Nicholson Kathryn, Griffith Lauren E, Sohel Nazmul, Raina Parminder
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster Institute for Research on Aging, Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Ontario, Canada.
J Am Geriatr Soc. 2021 Jun;69(6):1579-1591. doi: 10.1111/jgs.17096. Epub 2021 Mar 17.
BACKGROUND/OBJECTIVES: The study objective was to understand characteristics and health outcomes of multimorbidity, distinguishing between multimorbidity onset in earlier and later phases of life among community-dwelling older adults in Canada.
A cross-sectional analysis was conducted using baseline data from the Canadian Longitudinal Study on Aging (CLSA).
This analysis included 11,161 older adults who were between the ages of 65 and 85 years at baseline and who were living in community-based settings.
Multimorbidity was defined using two cutpoints: two or more chronic conditions (MM2+) and three or more chronic conditions (MM3+). After calculating the age of diagnosis for eligible participants, "early multimorbidity" was defined as multiple chronic conditions diagnosed before 45 years of age, while "late multimorbidity" was defined as multiple chronic conditions diagnosed at or after 45 years of age. The five health outcomes explored were physical disability, social limitation, frailty level, perceived general health status, and perceived mental health status.
Overall, the prevalence of MM2+ was 75.3% (95% CI: 74.3, 76.1) and the prevalence of MM3+ was 47.0% (95% CI: 46.0, 48.0). The majority of participants (both females and males) living with multimorbidity were categorized with late multimorbidity. Participants with early multimorbidity or both early and late multimorbidity had increased odds of physical disability, social limitation, increased frailty level, and negative perceived general and mental health. These patterns were detected for both MM2+ and MM3+.
This study examined the impact of the timing of multimorbidity onset on five health outcomes. Our findings highlight the importance of clinical and public health interventions to prevent and manage the causes and consequences of multimorbidity, with particular focus on age of onset. Future longitudinal research should be done to further articulate the relationships between multimorbidity and these health outcomes over time.
背景/目的：本研究的目的是了解多重疾病的特征和健康结局，区分加拿大社区居住的老年人在生命早期和晚期发生的多重疾病。
使用加拿大老龄化纵向研究（CLSA）的基线数据进行横断面分析。
该分析纳入了11161名年龄在65至85岁之间、居住在社区环境中的老年人。
多重疾病采用两个切点进行定义：两种或更多种慢性病（MM2+）和三种或更多种慢性病（MM3+）。在计算符合条件的参与者的诊断年龄后，“早期多重疾病”定义为45岁之前诊断出的多种慢性病，而“晚期多重疾病”定义为45岁及以后诊断出的多种慢性病。探讨的五项健康结局为身体残疾、社会限制、虚弱程度、自我感知的总体健康状况和自我感知的心理健康状况。
总体而言，MM2+的患病率为75.3%（95%CI：74.3，76.1），MM3+的患病率为47.0%（95%CI：46.0，48.0）。大多数患有多重疾病的参与者（包括女性和男性）被归类为晚期多重疾病。患有早期多重疾病或同时患有早期和晚期多重疾病的参与者出现身体残疾、社会限制、虚弱程度增加以及自我感知的总体和心理健康状况不佳的几率更高。MM2+和MM3+均呈现出这些模式。
本研究考察了多重疾病发病时间对五项健康结局的影响。我们的研究结果强调了临床和公共卫生干预措施对于预防和管理多重疾病的病因及后果的重要性，尤其要关注发病年龄。未来应开展纵向研究，以进一步阐明多重疾病与这些健康结局随时间的关系。
