Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine.
Section of Cardiovascular Medicine, Department of Internal Medicine.
Am J Med. 2022 Sep;135(9):1083-1092.e14. doi: 10.1016/j.amjmed.2022.04.010. Epub 2022 Apr 25.
Disparities in multimorbidity prevalence indicate health inequalities, as the risk of morbidity does not intrinsically differ by race/ethnicity. This study aimed to determine if multimorbidity differences by race/ethnicity are decreasing over time.
Serial cross-sectional analysis of the National Health Interview Survey, 1999-2018. Included individuals were ≥18 years old and categorized by self-reported race, ethnicity, age, and income. The main outcomes were temporal trends in multimorbidity prevalence based on the self-reported presence of ≥2 of 9 common chronic conditions.
The study sample included 596,355 individuals (4.7% Asian, 11.8% Black, 13.8% Latino/Hispanic, and 69.7% White). In 1999, the estimated prevalence of multimorbidity was 5.9% among Asian, 17.4% among Black, 10.7% among Latino/Hispanic, and 13.5% among White individuals. Prevalence increased for all racial/ethnic groups during the study period (P ≤ .001 for each), with no significant change in the differences between them. In 2018, compared with White individuals, multimorbidity was more prevalent among Black individuals (+2.5 percentage points) and less prevalent among Asian and Latino/Hispanic individuals (-6.6 and -2.1 percentage points, respectively). Among those aged ≥30 years, Black individuals had multimorbidity prevalence equivalent to that of Latino/Hispanic and White individuals aged 5 years older, and Asian individuals aged 10 years older.
From 1999 to 2018, a period of increasing multimorbidity prevalence for all the groups studied, there was no significant progress in eliminating disparities between Black individuals and White individuals. Public health interventions that prevent the onset of chronic conditions in early life may be needed to eliminate these disparities.
多种疾病的患病率差异表明存在健康不平等，因为发病风险并非固有地因种族/民族而异。本研究旨在确定种族/民族之间的多种疾病差异是否随时间减少。
对 1999 年至 2018 年的全国健康访谈调查进行了一系列的横断面分析。纳入的个体年龄均≥18 岁，并按自我报告的种族、民族、年龄和收入进行分类。主要结局是基于自我报告存在≥9 种常见慢性疾病中的 2 种以上的多种疾病患病率的时间趋势。
本研究样本包括 596355 人（4.7%为亚洲人，11.8%为黑人，13.8%为拉丁裔/西班牙裔，69.7%为白人）。1999 年，亚洲人、黑人、拉丁裔/西班牙裔和白人的多种疾病患病率分别为 5.9%、17.4%、10.7%和 13.5%。在研究期间，所有种族/民族群体的患病率均有所增加（每个组间差异均 P≤0.001），但它们之间的差异没有显著变化。2018 年，与白人相比，黑人的多种疾病患病率更高（增加了 2.5 个百分点），而亚洲人和拉丁裔/西班牙裔的患病率更低（分别降低了 6.6 和 2.1 个百分点）。在≥30 岁的人群中，黑人的多种疾病患病率与 5 岁以上的拉丁裔/西班牙裔和白人相当，与 10 岁以上的亚洲人相当。
在研究期间，所有研究组的多种疾病患病率都在增加，但在消除黑人和白人之间的差异方面没有取得显著进展。可能需要采取公共卫生干预措施，防止慢性疾病在生命早期发生，以消除这些差异。
