Kader Shirmin Bintay, Shakurun Nahin, Janzen Bonnie, Pahwa Punam
American International University-Bangladesh, Dhaka, Bangladesh.
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.
J Multimorb Comorb. 2024 Mar 21;14:26335565241228549. doi: 10.1177/26335565241228549. eCollection 2024 Jan-Dec.
Self-rated health (SRH) is a globally recognized measure of health status. Both impaired sleep (IS) and the presence of multimorbidity are related to poorer SRH, but the precise nature of these associations remains unclear. This study explored the association between IS, multimorbidity, and SRH among Canadian adults.
We used 2017-18 Canadian Community Health Survey (CCHS) data for this study. The main variable of interest, self-rated health (SRH), measured participants' health on a 5-point Likert scale, later categorized as "good or better" "fair or poor". The primary predictor, IS, was derived from two variables and categorized into four groups: no sleep issues; fewer sleeping hours (<7 hours) only; trouble sleeping only; and fewer hours & trouble sleeping. Multimorbidity was present (yes/no) if a participant indicated being diagnosed with two or more chronic conditions.
Just over one in ten Canadians reported fair/poor SRH and approximately one-quarter had multimorbidity or experienced few sleep hours in combination with trouble sleeping. The adjusted model indicated greater odds of fair/poor SRH associated with the 40-64 years age group, male sex, and lower socio-economic status. It also suggested the presence of multimorbidity (AOR= 4.63, 95% CI: 4.06-5.28) and a combination of fewer sleep hours and troubled sleep (AOR= 4.05, 95% CI: 2.86-5.74) is responsible for poor SRH. Forty-four percent of the total effect of IS on SRH was mediated by multimorbidity.
This unique finding highlights the mediating role of multimorbidity, emphasizing the importance of addressing it alongside sleep issues for optimal health outcomes.
自评健康状况（SRH）是一种全球公认的健康状况衡量指标。睡眠障碍（IS）和多种疾病并存均与较差的自评健康状况相关，但这些关联的确切性质仍不明确。本研究探讨了加拿大成年人中睡眠障碍、多种疾病并存与自评健康状况之间的关联。
我们使用了2017 - 18年加拿大社区健康调查（CCHS）的数据进行本研究。主要关注变量自评健康状况（SRH）通过5点李克特量表衡量参与者的健康状况，随后分为“良好或更好”“一般或较差”。主要预测因素睡眠障碍（IS）由两个变量得出，并分为四组：无睡眠问题；仅睡眠时间较少（<7小时）；仅睡眠困难；睡眠时间少且睡眠困难。如果参与者表示被诊断患有两种或更多慢性疾病，则存在多种疾病并存（是/否）。
略多于十分之一的加拿大人报告自评健康状况一般或较差，约四分之一的人患有多种疾病或睡眠时间少且睡眠困难。调整后的模型表明，40 - 64岁年龄组、男性以及社会经济地位较低者自评健康状况一般或较差的几率更高。研究还表明，多种疾病并存（比值比=4.63，95%置信区间：4.06 - 5.28）以及睡眠时间少和睡眠困难并存（比值比=4.05，95%置信区间：2.86 - 5.74）是自评健康状况较差的原因。睡眠障碍对自评健康状况的总体影响中有44%是由多种疾病并存介导的。
这一独特发现突出了多种疾病并存的中介作用，强调了在解决睡眠问题的同时应对多种疾病并存以实现最佳健康结果的重要性。
