Anza-Ramirez Cecilia, Najarro Lizzete, Bernabé-Ortiz Antonio, Diez-Canseco Francisco, Fottrell Edward, Abubakar Ibrahim, Hernández-Vásquez Akram, Carrillo-Larco Rodrigo M, Hurst John R, Miranda Juan Jaime
CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
UCL Institute for Global Health, University College London, London, UK.
J Multimorb Comorb. 2024 May 23;14:26335565241256826. doi: 10.1177/26335565241256826. eCollection 2024 Jan-Dec.
BACKGROUND: The co-occurrence of chronic diseases and acute infectious events exacerbates disability and diminishes quality of life, yet research in Low- and Middle-Income countries is scarce. We aimed to investigate the relationship between infectious events and multimorbidity in resource-constrained settings. METHODS: We conducted a sequential mixed-method study in Lima and Tumbes, Peru, with participants having multimorbidity from the CRONICAS Cohort Study. They completed a questionnaire on the occurrence, treatment, and health-seeking behaviour related to acute infectious events. Qualitative interviews explored the perceptions and links between multimorbidity and acute infectious events for a subgroup of participants. FINDINGS: Among individuals with multimorbidity, low awareness of chronic conditions and poor medication adherence. The cumulative incidence for respiratory and gastrointestinal infections, the most reported acute conditions, was 2.0 [95%CI: 1.8-2.2] and 1.6 [1.2-1.9] events per person per year, respectively. Individuals with cancer (6.4 [1.6-11.2] events per person per year) or gastrointestinal reflux (7.2 [4.4-10.1] events per person per year) reported higher cumulative incidence of infectious events than others, such as those with cardiovascular and metabolic conditions (5.2 [4.6-5.8] events per person per year). Those with three or more chronic conditions had a slightly higher cumulative incidence compared with individuals with two conditions (5.7 [4.4-7.0] vs 5.0 [4.4-5.6] events per person per year). Around 40% of individuals with multimorbidity sought healthcare assistance, while others chose drugstores or didn't seek help. Our qualitative analysis showed diverse perceptions among participants regarding the connections between chronic and acute conditions. Those who recognized a connection emphasized the challenges in managing these interactions. INTERPRETATION: Our study advances understanding of multimorbidity challenges in resource-limited settings, highlighting the impact of acute infections on patients' existing multimorbidity burden.
背景：慢性病与急性感染事件同时发生会加剧残疾并降低生活质量，但低收入和中等收入国家对此的研究却很匮乏。我们旨在调查资源受限环境中感染事件与多种疾病并存之间的关系。 方法：我们在秘鲁的利马和通贝斯进行了一项序贯混合方法研究，参与者来自CRONICAS队列研究中的患有多种疾病的人群。他们完成了一份关于急性感染事件的发生、治疗及就医行为的问卷。定性访谈探讨了部分参与者对多种疾病并存与急性感染事件之间的认知及联系。 结果：在患有多种疾病的个体中，对慢性病的认知度较低且药物依从性较差。报告最多的急性疾病——呼吸道和胃肠道感染的累积发病率分别为每人每年2.0次[95%置信区间：1.8 - 2.2]和1.6次[1.2 - 1.9]。患有癌症（每人每年6.4次[1.6 - 11.2]）或胃食管反流（每人每年7.2次[4.4 - 10.1]）的个体报告的感染事件累积发病率高于其他疾病患者，如患有心血管和代谢疾病的个体（每人每年5.2次[4.6 - 5.8]）。患有三种或更多慢性病的个体的累积发病率略高于患有两种慢性病的个体（每人每年5.7次[4.4 - 7.0]对5.0次[4.4 - 5.6]）。约40%患有多种疾病的个体寻求医疗救助，而其他个体则选择去药店或不寻求帮助。我们的定性分析表明，参与者对慢性病和急性疾病之间的联系有不同的认知。那些认识到两者有联系的人强调了管理这些相互作用的挑战。 解读：我们的研究增进了对资源有限环境中多种疾病并存挑战的理解，突出了急性感染对患者现有多种疾病负担的影响。
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