Xiao Xiang, Beach Jeremy, Senthilselvan Ambikaipakan
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Multimorb Comorb. 2023 Feb 17;13:26335565231157626. doi: 10.1177/26335565231157626. eCollection 2023 Jan-Dec.
The aim of this study was to examine the effect of multimorbidity and the joint effect of chronic diseases on all-cause mortality among subjects aged 35 years and above.
Population-based retrospective cohort study.
Multimorbidity was defined by the respondent's self-report of having two or more chronic diseases of the nine considered. The Canadian Community Health Surveys conducted in 2003/2004, 2005/2006 and 2007 to 2014 were linked with the Canadian Vital Statistics Death Database to examine the association between multimorbidity and all-cause mortality in subjects aged 35 years and above. Cox's proportional hazards models were used to estimate risk of multimorbidity on death after adjusting for the confounders in three age groups.
Multimorbidity had an increased risk of death in all three age groups with the youngest having the highest risk after adjusting for potential confounders (35 to 54 years: hazard ratio (HR) = 3.77, 95% CI: 3.04, 4.67; 55 to 64 years: HR = 2.64, 95% CI: 2.36, 2.95; 65 years and above: HR = 1.71; 95% CI:1.63,1.80). Subjects with cancer had the highest risk of death in the three age groups. When the interactions between chronic diseases were considered, subjects with COPD and diabetes had a significantly increased risk of death in comparison to those without COPD or diabetes in the 55 to 64 years. (HR = 2.59, 95% CI: 2.01, 3.34).
Prevention of multimorbidity should be targeted not only in the older population but also in the younger populations. Synergistic effects of chronic diseases should be considered in the management of multimorbidities.
本研究旨在探讨35岁及以上人群中多种疾病并存情况以及慢性病的联合作用对全因死亡率的影响。
基于人群的回顾性队列研究。
多种疾病并存情况由受访者自我报告是否患有九种所考虑慢性病中的两种或更多种来定义。将2003/2004年、2005/2006年以及2007年至2014年进行的加拿大社区健康调查与加拿大人口动态统计死亡数据库相链接，以研究35岁及以上人群中多种疾病并存情况与全因死亡率之间的关联。采用Cox比例风险模型，在对三个年龄组的混杂因素进行调整后，估计多种疾病并存情况导致死亡的风险。
在调整潜在混杂因素后，多种疾病并存情况在所有三个年龄组中均增加了死亡风险，其中最年轻的年龄组风险最高（35至54岁：风险比（HR）= 3.77，95%置信区间：3.04，4.67；55至64岁：HR = 2.64，95%置信区间：2.36，2.95；65岁及以上：HR = 1.71；95%置信区间：1.63，1.80）。在三个年龄组中，患有癌症的受试者死亡风险最高。当考虑慢性病之间的相互作用时，在55至64岁年龄组中，患有慢性阻塞性肺疾病（COPD）和糖尿病的受试者与未患COPD或糖尿病的受试者相比，死亡风险显著增加（HR = 2.59，95%置信区间：2.01，3.34）。
预防多种疾病并存情况不仅应针对老年人群，也应针对年轻人群。在管理多种疾病并存情况时应考虑慢性病的协同作用。
