Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
BMC Med. 2022 Sep 8;20(1):304. doi: 10.1186/s12916-022-02487-x.
Multimorbidity poses a major challenge for care coordination. However, data on what non-communicable diseases lead to multimorbidity, and whether the lifetime risk differs between men and women are lacking. We determined sex-specific differences in multimorbidity patterns and estimated sex-specific lifetime risk of multimorbidity in the general population.
We followed 6,094 participants from the Rotterdam Study aged 45 years and older for the occurrence of ten diseases (cancer, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, diabetes, dementia, asthma, heart failure, parkinsonism). We visualised participants' trajectories from a single disease to multimorbidity and the most frequent combinations of diseases. We calculated sex-specific lifetime risk of multimorbidity, considering multimorbidity involving only somatic diseases (1) affecting the same organ system, (2) affecting different organ systems, and (3) multimorbidity involving depression.
Over the follow-up period (1993-2016, median years of follow-up 9.2), we observed 6334 disease events. Of the study population, 10.3% had three or more diseases, and 27.9% had two or more diseases. The most frequent pair of co-occurring diseases among men was COPD and cancer (12.5% of participants with multimorbidity), the most frequent pair of diseases among women was depression and dementia (14.9%). The lifetime risk of multimorbidity was similar among men (66.0%, 95% CI: 63.2-68.8%) and women (65.1%, 95% CI: 62.5-67.7%), yet the risk of multimorbidity with depression was higher for women (30.9%, 95% CI: 28.4-33.5%, vs. 17.5%, 95% CI: 15.2-20.1%). The risk of multimorbidity with two diseases affecting the same organ is relatively low for both sexes (4.2% (95% CI: 3.2-5.5%) for men and 4.5% (95% CI: 3.5-5.7%) for women).
Two thirds of people over 45 will develop multimorbidity in their remaining lifetime, with women at nearly double the risk of multimorbidity involving depression than men. These findings call for programmes of integrated care to consider sex-specific differences to ensure men and women are served equally.
多种疾病对医疗协调构成了重大挑战。然而，缺乏关于哪些非传染性疾病导致多种疾病以及男性和女性的终生风险是否存在差异的数据。我们确定了一般人群中多种疾病模式的性别差异，并估计了多种疾病的特定性别终生风险。
我们对年龄在 45 岁及以上的 6094 名 Rotterdam 研究参与者进行了随访，以观察十种疾病（癌症、冠心病、中风、慢性阻塞性肺疾病、抑郁症、糖尿病、痴呆、哮喘、心力衰竭、帕金森病）的发生情况。我们从单一疾病到多种疾病以及最常见的疾病组合的轨迹可视化参与者的轨迹。我们计算了特定性别终生的多种疾病风险，考虑了仅涉及躯体疾病的多种疾病（1）影响同一器官系统，（2）影响不同器官系统，以及（3）涉及抑郁症的多种疾病。
在随访期间（1993-2016 年，中位随访时间为 9.2 年），我们观察到 6334 例疾病事件。在研究人群中，有 10.3%的人有三种或三种以上的疾病，27.9%的人有两种或两种以上的疾病。男性中最常见的两种同时发生的疾病是 COPD 和癌症（12.5%的多种疾病患者），女性中最常见的两种同时发生的疾病是抑郁症和痴呆（14.9%）。男性（66.0%，95%CI：63.2-68.8%）和女性（65.1%，95%CI：62.5-67.7%）的终生多种疾病风险相似，但女性的抑郁症相关多种疾病风险更高（30.9%，95%CI：28.4-33.5%，而男性为 17.5%，95%CI：15.2-20.1%）。两种影响同一器官的疾病同时发生的风险相对较低，男性为 4.2%（95%CI：3.2-5.5%），女性为 4.5%（95%CI：3.5-5.7%）。
超过 45 岁的人中有三分之二将在他们的余生中患上多种疾病，女性患抑郁症相关多种疾病的风险几乎是男性的两倍。这些发现呼吁综合护理计划考虑性别差异，以确保男性和女性得到平等对待。
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