Population Research Centre, Dharwad, Karnataka, India.
International Institute for Population Sciences, Mumbai, Maharashtra, India
BMJ Open. 2023 Feb 6;13(2):e062554. doi: 10.1136/bmjopen-2022-062554.
This study aims to identify the unique multimorbidity combinations (MMCs) and their associations with the functional disability of Indian older adults. Moreover, the population attributable fractions (PAFs) were calculated to assess the potential impact of additional diseases in the nested groups on disability.
A cross-sectional data were analysed in this study.
The present study uses data from the first wave of the Longitudinal Ageing Study in India (2017-2018). The sample for the study consists of 27 753 aged 60 years and over.
The primary outcome variable was functional disability, measured by the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index.
Out of 197 uniquely identified MMCs, the combination of hypertension and high depressive symptoms (HDS) was the most prevalent (10.3%). Overall, all MMCs were associated with increased functional limitation. Specifically, the combination of hypertension, arthritis and HDS was associated with greater ADL-IADL disability than any other MMC. The addition of HDS in group 3 (hypertension and arthritis) (incidence rate ratios (IRR)=1.44; 95% CI 1.26 to 1.64) and the addition of arthritis in group 1 (hypertension, HDS) (IRR=1.48; 95% CI 1.28 to 1.71) and group 2 (hypertension, diabetes) (IRR=1.49; 95% CI 1.22 to 1.82) significantly increases the rates of ADL-IADL disability. The estimated PAFs of the group 1 (hypertension and HDS), group 3 (hypertension and arthritis) and group 4 (arthritis and HDS) for ADL-IADL disability were 22.5% (19.2-25.5), 21.6% (18.7-24.4) and 23.5% (20.6-26.3), respectively.
The findings from this study underscore the importance of addressing the morbidity combinations which are more disabling than the others in older adults. Understanding the somatic and psychological relevance of the morbidities in functional health is necessary and can help reduce disabilities among older adults.
本研究旨在确定印度老年人独特的多重合并症组合（MMCs）及其与功能障碍的关联。此外，还计算了人群归因分数（PAF），以评估嵌套组中其他疾病对残疾的潜在影响。
本研究采用了横断面数据分析。
本研究使用了印度纵向老龄化研究（2017-2018 年）第一波的数据。研究样本由 27753 名 60 岁及以上的老年人组成。
主要结局变量是功能障碍，通过日常生活活动（ADL）-工具性日常生活活动（IADL）指数的综合来衡量。
在 197 种独特识别的 MMC 中，高血压和高抑郁症状（HDS）的组合最为常见（10.3%）。总体而言，所有 MMC 均与功能受限增加相关。具体而言，高血压、关节炎和 HDS 的组合与任何其他 MMC 相比，与更大的 ADL-IADL 残疾相关。在第 3 组（高血压和关节炎）中加入 HDS（发病率比（IRR）=1.44；95%置信区间 1.26 至 1.64），以及在第 1 组（高血压、HDS）（IRR=1.48；95%置信区间 1.28 至 1.71）和第 2 组（高血压、糖尿病）（IRR=1.49；95%置信区间 1.22 至 1.82）中加入关节炎，均显著增加了 ADL-IADL 残疾的发生率。第 1 组（高血压和 HDS）、第 3 组（高血压和关节炎）和第 4 组（关节炎和 HDS）的 ADL-IADL 残疾的估计 PAF 分别为 22.5%（19.2-25.5）、21.6%（18.7-24.4）和 23.5%（20.6-26.3）。
本研究结果强调了在老年人中，解决比其他组合更具致残性的合并症的重要性。了解功能健康中躯体和心理相关的合并症对于减少老年人的残疾是必要的。
