Verbrugge L M, Patrick D L
Institute of Gerontology, University of Michigan, Ann Arbor 48109-2007.
Am J Public Health. 1995 Feb;85(2):173-82. doi: 10.2105/ajph.85.2.173.
This paper analyzes the impact of seven chronic conditions (three nonfatal: arthritis, visual impairment, hearing impairment; four fatal: ischemic heart disease, chronic obstructive pulmonary disease, diabetes mellitus, malignant neoplasms) on US adults aged 18 and older. Impact refers to how readily a condition prompts activity limitations, physician visits, and hospital stays.
Data come from three national health surveys and vital statistics. For comparability, a single disease classification scheme was applied, and new rates were estimated. Frequency, impact, and prominence of the target conditions are studied via rates, ratios of rates, and ranks, respectively.
In young adulthood, the nonfatal conditions prompt limitations less readily than do the fatal ones, but by older ages, arthritis and visual impairment have a limiting impact equivalent to that of fatal conditions. Despite high prevalence and limitations, nonfatal conditions stand well below fatal conditions for health services use.
Although statistics on frequency, impact, and prominence all indicate conditions "importance," they give only weak clues about specific service needs of affected persons. The persistent finding that nonfatal conditions do not receive health services care commensurate with their prevalence and impact reflects long-standing imbalanced attention on fatal conditions in research and medical care.
本文分析了七种慢性病（三种非致命性疾病：关节炎、视力障碍、听力障碍；四种致命性疾病：缺血性心脏病、慢性阻塞性肺疾病、糖尿病、恶性肿瘤）对18岁及以上美国成年人的影响。影响是指一种疾病引发活动受限、就医和住院的容易程度。
数据来自三项全国性健康调查和人口动态统计数据。为了便于比较，采用了单一的疾病分类方案，并估算了新的发病率。分别通过发病率、发病率之比和排名来研究目标疾病的发生频率、影响程度和突出程度。
在青年时期，非致命性疾病引发活动受限的可能性低于致命性疾病，但到了老年，关节炎和视力障碍造成的限制影响与致命性疾病相当。尽管非致命性疾病患病率高且会导致活动受限，但在医疗服务使用方面，非致命性疾病的情况远低于致命性疾病。
尽管关于发生频率、影响程度和突出程度的统计数据都表明了疾病的“重要性”，但它们对于受影响人群的具体服务需求提供的线索却很有限。非致命性疾病未得到与其患病率和影响程度相称的医疗服务这一持续存在的现象，反映出在研究和医疗护理中对致命性疾病长期以来的不平衡关注。
