Public Health France, Saint-Maurice, France.
Department of Family Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
PLoS One. 2022 Apr 6;17(4):e0265842. doi: 10.1371/journal.pone.0265842. eCollection 2022.
Robust public health and health system response to the increasing burden of multimorbidity worldwide requires detailed epidemiological examination of its key sociodemographic and geographic determinants. We investigated the role of gender, age and socioeconomic and geographic factors on multimorbidity (i.e., having two or more conditions) in the adult population in France and examined implications for surveillance and prevention.
We used data from two large nationwide representative surveys with cross-sectional and longitudinal health and socio-demographic indicators, conducted in France between 2008 and 2014. Morbidity counts and frequent dyads/triads of conditions independently impacting mortality, activity limitations, and perceived health were investigated with regard to differences in gender, age, socioeconomic (education, occupation and income) and geography (size of the urban unit and region).
The component conditions of multimorbidity varied with gender and age. Women experienced multimorbidity 23-31% more frequently and at a younger age (5-15 years earlier) than men. Multimorbidity increased with age while its associations with most health indicators weakened with it. Multimorbidity was strongly and independently associated with socioeconomic indicators, with a strong inverse dose-response relationship with education, but less consistently with geographic factors.
Multimorbidity has diverse and variable components and impacts across gender and age. It is strongly associated with socioeconomic factors, notably educational level, for which causality appears likely. Consideration of this diversity and variability, its common occurrence in dyads and triads, and its impact on health outcomes according to age and gender may contribute to efficient surveillance and support the identification of prevention strategies targeting middle-aged men and women.
稳健的公共卫生和卫生系统应对全球不断增加的多种疾病负担，需要对其关键的社会人口和地理决定因素进行详细的流行病学研究。我们调查了性别、年龄以及社会经济和地理因素在法国成年人中对多种疾病（即患有两种或两种以上疾病）的影响，并研究了其对监测和预防的影响。
我们使用了 2008 年至 2014 年间在法国进行的两次具有代表性的全国性大型调查的数据，这些调查具有横断面和纵向的健康和社会人口统计学指标。我们根据性别、年龄、社会经济（教育、职业和收入）和地理（城市单位和地区的规模）方面的差异，研究了对死亡率、活动受限和健康感知有影响的常见多发病（共病）的数量以及多发病的常见双重/三重组合。
多种疾病的组成条件因性别和年龄而异。女性比男性经历多种疾病的频率高 23-31%，且发病年龄早 5-15 年。多种疾病随着年龄的增长而增加，而其与大多数健康指标的关联则随着年龄的增长而减弱。多种疾病与社会经济指标密切相关，与教育水平呈强烈的负相关，但与地理因素的相关性不太一致。
多种疾病的组成和影响在性别和年龄方面存在多样性和可变性。它与社会经济因素密切相关，特别是教育水平，这表明因果关系可能存在。考虑到这种多样性和可变性，以及它在双重和三重组合中的常见发生情况及其对健康结果的影响，根据年龄和性别进行监测，可能有助于制定针对中年男女的预防策略。
