Zhao Ting, Winzenberg Tania, Aitken Dawn, Graaff Barbara de, Ahmad Hasnat, Jones Graeme, Palmer Andrew J
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Rheumatology (Oxford). 2021 Dec 24;61(1):139-145. doi: 10.1093/rheumatology/keab358.
To investigate the impact of total number and patterns of comorbidities on health-related quality of life (HRQoL) and identify the most prevalent and influential comorbidity patterns in people with OA over 10 years.
Participants from the Tasmanian Older Adult Cohort aged 50-80 years, with self-reported OA and data on comorbidities and HRQoL were included. Participants were interviewed at baseline (n = 398), 2.5 (n = 304), 5 (n = 269) and 10 years (n = 191). Data on the self-reported presence of 10 chronic comorbidities were collected at baseline. HRQoL was assessed using the Assessment of Quality of Life-4-Dimensions. The long-term impacts of the number and of the nine most prevalent combinations of cardiovascular (CVD), non-OA musculoskeletal (Ms), metabolic and respiratory comorbidities on HRQoL over 10 years were analysed using linear mixed regressions.
Compared with comorbidity-free OA participants, the health state utility (HSU) of those with 2 or ≥3 comorbidities was respectively -0.07 and -0.13 units lower over 10 years, largely driven by reduced scores for independent living, social relationships and psychological wellness. Comorbidity patterns including 'CVD+Ms' were most influential, and associated with up to 0.13 units lower HSU, mostly through negative impacts on independent living (up to -0.12), psychological wellness (up to -0.08) and social relationship (up to -0.06).
Having more comorbidities negatively impacted OA patients' long-term HRQoL. OA patients with CVD and non-OA musculoskeletal conditions had the largest HSU impairment, and therefore optimal management and prevention of these conditions may yield improvements in OA patients' HRQoL.
探讨共病的总数和模式对健康相关生活质量（HRQoL）的影响，并确定10年间骨关节炎（OA）患者中最常见和最具影响力的共病模式。
纳入塔斯马尼亚老年队列中年龄在50 - 80岁、自我报告患有OA且有共病和HRQoL数据的参与者。在基线（n = 398）、2.5年（n = 304）、5年（n = 269）和10年（n = 191）时对参与者进行访谈。在基线时收集关于10种慢性共病自我报告存在情况的数据。使用生活质量4维度评估法评估HRQoL。采用线性混合回归分析10年间心血管疾病（CVD）、非OA肌肉骨骼疾病（Ms）、代谢和呼吸系统共病的数量以及九种最常见组合对HRQoL的长期影响。
与无共病的OA参与者相比，有2种或≥3种共病的参与者在10年间的健康状态效用（HSU）分别低0.07和0.13单位，这主要是由于独立生活、社会关系和心理健康得分降低所致。包括“CVD + Ms”的共病模式最具影响力，与HSU降低达0.13单位相关，主要是通过对独立生活（高达 - 0.12）、心理健康（高达 - 0.08）和社会关系（高达 - 0.06）的负面影响。
更多的共病对OA患者的长期HRQoL有负面影响。患有CVD和非OA肌肉骨骼疾病的OA患者的HSU受损最大，因此对这些疾病进行最佳管理和预防可能会改善OA患者的HRQoL。
