Spyropoulos Konstantinos, Ellis Naomi J, Gidlow Christopher J
Centre for Health and Development (CHAD), University of Staffordshire, Stoke-on-Trent ST4 2DF, UK.
School of Medicine, Keele University, University Road, Staffordshire ST5 5BG, UK.
Int J Environ Res Public Health. 2025 Aug 10;22(8):1251. doi: 10.3390/ijerph22081251.
The growing challenge of multimorbidity for healthcare systems worldwide demands a dual prevention framework, targeting both primary and secondary prevention. Multimorbidity-multibehaviours can provide such a theoretical and clinical framework to explore new aetiological evidence for multimorbidity risk. While the role of single health risk behaviours, such as smoking, nutrition, alcohol, and physical activity (SNAP), in chronic disease prevention is well-documented, their synergistic effect on multimorbidity has received relatively little attention.
Using retrospective observational data from electronic health records of 21,079 patients from a convenience sample of three general practices in Staffordshire, UK (2015-2018), we examined the association between SNAP-multibehaviours and multimorbidity risk, defined as follows: MM2+ (≥2 morbidities), MM3+ (≥3 morbidities), and complex multimorbidity (accumulated morbidities affecting ≥3 body systems). Multiple logistic regression models, stratified by sex and adjusted for age and area, were applied to analyse the associations between both combined and accumulative SNAP-health risk behaviours (HRBs) and all multimorbidity operational definitions.
A dose-response association was observed, indicating increased multimorbidity risk with greater accumulation of SNAP-HRBs. Additionally, sex-specific patterns were identified, which varied according to the operational definitions of multimorbidity. These findings underscored both the clinical significance of the identified outcomes for promoting tailored multimorbidity guidelines and the need for further sex-sensitive research.
These findings support the importance of transcending traditional silos in healthcare and public health research by integrating preventive and curative medicines under a multimorbidity-multibehaviour framework. Embracing the complexity of coexisting morbidities and health risk behaviours, healthcare systems can move beyond disease-specific and behaviour-specific paradigms. This approach has the potential to enhance clinical outcomes and to address the complex needs of individuals with multimorbidity in real-world healthcare settings.
全球医疗保健系统面临的多重疾病负担日益加重，这需要一个双重预防框架，同时针对一级预防和二级预防。多重疾病-多种行为可以提供这样一个理论和临床框架，以探索多重疾病风险的新病因学证据。虽然单一健康风险行为，如吸烟、营养、饮酒和身体活动（SNAP）在慢性病预防中的作用已有充分记录，但它们对多重疾病的协同作用相对较少受到关注。
利用来自英国斯塔福德郡三个普通诊所便利样本中21079名患者电子健康记录的回顾性观察数据（2015 - 2018年），我们研究了SNAP - 多种行为与多重疾病风险之间的关联，定义如下：MM2 +（≥2种疾病）、MM3 +（≥3种疾病）和复杂多重疾病（累积疾病影响≥3个身体系统）。应用按性别分层并调整年龄和地区的多重逻辑回归模型，分析综合和累积的SNAP - 健康风险行为（HRB）与所有多重疾病操作定义之间的关联。
观察到剂量反应关联，表明随着SNAP - HRB累积增加，多重疾病风险增加。此外，还确定了特定性别的模式，这些模式因多重疾病的操作定义而异。这些发现强调了所确定结果对于制定针对性多重疾病指南的临床意义，以及进一步开展性别敏感性研究的必要性。
这些发现支持在多重疾病-多种行为框架下整合预防和治疗药物，超越医疗保健和公共卫生研究中传统的孤立领域的重要性。认识到共存疾病和健康风险行为的复杂性，医疗保健系统可以超越疾病特定和行为特定的范式。这种方法有可能改善临床结果，并满足现实世界医疗环境中患有多重疾病个体的复杂需求。
