Association of multimorbidity patterns with incident disability and recovery of independence among middle-aged and older adults.
Association of multimorbidity patterns with incident disability and recovery of independence among middle-aged and older adults.
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DOI：
10.1093/ageing/afac177
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发表时间：
2022-08
期刊：
影响因子：
6.7
通讯作者：
Jiayi Zhou;M. Wei;Jingyi Zhang;Hua Liu;Chenkai Wu
中科院分区：
文献类型：
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作者：
Jiayi Zhou;M. Wei;Jingyi Zhang;Hua Liu;Chenkai Wu
目的：确定中国中老年人的多发病模式，并研究这些模式与偶发性残疾和独立恢复的关系。方法数据来自中国健康与退休纵向研究。我们纳入14613名年龄≥45岁的患者。进行潜在类别分析（LCA）以确定具有临床意义的多病模式。使用多项逻辑模型来确定多重疾病模式与事件残疾和独立恢复之间的调整关联。结果：我们确定了四种多发病模式：“低发病率”（67.91%）、“肺-消化-风湿病”（17.28%）、“心血管-代谢-神经”（10.77%）和“高发病率”（4.04%）。与“低发病率”组相比，“高发病率”组（OR = 2.63, 95% CI = 1.97-3.51）、“肺-消化-风湿病”组（OR = 1.89, 95% CI = 1.63-2.21）和“心血管-代谢-神经”组（OR = 1.61, 95% CI = 1.31-1.97）在调整后的多项logistic模型中具有更高的致残几率。“心血管-代谢-神经”组（OR = 0.60, 95% CI = 0.44-0.81）、“高发病率”组（OR = 0.68, 95% CI = 0.47-0.98）和“肺-消化-风湿病”组（OR = 0.75, 95% CI = 0.60-0.95）的残疾康复几率低于“低发病率”组。在无残疾人群中，“心血管-内分泌-神经”模式与最高的2年死亡率相关（OR = 2.42, 95% CI = 1.56-3.72）。结论：多病是复杂和异质性的，但我们的研究表明，使用LCA可以获得临床有意义的模式。我们强调四种多发病模式与不同的影响事件残疾和残疾恢复。这些研究表明，需要有针对性的预防和治疗方法来治疗多病患者。
OBJECTIVE to identify multimorbidity patterns among middle-aged and older adults in China and examine how these patterns are associated with incident disability and recovery of independence. METHODS data were from The China Health and Retirement Longitudinal Study. We included 14,613 persons aged ≥45 years. Latent class analysis (LCA) was conducted to identify multimorbidity patterns with clinical meaningfulness. Multinomial logistic models were used to determine the adjusted association between multimorbidity patterns and incident disability and recovery of independence. RESULTS we identified four multimorbidity patterns: 'low morbidity' (67.91% of the sample), 'pulmonary-digestive-rheumatic' (17.28%), 'cardiovascular-metabolic-neuro' (10.77%) and 'high morbidity' (4.04%). Compared to the 'low morbidity' group, 'high morbidity' (OR = 2.63, 95% CI = 1.97-3.51), 'pulmonary-digestive-rheumatic' (OR = 1.89, 95% CI = 1.63-2.21) and 'cardiovascular-metabolic-neuro' pattern (OR = 1.61, 95% CI = 1.31-1.97) had higher odds of incident disability in adjusted multinomial logistic models. The 'cardiovascular-metabolic-neuro' (OR = 0.60, 95% CI = 0.44-0.81), 'high morbidity' (OR = 0.68, 95% CI = 0.47-0.98) and 'pulmonary-digestive-rheumatic' group (OR = 0.75, 95% CI = 0.60-0.95) had lower odds of recovery from disability than the 'low morbidity' group. Among people without disability, the 'cardiovascular-endocrine-neuro' pattern was associated with the highest 2-year mortality (OR = 2.42, 95% CI = 1.56-3.72). CONCLUSIONS multimorbidity is complex and heterogeneous, but our study demonstrates that clinically meaningful patterns can be obtained using LCA. We highlight four multimorbidity patterns with differential effects on incident disability and recovery from disability. These studies suggest that targeted prevention and treatment approaches are needed for people with multimorbidity.