Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands.
Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
PLoS One. 2022 Feb 25;17(2):e0264343. doi: 10.1371/journal.pone.0264343. eCollection 2022.
After stratifying for age, sex and multimorbidity at baseline, our aim is to analyse time trends in incident multimorbidity and polypharmacy in the 15-year clinical trajectories of individual patients in a family medicine setting.
This study was carried out using data from the Registration Network Family Medicine in the South of the Netherlands. The clinical trajectories of 10037 subjects during the 15-year period (2000-2014) were analyzed in a repeated measurement of using a generalized estimating equations model as well as a multilevel random intercept model with repeated measurements to determine patterns of incident multimorbidity and polypharmacy. Hierarchical age-period-cohort models were used to generate age and cohort trajectories for comparison with prevalence trends in multimorbidity literature.
Multimorbidity was more common in females than in males throughout the duration of the 15-year trajectory (females: 39.6%; males: 33.5%). With respective ratios of 11.7 and 5.9 between the end and the beginning of the 15-year period, the youngest female and male groups showed a substantial increase in multimorbidity prevalence. Ratios in the oldest female and male groups were 2.2 and 1.9 respectively. Females had higher levels of multimorbidity than males in the 0-24-year and 25-44-year age groups, but the levels converged to a prevalence of 92.2% in the oldest male and 90.7% in the oldest female group. Similar, albeit, moderate differences were found in polypharmacy patterns.
We sought to specify the progression of multimorbidity from an early age. As a result, our study adds to the multimorbidity literature by specifying changes in chronic disease accumulation with relation to polypharmacy, and by tracking differences in patient trajectories according to age and sex. Multimorbidity and polypharmacy are common and their prevalence is accelerating, with a relatively rapid increase in younger groups. From the point of view of family medicine, this underlines the need for a longitudinal approach and a life course perspective in patient care.
在基线时按年龄、性别和多种合并症进行分层后，我们旨在分析家庭医学环境中个体患者 15 年临床轨迹中的新发多种合并症和多种药物治疗的时间趋势。
本研究使用荷兰南部注册网络家庭医学的数据进行。在 15 年期间（2000-2014 年），使用广义估计方程模型和重复测量的多级随机截距模型对 10037 名受试者的临床轨迹进行了重复测量分析，以确定新发多种合并症和多种药物治疗的模式。分层年龄-时期-队列模型用于生成年龄和队列轨迹，以与多种合并症文献中的流行趋势进行比较。
在整个 15 年轨迹期间，女性的多种合并症发生率高于男性（女性：39.6%；男性：33.5%）。在 15 年期间结束和开始时，相应的比例分别为 11.7 和 5.9，最年轻的女性和男性组的多种合并症患病率显著增加。最年长的女性和男性组的比例分别为 2.2 和 1.9。在 0-24 岁和 25-44 岁年龄组中，女性的多种合并症发生率高于男性，但在最年长的男性和女性组中，这一比例分别为 92.2%和 90.7%，患病率趋于一致。在多种药物治疗模式方面也发现了类似但程度较轻的差异。
我们试图从早期指定多种合并症的进展情况。因此，我们的研究通过指定与多种药物治疗相关的慢性疾病积累变化，并根据年龄和性别跟踪患者轨迹的差异，为多种合并症文献增添了新的内容。多种合并症和多种药物治疗很常见，其流行率正在加速，年轻群体的增长速度相对较快。从家庭医学的角度来看，这强调了在患者护理中采用纵向方法和生命历程观点的必要性。
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