Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
J Epidemiol Glob Health. 2024 Sep;14(3):1077-1088. doi: 10.1007/s44197-024-00256-y. Epub 2024 Jun 13.
To evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups.
Retrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50-64, 65-79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined.
4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60-4.03) and 1.38 (1.36-1.40), respectively, which increased to 14.22 (9.87-20.47) and 2.20 (2.13-2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43-2.53) among all identified clusters arising from the clustering analysis.
Given the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words).
评估特定年龄组的多种疾病模式以及多种疾病负担对死亡率和医疗支出的影响。
这是一项使用香港电子健康记录进行的 2009 年 1 月 1 日至 2017 年 12 月 31 日之间的回顾性观察性研究：个体根据年龄（<50 岁、50-64 岁、65-79 岁、≥80 岁）分层，并根据 21 种常见慢性疾病中存在的疾病数量（0、1、2、3、≥4）进行亚分类。进行聚类分析以确定多种疾病的特定模式。研究了疾病数量以及疾病组合与全因死亡率和公共支出之间的关系。
共纳入 4562832 名中位随访时间为 7 年的个体。精神障碍是年轻人中最常见的疾病，而心血管疾病在老年人中较为普遍。疾病数量的增加与死亡率和医疗支出的相对风险增加相关，这种关系在年轻患者中更强。与同年龄组无疾病的个体相比，年龄<50 岁和≥80 岁的患者中，有两种合并症的全因死亡率的风险比（HR；95%CI）分别为 3.81（3.60-4.03）和 1.38（1.36-1.40），而当疾病数量增加至≥4 种时，HR 分别增加至 14.22（9.87-20.47）和 2.20（2.13-2.26）。聚类分析中确定的所有聚类中，中风-高血压聚类的死亡率 HR 最高，为 2.48（2.43-2.53）。
鉴于多种疾病与全因死亡率之间的关联更强，并且年轻人群的机会成本更高，因此需要预防和管理早发性多种疾病。（248 字）
