Bisquera Alessandra, Gulliford Martin, Dodhia Hiten, Ledwaba-Chapman Lesedi, Durbaba Stevo, Soley-Bori Marina, Fox-Rushby Julia, Ashworth Mark, Wang Yanzhong
School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
Lancet Reg Health Eur. 2021 Mar 2;3:100047. doi: 10.1016/j.lanepe.2021.100047. eCollection 2021 Apr.
Globally, there is increasing research on clusters of multimorbidity, but few studies have investigated multimorbidity in urban contexts characterised by a young, multi-ethnic, deprived populations. This study identified clusters of associative multimorbidity in an urban setting.
This is a population-based retrospective cross-sectional study using electronic health records of all adults aged 18 years and over, registered between April 2005 to May 2020 in general practices in one inner London borough. Multiple correspondence analysis and cluster analysis was used to identify groups of multimorbidity from 32 long-term conditions (LTCs).
The population included 41 general practices with 826,936 patients registered between 2005 and 2020, with mean age 40 (SD15·6) years. The prevalence of multimorbidity was 21% ( = 174,881), with the median number of conditions being three and increasing with age. Analysis identified five consistent LTC clusters: 1) anxiety and depression (Ratio of within- to between- sum of squares (WSS/BSS <0·01 to <0·01); 2) heart failure, atrial fibrillation, chronic kidney disease (CKD), chronic heart disease (CHD), stroke/transient ischaemic attack (TIA), peripheral arterial disease (PAD), dementia and osteoporosis (WSS/BSS 0·09 to 0·12); 3) osteoarthritis, cancer, chronic pain, hypertension and diabetes (0·05 to 0·06); 4) chronic liver disease and viral hepatitis (WSS/BSS 0·02 to 0·03); 5) substance dependency, alcohol dependency and HIV (WSS/BSS 0·37 to 0·55).
Mental health problems, pain, and at-risk behaviours leading to cardiovascular diseases are the important clusters identified in this young, urban population.
Impact on Urban Health, United Kingdom.
在全球范围内，关于多种疾病并存的研究越来越多，但很少有研究在以年轻、多民族、贫困人群为特征的城市环境中调查多种疾病并存的情况。本研究在城市环境中识别出了关联性多种疾病并存的集群。
这是一项基于人群的回顾性横断面研究，使用了2005年4月至2020年5月在伦敦市中心一个行政区的全科诊所登记的所有18岁及以上成年人的电子健康记录。采用多重对应分析和聚类分析从32种长期疾病（LTCs）中识别出多种疾病并存的组。
该人群包括41家全科诊所，2005年至2020年期间登记了826,936名患者，平均年龄40岁（标准差15.6）。多种疾病并存的患病率为21%（n = 174,881），疾病数量中位数为3种，且随年龄增长而增加。分析确定了五个一致的长期疾病集群：1）焦虑和抑郁（组内与组间平方和之比（WSS/BSS）<0.01至<0.01）；2）心力衰竭、心房颤动、慢性肾病（CKD）、慢性心脏病（CHD）、中风/短暂性脑缺血发作（TIA）、外周动脉疾病（PAD）、痴呆和骨质疏松症（WSS/BSS 0.09至0.12）；3）骨关节炎、癌症、慢性疼痛、高血压和糖尿病（0.05至0.06）；4）慢性肝病和病毒性肝炎（WSS/BSS 0.02至0.03）；5）物质依赖、酒精依赖和艾滋病毒（WSS/BSS 0.37至0.55）。
心理健康问题、疼痛以及导致心血管疾病的高危行为是在这个年轻的城市人群中识别出的重要集群。
英国城市健康影响项目。
