Craig Leslie S, Cunningham-Myrie Colette A, Theall Katherine P, Gustat Jeanette, Hernandez Julie H, Hotchkiss David R
Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States.
Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica.
Front Med (Lausanne). 2023 Jun 2;10:1094280. doi: 10.3389/fmed.2023.1094280. eCollection 2023.
Multimorbidity and health-related quality of life (HRQoL) are intimately linked. Multiple chronic conditions may adversely affect physical and mental functioning, while poorer HRQoL may contribute to the worsening course of diseases. Understanding mechanisms through which specific combinations of diseases affect HRQoL outcomes can facilitate identification of factors which are amenable to intervention. Jamaica, a middle-income country with high multimorbidity prevalence, has a health service delivery system dominated by public sector provision via a broad healthcare network. This study aims to examine whether multimorbidity classes differentially impact physical and mental dimensions of HRQoL in Jamaicans and quantify indirect effects on the multimorbidity-HRQoL relationship that are mediated by health system factors pertaining to financial healthcare access and service use.
Latent class analysis (LCA) was used to estimate associations between multimorbidity classes and HRQoL outcomes, using latest available data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 ( = 2,551). Multimorbidity measurement was based on self-reported presence/absence of 11 non-communicable diseases (NCDs). HRQoL was measured using the 12-item short-form (SF-12) Health Survey. Mediation analyses guided by the counterfactual approach explored indirect effects of insurance coverage and service use on the multimorbidity-HRQoL relationship.
LCA revealed four profiles, including a class (52.7%) characterized by little to no morbidity and three multimorbidity classes characterized by specific patterns of NCDs and labelled (30.9%), (12.2%), and (4.2%). Compared to the class, class membership was associated with lower physical functioning ( = -5.5; < 0.001); membership in ( = -1.7; < 0.05), and ( = -2.5; < 0.05) classes was associated with lower mental functioning. Significant mediated effects of health service use, on mental functioning, were observed for ( < 0.05) and ( < 0.05) classes.
Specific combinations of diseases differentially impacted HRQoL outcomes in Jamaicans, demonstrating the clinical and epidemiological value of multimorbidity classes for this population, and providing insights that may also be relevant to other settings. To better tailor interventions to support multimorbidity management, additional research is needed to elaborate personal experiences with healthcare and examine how health system factors reinforce or mitigate positive health-seeking behaviours, including timely use of services.
多种疾病共存与健康相关生活质量（HRQoL）密切相关。多种慢性病可能会对身体和心理功能产生不利影响，而较差的健康相关生活质量可能会导致疾病病程恶化。了解特定疾病组合影响健康相关生活质量结果的机制有助于识别可干预的因素。牙买加是一个多种疾病共存患病率较高的中等收入国家，其医疗服务提供系统以公共部门通过广泛的医疗网络提供服务为主。本研究旨在探讨多种疾病共存类别是否对牙买加人的健康相关生活质量的身体和心理维度产生不同影响，并量化与医疗保健获取和服务使用相关的卫生系统因素对多种疾病共存与健康相关生活质量关系的间接影响。
使用潜在类别分析（LCA）来估计多种疾病共存类别与健康相关生活质量结果之间的关联，采用来自具有全国代表性的2007/2008年牙买加健康与生活方式调查的最新可用数据（n = 2551）。多种疾病共存的测量基于自我报告的11种非传染性疾病（NCDs）的存在/不存在情况。健康相关生活质量使用12项简短形式（SF - 12）健康调查进行测量。以反事实方法为指导的中介分析探讨了保险覆盖和服务使用对多种疾病共存与健康相关生活质量关系的间接影响。
潜在类别分析揭示了四种概况，包括一个发病率极低或无发病率的类别（52.7%）以及三个以特定非传染性疾病模式为特征的多种疾病共存类别，分别标记为A类（30.9%）、B类（12.2%）和C类（4.2%）。与无病类别相比，A类成员的身体功能较低（β = -5.5；p < 0.001）；B类（β = -1.7；p < 0.05）和C类（β = -2.5；p < 0.05）成员的心理功能较低。观察到卫生服务使用对B类（p < 0.05）和C类（p < 0.05）的心理功能有显著的中介作用。
特定的疾病组合对牙买加人的健康相关生活质量结果产生了不同影响，证明了多种疾病共存类别对该人群的临床和流行病学价值，并提供了可能与其他环境相关的见解。为了更好地定制干预措施以支持多种疾病共存的管理，需要进行更多研究来详细阐述个人的医疗保健经历，并研究卫生系统因素如何加强或减轻积极寻求健康行为，包括及时使用服务。
