Basto-Abreu Ana, Barrientos-Gutierrez Tonatiuh, Wade Alisha N, Oliveira de Melo Daniela, Semeão de Souza Ana S, Nunes Bruno P, Perianayagam Arokiasamy, Tian Maoyi, Yan Lijing L, Ghosh Arpita, Miranda J Jaime
Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Multimorb Comorb. 2022 Jun 16;12:26335565221106074. doi: 10.1177/26335565221106074. eCollection 2022 Jan-Dec.
Multimorbidity is a complex challenge affecting individuals, families, caregivers, and health systems worldwide. The burden of multimorbidity is remarkable in low- and middle-income countries (LMICs) given the many existing challenges in these settings. Investigating multimorbidity in LMICs poses many challenges including the different conditions studied, and the restriction of data sources to relatively few countries, limiting comparability and representativeness. This has led to a paucity of evidence on multimorbidity prevalence and trends, disease clusters, and health outcomes, particularly longitudinal outcomes. In this paper, based on our experience of investigating multimorbidity in LMICs contexts, we discuss how the structure of the health system does not favor addressing multimorbidity, and how this is amplified by social and economic disparities and, more recently, by the COVID-19 pandemic. We argue that generating epidemiologic data around multimorbidity with similar methods and definition is essential to improve comparability, guide clinical decision-making and inform policies, research priorities, and local responses. We call for action on policy to refinance and prioritize primary care and integrated care as the center of multimorbidity.
多重疾病是一个复杂的挑战，影响着全球范围内的个人、家庭、护理人员和卫生系统。鉴于低收入和中等收入国家（LMICs）存在诸多现有挑战，多重疾病的负担在这些国家尤为显著。在低收入和中等收入国家研究多重疾病存在许多挑战，包括所研究的不同疾病状况，以及数据源仅限于相对较少的国家，这限制了可比性和代表性。这导致了关于多重疾病患病率和趋势、疾病集群以及健康结果，特别是纵向结果的证据匮乏。在本文中，基于我们在低收入和中等收入国家背景下研究多重疾病的经验，我们讨论了卫生系统的结构如何不利于应对多重疾病，以及社会和经济差距，以及最近的新冠疫情如何加剧了这一问题。我们认为，采用相似的方法和定义生成关于多重疾病的流行病学数据对于提高可比性、指导临床决策以及为政策、研究重点和地方应对措施提供信息至关重要。我们呼吁采取政策行动，为初级保健和综合护理重新融资并将其作为多重疾病的核心进行优先安排。
