Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study
Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study
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DOI：
10.1016/s0140-6736(12)60240-2
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发表时间：
2012-07-07
期刊：
影响因子：
168.9
通讯作者：
Guthrie, Bruce
中科院分区：
文献类型：
--
作者：
Barnett, Karen;Mercer, Stewart W.;Guthrie, Bruce
背景 长期疾病是全世界卫生保健系统面临的主要挑战，但卫生系统主要是针对个体疾病而不是多种疾病进行配置的。我们研究了与年龄和社会经济剥夺相关的多种发病率以及身心健康疾病的共病分布情况。 方法 在一项横断面研究中，我们从截至 2007 年 3 月在苏格兰 314 家医疗机构注册的 1 751 841 人的数据库中提取了 40 种发病率的数据。我们根据发病数、疾病类型（身体或精神）、性别、年龄和年龄来分析数据。社会经济地位。我们将多发病定义为存在两种或多种疾病。结果显示，42.2% (95% CI 42.1-42.3) 的所有患者患有一种或多种疾病，23.2% (23.08-23.21) 患有多发病。尽管多种疾病的患病率随着年龄的增长而大幅增加，并且存在于大多数 65 岁及以上的人群中，但 65 岁以下人群中多种疾病的绝对人数更高（210 500 人 vs 194 996 人）。与最富裕地区相比，生活在最贫困地区的人们多病发病时间要早 10-15 年，社会经济贫困尤其与包括精神健康障碍在内的多病相关（最贫困地区的身心健康障碍患病率为 11.0%，95% CI 10.9-11.2%，而最贫困地区的患病率为 5.9%、5.8%-6.0%）。随着身体疾病数量的增加，精神健康障碍的存在也会增加（调整后的比值比为 6.74，五种或更多疾病的 95% CI 为 6.59-6.90，而一种疾病为 1.95、1.93-1.98），而且贫困程度较高的人比贫困程度较低的人患精神疾病的比例要高得多（2.28、2.21-2.32 vs 1.08、 1.05-1.11).解释 我们的研究结果对大多数医疗保健、医学研究和医学教育所依据的单一疾病框架提出了挑战。需要一种补充策略，支持全科临床医生提供个性化、全面的连续性护理，特别是在社会经济贫困地区。
Background Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation.Methods In a cross-sectional study we extracted data on 40 morbidities from a database of 1 751 841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders.Findings 42.2% (95% CI 42.1-42.3) of all patients had one or more morbidities, and 23.2% (23.08-23.21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210 500 vs 194 996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11.0%, 95% CI 10.9-11.2% in most deprived area vs 5.9%, 5.8%-6.0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6.74, 95% CI 6.59-6.90 for five or more disorders vs 1.95, 1.93-1.98 for one disorder), and was much greater in more deprived than in less deprived people (2.28, 2.21-2.32 vs 1.08, 1.05-1.11).Interpretation Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas.