The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Int J Cancer. 2023 Jun 15;152(12):2485-2492. doi: 10.1002/ijc.34476. Epub 2023 Mar 1.
Monoclonal gammopathy of undetermined significance (MGUS), a precursor to multiple myeloma, is present in over 5% of adults aged 70 and older, a population with a high prevalence of multimorbidity. MGUS is often diagnosed incidentally when patients seek care for unrelated conditions. Our study sought to examine patterns of multimorbidity among MGUS patients, as overall health may impact patient care and the prioritization of MGUS surveillance. We examined patterns of comorbidities in 429 patients diagnosed with MGUS (2007-2015) and 1287 matched controls. Twenty-seven conditions were defined at diagnosis/index date using algorithms developed by the Centers for Medicare and Medicaid Chronic Conditions Warehouse. Patterns of common comorbidities were identified individually, in dyads and triads, and compared between MGUS cases and controls. We conducted a latent class analysis to identify comorbidity patterns among cases only. We also examined comorbidity patterns among a subset of 32 MGUS cases who progressed to cancer during the study period. The most common comorbidities among both MGUS cases and controls included hypertension and hyperlipidemia. Anemia (cases: 43%; controls: 16%) and chronic kidney disease (CKD; cases: 36%; controls: 18%), and dyads and triads containing those conditions, were more common among cases. Latent class analysis identified three classes of comorbidity among MGUS cases: hypertension-hyperlipidemia plus anemia and CKD (31%); low comorbidity burden (17%); and hypertension-hyperlipidemia alone (52%). The higher prevalence among cases of anemia and CKD, which may be involved in the pathogenesis of, or surveillance for, MGUS, warrants additional investigation.
意义未明的单克隆丙种球蛋白血症（MGUS）是多发性骨髓瘤的前体，在 70 岁及以上的成年人中超过 5%，而这一人群的多种合并症的患病率很高。MGUS 通常是在患者因其他无关疾病就诊时偶然诊断出来的。我们的研究旨在检查 MGUS 患者的多种合并症模式，因为整体健康状况可能会影响患者的护理和 MGUS 监测的优先级。我们使用医疗保险和医疗补助慢性病仓库开发的算法，在 429 名被诊断为 MGUS（2007-2015 年）的患者和 1287 名匹配对照者中检查了合并症模式。在诊断/索引日期时，有 27 种疾病通过算法定义。分别确定了常见合并症的模式，并在 MGUS 病例和对照组之间比较了双因素和三因素组合。我们仅对病例进行了潜在类别分析，以确定合并症模式。我们还检查了在研究期间进展为癌症的 32 名 MGUS 病例亚组中的合并症模式。MGUS 病例和对照组中最常见的合并症包括高血压和高血脂症。贫血（病例：43%；对照：16%）和慢性肾脏病（CKD；病例：36%；对照：18%），以及包含这些疾病的双因素和三因素组合，在病例中更为常见。潜在类别分析确定了 MGUS 病例中的三种合并症类型：高血压-高血脂症加贫血和 CKD（31%）；低合并症负担（17%）；和高血压-高血脂症单独存在（52%）。病例中贫血和 CKD 的更高患病率可能与 MGUS 的发病机制或监测有关，需要进一步调查。
