Kudesia Prtha, Salimarouny Banafsheh, Stanley Meagan, Fortin Martin, Stewart Moira, Terry Amanda, Ryan Bridget L
Schulich Interfaculty Program in Public Health, University of Western Ontario, London, Ontario, Canada.
Allyn & Betty Taylor Library, University of Western Ontario, London, Ontario, Canada.
J Multimorb Comorb. 2021 Jul 15;11:26335565211032880. doi: 10.1177/26335565211032880. eCollection 2021 Jan-Dec.
Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
多重疾病，即个体存在一种及以上慢性病，仍是全球范围内对健康的最大挑战之一。尽管多重疾病的患病率已得到充分证实，但其发病率尚未完全明确。本系统综述确定了全生命周期中多重疾病的发病率；慢性病累积导致多重疾病的顺序；并梳理了用于确定和报告导致多重疾病的慢性病累积情况的方法。通过检索MEDLINE、Embase、CINAHL和Cochrane电子数据库来识别研究。两名独立评审员评估研究是否纳入并进行质量评估。在纳入的36项研究中，研究设计和多重疾病的操作定义存在高度异质性。报告发病率的研究（n = 32）报告的发病率中位数为每1000人年30.7例（四分位间距为每1000人年39.5例），累积发病率中位数为2.8%（四分位间距为28.7%）。基线时年龄较大且患有一种及以上慢性病的人群发病率明显更高。报告慢性病累积模式的研究（n = 5）报告高血压、心脏病和糖尿病是导致后期多重疾病的常见起始疾病。用于识别模式的方法高度异质，从使用潜在增长轨迹到分裂聚类分析，以及使用冲积图来呈现聚类轨迹。报告多重疾病发病率和慢性病累积模式的研究在研究设计和所用定义方面差异很大。为了进行更准确的估计和比较，研究在应用的多重疾病操作定义上必须保持透明和一致。
