Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.
BMJ Glob Health. 2022 May;7(5). doi: 10.1136/bmjgh-2021-007278.
As the populations of lower-income and middle-income countries age, multimorbidity is increasing, but there is little information on its long-term consequences. We aimed to show associations between multimorbidity and outcomes of mortality and hospitalisation in Iran, a middle-income country undergoing rapid economic transition.
We conducted a secondary analysis of longitudinal data collected in the Golestan Cohort Study. Data on demographics, morbidities and lifestyle factors were collected at baseline, and information on hospitalisations or deaths was captured annually. Logistic regression was used to analyse the association between baseline multimorbidity and 10-year mortality, Cox-proportional hazard models to measure lifetime risk of mortality and zero-inflation models to investigate the association between hospitalisation and multimorbidity. Multimorbidity was classified as ≥2 conditions or number of conditions. Demographic, lifestyle and socioeconomic variables were included as covariables.
The study recruited 50 045 participants aged 40-75 years between 2004 and 2008, 47 883 were available for analysis, 416 (57.3%) were female and 12 736 (27.94%) were multimorbid. The odds of dying at 10 years for multimorbidity defined as ≥2 conditions was 1.99 (95% CI 1.86 to 2.12, p<0.001), and it increased with increasing number of conditions (OR of 3.57; 95% CI 3.12 to 4.08, p<0.001 for ≥4 conditions). The survival analysis showed the hazard of death for those with ≥4 conditions was 3.06 (95% CI 2.74 to 3.43, p<0.001). The number of hospital admissions increased with number of conditions (OR of not being hospitalised of 0.36; 95% CI 0.31 to 0.52, p<0.001, for ≥4 conditions).
The long-terms effects of multimorbidity on mortality and hospitalisation are similar in this population to those seen in high-income countries.
随着低收入和中等收入国家的人口老龄化，多种疾病的发病率正在增加，但关于其长期后果的信息却很少。我们旨在展示伊朗（一个正在经历快速经济转型的中等收入国家）多种疾病与死亡率和住院率之间的关联。
我们对在戈勒斯坦队列研究中收集的纵向数据进行了二次分析。在基线时收集了人口统计学、多种疾病和生活方式因素的数据，并每年记录住院或死亡信息。我们使用逻辑回归分析基线时多种疾病与 10 年死亡率之间的关联，使用 Cox 比例风险模型来衡量终生死亡率风险，使用零膨胀模型来调查住院与多种疾病之间的关联。多种疾病被定义为≥2 种疾病或疾病数量。人口统计学、生活方式和社会经济变量被作为协变量。
该研究于 2004 年至 2008 年间招募了 50045 名年龄在 40-75 岁之间的参与者，其中 47883 名可用于分析，416 名（57.3%）为女性，12736 名（27.94%）为多种疾病患者。定义为≥2 种疾病的多种疾病患者在 10 年内死亡的几率为 1.99（95%CI 1.86 至 2.12，p<0.001），且随着疾病数量的增加而增加（OR 为 3.57；95%CI 3.12 至 4.08，p<0.001 为≥4 种疾病）。生存分析显示，≥4 种疾病患者的死亡风险为 3.06（95%CI 2.74 至 3.43，p<0.001）。住院次数随疾病数量的增加而增加（OR 为 0.36；95%CI 0.31 至 0.52，p<0.001，为≥4 种疾病）。
在这个人群中，多种疾病对死亡率和住院率的长期影响与高收入国家相似。
