Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
Lancet Healthy Longev. 2021 Aug;2(8):e489-e497. doi: 10.1016/S2666-7568(21)00146-X. Epub 2021 Jul 21.
The increasing burden of multimorbidity and its socioeconomic gradient poses unique challenges to the provision and structure of health care. We aimed to describe inequalities and trends over time in multimorbidity prevalence, incidence, and case fatality among adults of all ages in England using primary care electronic health records.
We used a random sample of 991 243 individuals from the Clinical Practice Research Datalink Aurum database registered at participating general practices within England between Jan 1, 2004, and Dec 31, 2019, linked to the 2015 English Index of Multiple Deprivation (IMD). We used the following two outcome measures: basic multimorbidity, comprising two or more chronic conditions; and complex multimorbidity, comprising at least three chronic conditions affecting at least three body systems. We calculated crude, age-standardised, and age-sex-standardised annual incidence, prevalence, and case fatality rates, along with median age of onset for both multimorbidity types. We calculated absolute and relative inequalities for each outcome.
In 2004, 30·8% of our study population had basic multimorbidity and 15·1% had complex multimorbidity. This increased to 52·8% and 32·7%, respectively, in 2019. Although the overall incidence of basic multimorbidity remained stable over the 16-year study period, the incidence among people of working age and the incidence of complex multimorbidity increased gradually. Socioeconomic deprivation was associated with an increased incidence of both multimorbidity types in working-age adults. The median age at onset of complex multimorbidity was 7 years younger for the most deprived quintile of the IMD compared with the least deprived quintile.
The burden of multimorbidity in England has increased substantially over the past 16 years with persistent inequalities, which are worse in working-age adults and for complex multimorbidity. Prevention efforts to reduce the onset and slow the progression of multimorbidity are essential to reduce the increasing impact on patients and health systems alike.
University of Liverpool and UK National Institute for Health Research School for Public Health Research.
多种疾病负担的增加及其社会经济梯度给医疗保健的提供和结构带来了独特的挑战。我们旨在使用英格兰初级保健电子健康记录描述所有年龄段成年人的多种疾病的患病率、发病率和病死率随时间的变化情况，以及这些变化的不平等现象和趋势。
我们使用了 2004 年 1 月 1 日至 2019 年 12 月 31 日期间在英格兰参与的常规实践中注册的临床实践研究开发数据链接 Aurum 数据库中的 991243 名个体的随机样本，该数据库与 2015 年英国多重剥夺指数（IMD）相关联。我们使用以下两种结果衡量标准：基本多种疾病，包括两种或两种以上的慢性疾病；复杂多种疾病，包括至少三种影响至少三个身体系统的慢性疾病。我们计算了这两种疾病类型的粗发病率、年龄标准化发病率和年龄性别标准化发病率、患病率和病死率以及发病年龄中位数。我们计算了每个结果的绝对和相对不平等。
2004 年，我们研究人群中有 30.8%患有基本多种疾病，15.1%患有复杂多种疾病。到 2019 年，这一比例分别上升到 52.8%和 32.7%。虽然在 16 年的研究期间，基本多种疾病的总体发病率保持稳定，但工作年龄段人群的发病率和复杂多种疾病的发病率逐渐增加。社会经济剥夺与工作年龄段成年人的两种多种疾病发病率增加有关。与 IMD最贫困的五分位数相比，最贫困的五分位数的复杂多种疾病发病年龄中位数年轻 7 岁。
在过去的 16 年中，英格兰的多种疾病负担大大增加，不平等现象持续存在，在工作年龄段成年人和复杂多种疾病中更为严重。为减少多种疾病的发生和减缓其发展，预防工作对于减轻对患者和卫生系统的影响至关重要。
利物浦大学和英国国民健康保险制度公共卫生研究学院。
