform the development of preventative interventions and align health and social care services more closely with patients' needs.
尽管一生中多种疾病并存的情况日益增多，但对于年轻人中疾病和风险因素的共现情况却知之甚少。这项基于人群的研究调查了年轻人和中年成年人中的多种疾病并存情况、社会决定因素及相关死亡率。
分析基于2011年人口普查中列举的25至64岁的北爱尔兰人群（n = 878345），全因死亡率随访至2014年（8659例死亡）。在分析相关死亡率时，采用逻辑回归来研究社会决定因素，并使用Cox比例风险模型。
女性多种疾病并存的患病率为13.7%，男性为12.7%。包括精神/认知疾病在内的多种疾病并存与贫困之间存在密切关联。在从未结婚的人群中，多种身体疾病的发生可能性较小[相对风险比（RRR）= 0.92：男性的95%置信区间（CI）= 0.88，0.95；女性的RRR = 0.90：0.87，0.94]。农村地区与女性较低的身体多种疾病并存率（RRR = 0.92：0.89，0.95）相关，但与较高的精神/认知多种疾病并存率（RRR = 1.35：1.12，1.64）相关。所有多种疾病并存类别都与死亡率升高风险相关。
多种疾病并存所带来的健康和经济挑战应在“上游”层面得到进一步解决。未来的多种疾病并存研究应纳入年轻人，以为预防性干预措施的制定提供信息，并使卫生和社会护理服务更紧密地符合患者需求。
