Human Development and Family Science Program, Norton School of Human Ecology, University of Arizona, Tucson, Arizona, USA.
College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
J Gerontol A Biol Sci Med Sci. 2024 Dec 1;79(12). doi: 10.1093/gerona/glae239.
Person-centered approaches to measuring severity of multimorbidity (≥ 2 chronic conditions) can help clinicians assess the individual experience of multimorbidity and inform effective caregiving and intervention strategies. We examine how limitations in everyday activities attributable to specific chronic conditions act independently and in tandem to influence individual perceptions of multimorbidity severity.
Data from the Panel Study of Income Dynamics (2005-2021) were used to investigate self-reported limitations in normal daily activities resulting from nine chronic conditions (hypertension, arthritis, diabetes, heart condition [heart disease/heart attack], cancer, lung disease, stroke, depression, and memory loss) in 4 318 adults aged 55-95 (18 878 person-wave observations). We used descriptive and inferential analyses to estimate limitations resulting from specific conditions, limitations attributable to condition combinations, and the contribution of comorbid conditions to condition-specific and overall severity. Follow-up analyses addressed mortality selection using inverse probability weighting and examined cancer type and cancer status/treatment modality among respondents reporting cancer diagnosis.
Of the more prevalent conditions, arthritis was associated with the most severe limitations to normal activities. Memory loss was the least frequent condition reported but resulted in the most severe limitations, and as a comorbid condition, increased limitations reported for most conditions. Inverse probability weighting adjusted models revealed heterogeneity in estimates for some conditions including cancer and cancer survivors tended to report less lethal cancers that were cured or in remission.
Our results suggest that efforts to prevent and treat arthritis and support cognitive function may reduce the severity of multimorbidity experienced by the individual.
以患者为中心的方法来衡量多种慢性疾病（≥2 种慢性疾病）的严重程度，可以帮助临床医生评估患者对多种慢性疾病的个体体验，并为有效的护理和干预策略提供信息。我们研究了特定慢性疾病导致的日常活动受限如何独立和协同作用，从而影响个体对多种慢性疾病严重程度的感知。
使用来自收入动态面板研究（2005-2021 年）的数据，对 4318 名 55-95 岁的成年人（18878 人-波观察）的九种慢性疾病（高血压、关节炎、糖尿病、心脏状况[心脏病/心脏病发作]、癌症、肺部疾病、中风、抑郁和记忆力减退）导致的正常日常活动受限的自我报告进行了调查。我们使用描述性和推断性分析来估计特定疾病导致的受限、疾病组合归因的受限，以及共病对疾病特异性和整体严重程度的影响。后续分析使用逆概率加权处理死亡率选择问题，并对报告癌症诊断的受访者进行癌症类型和癌症状态/治疗方式的研究。
在所研究的更为普遍的疾病中，关节炎与正常活动受限最严重相关。记忆力减退是报告最不频繁的疾病，但导致的限制最严重，而且作为一种共病，它增加了大多数疾病的报告限制。逆概率加权调整模型揭示了一些疾病的估计存在异质性，包括癌症和癌症幸存者往往报告的癌症致死率较低，这些癌症已经治愈或处于缓解期。
我们的研究结果表明，预防和治疗关节炎和支持认知功能的努力可能会降低个体所经历的多种慢性疾病的严重程度。
