Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting.
Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting.
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DOI：
10.1136/bmjopen-2019-031649
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发表时间：
2019-12-23
期刊：
影响因子：
2.9
通讯作者：
Dodhia, Hiten
中科院分区：
文献类型：
--
作者：
Ashworth, Mark;Durbaba, Stevo;Dodhia, Hiten
目的：探讨多发病的社会决定因素、心血管危险因素及多发病的发生顺序。设计：基于匿名初级保健数据的纵向研究。地点：英国伦敦一个多民族市镇的全科医生。参与者：332353例年龄≥18岁的患者。主要结局指标：多病患者的临床和社会人口学特征，定义为根据高预测医疗保健使用选择的12种长期疾病（LTCs）中≥3种。采用多水平逻辑回归对社会决定因素和心血管危险因素进行建模。根据年龄、种族和社会剥夺的不同，构建了冲积样地来说明多病获得序列。结果：5597例（1.7%）患者有≥3个选定LTCs，即“多病队列”。最常见的LTCs是糖尿病（63.0%）和慢性疼痛（42.8%）。社会剥夺和种族是多重疾病的独立决定因素：与最不剥夺的五分位数相比，最剥夺的五分位数最多(调整OR (AOR) 1.56 (95% CI 1.41至1.72))；南亚人与白种人相比（AOR 1.44 (95% CI 1.29 - 1.61)）；黑人与白人相比（AOR 0.86 (95% CI 0.80 ~ 0.92)）。纳入的心血管危险因素是多重发病的相对重要的决定因素：高血压（AOR 5.05 (95% CI 4.69至5.44)）、中度肥胖（AOR 3.41 (95% CI 3.21至3.63)）和吸烟（AOR 2.30 (95% CI 2.16至2.45)）。最常见的发病条件是糖尿病和抑郁症；糖尿病，尤其是老年人和黑人群体；尤其是在年轻、贫困和白人群体中。CP作为初始条件较少见。结论：我们的研究结果证实了年龄、社会剥夺和种族是多重发病的决定因素的重要性。吸烟、肥胖和高血压作为心血管危险因素是多重发病的更强决定因素，而不是贫困或种族。多发病的获得顺序是由社会人口统计学决定因素决定的。了解多病的发病条件和心血管危险因素可能会导致干预措施的发展，以减缓多病的进展。
OBJECTIVE: To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity.DESIGN: Longitudinal study based on anonymised primary care data.SETTING: General practices in an urban multiethnic borough in London, UK.PARTICIPANTS: 332 353 patients aged ≥18 years.MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients with multimorbidity, defined as ≥3 of 12 long-term conditions (LTCs) selected according to high predicted healthcare use. Multilevel logistic regression was used to model social determinants and cardiovascular risk factors. Alluvial plots were constructed to illustrate multimorbidity acquisition sequences according to age, ethnicity and social deprivation.RESULTS: 5597 (1.7%) patients had ≥3 selected LTCs, the 'multimorbidity cohort'. The the most common LTCs were diabetes (63.0%) and chronic pain (CP) (42.8%). Social deprivation and ethnicity were independent determinants of multimorbidity: most compared with the least deprived quintile (adjusted OR (AOR) 1.56 (95% CI 1.41 to 1.72)); South Asian compared with white ethnicity (AOR 1.44 (95% CI 1.29 to 1.61)); and black compared with white ethnicity (AOR 0.86 (95% CI 0.80 to 0.92)). The included cardiovascular risk factors were relatively strong determinants of multimorbidity: hypertension (AOR 5.05 (95% CI 4.69 to 5.44)), moderate obesity (AOR 3.41 (95% CI 3.21 to 3.63)) and smoking (AOR 2.30 (95% CI 2.16 to 2.45)). The most common initial onset conditions were diabetes and depression; diabetes particularly in older and black ethnic groups; and depression particularly in younger, more deprived and white ethnicity groups. CP was less common as an initial condition.CONCLUSION: Our findings confirm the importance of age, social deprivation and ethnicity as determinants of multimorbidity. Smoking, obesity and hypertension as cardiovascular risk factors were stronger determinants of multimorbidity than deprivation or ethnicity. The acquisition sequence of multimorbidity is patterned by sociodemographic determinants. Understanding onset conditions of multimorbidity and cardiovascular cardiovascular risk factors may lead to the development of interventions to slow the progression of multimorbidity.