Associations between multimorbidity and frailty transitions among older Americans.
Associations between multimorbidity and frailty transitions among older Americans.
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DOI：
10.1002/jcsm.13197
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发表时间：
2023-04
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在老年人中，多模态模式与虚弱状态之间的转换的关联仍不清楚。我们使用了2011-2019年国家健康和老龄化趋势研究的数据。每年使用Fried虚弱表型测量虚弱。基于14种慢性疾病，使用潜在类别分析确定基线时的多发病模式。我们使用半马尔可夫多状态模型来研究以条件计数和模式为特征的多变量对后续脆弱性转变的影响。在基线时年龄≥65岁的9450例受试者中，34.8%为非虚弱，48.1%为虚弱前期，17.0%为虚弱。在中位随访4.0年期间，观察到16880例虚弱转变，其中10527例恶化，6353例改善。在7675例多发性骨髓瘤患者中，发现了4种多发性骨髓瘤类型：骨关节型（62.4%）、神经精神-感觉型（17.2%）、心脏代谢型（10.3%）和复杂多发性骨髓瘤型（10.1%）。与无疾病相比，多发性硬化症与恶化过渡的风险增加显著相关，包括从非虚弱到虚弱前期（风险比[HR] = 1.35; 95%置信区间[CI] = 1.21-1.52），从非虚弱到虚弱（HR = 1.68; 95% CI = 1.04-2.73）、从虚弱前期至虚弱（HR = 2.19; 95% CI = 1.66-2.90）和从虚弱前期至死亡（HR = 1.64; 95% CI = 1.11-2.41）。与骨关节型相比，神经精神-感觉型、心脏代谢型和复杂多功能型患者的虚弱加重风险显著增高（均P < 0.05）。在美国老年人中，多重死亡与虚弱状态和死亡之间的动态转换相关，并且这种关联在多重死亡模式中各不相同。这些发现可以为公共卫生政策制定者规划干预措施和医疗资源提供重要影响。他们还可以告知临床医生提供有针对性的临床治疗和健康管理的基础上，老年人的多发病模式。
The associations of multimorbidity patterns with transitions between frailty states remain unclear in older individuals. We used data from the National Health and Aging Trends Study 2011–2019. Frailty was measured annually using the Fried frailty phenotype. Multimorbidity patterns at baseline were identified using latent class analysis based on 14 chronic conditions. We used the semi‐Markov multi‐state model to investigate the influences of multimorbidity characterized by condition counts and patterns on subsequent frailty transitions over follow‐ups. Among 9450 participants aged ≥65 years at baseline, 34.8% were non‐frail, 48.1% were pre‐frail and 17.0% were frail. Over a median follow‐up of 4.0 years, 16 880 frailty transitions were observed, with 10 527 worsening and 6353 improving. For 7675 participants with multimorbidity, four multimorbidity patterns were identified: osteoarticular pattern (62.4%), neuropsychiatric–sensory pattern (17.2%), cardiometabolic pattern (10.3%) and complex multimorbidity pattern (10.1%). Compared with no disease, multimorbidity was significantly associated with an increased risk of worsening transitions, including from non‐frail to pre‐frail (hazard ratio [HR] = 1.35; 95% confidence interval [CI] = 1.21–1.52), from non‐frail to frail (HR = 1.68; 95% CI = 1.04–2.73), from pre‐frail to frail (HR = 2.19; 95% CI = 1.66–2.90) and from pre‐frail to death (HR = 1.64; 95% CI = 1.11–2.41). Compared with the osteoarticular pattern, neuropsychiatric–sensory, cardiometabolic and complex multimorbidity patterns had a significantly higher risk of worsening frailty (all P < 0.05). Multimorbidity was associated with dynamic transitions between frailty states and death among older American adults, and the associations varied across multimorbidity patterns. The findings could offer significant implications for public health policymakers in planning interventions and healthcare resources. They also might inform clinicians regarding providing targeted clinical treatment and health management based on multimorbidity patterns of older people.
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