Recent Patterns of Multimorbidity Among Older Adults in High-Income Countries
Recent Patterns of Multimorbidity Among Older Adults in High-Income Countries
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DOI：
10.1089/pop.2018.0069
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发表时间：
2019-04-01
影响因子：
2.5
通讯作者：
Liew, Danny
中科院分区：
文献类型：
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作者：
Ofori-Asenso, Richard;Chin, Ken Lee;Liew, Danny
随着人口老龄化和慢性疾病(CMCs)负担的增加，全球卫生保健系统的可持续性正在受到挑战。作者试图描述高收入国家(HIC)老年人(年龄=65岁)多发病的当代模式。在2018年1月检索Medline、EMBASE、CINAHL、QicINFO和Web of Science的英文文章，这些文章报道了HICs中老年人的多发病(定义为在没有定义指数疾病的情况下同时发生>；=2个CMC)，或&>=3或&>；=5个CMC的比例。只有利用2007年1月至2017年12月期间收集的数据的研究才被纳入。总共有52篇文章(45项研究)报道了30个HIC中6000万老年人的数据。总的多病患病率为66.1%(四分位数范围[IQR]54.4-76.6)。多病患病率随着年龄的增长以及评估中包括的CMC数量的增加而增加。>；=3和>；=5 CMCs的患病率分别为44.2%(IQR34.0~70.3)和12.3%(IQR8.7~19.1)。在女性中以及在使用基于护理的数据而不是自我报告的数据的研究中，多病患病率也更高。高血压、血脂异常、糖尿病、疼痛障碍、抑郁、心力衰竭、癌症和痴呆症的患病率分别为60.6%、51.2%、25.2%、34.0%、12.0%、14.0%、8.6%和8.4%。现有数据表明，在老年人中，多发性疾病的发病率很高。有必要增加研究，以了解多发性疾病的因果机制，以支持成本效益干预措施的发展。此外，研究结果重申，预防性保健需要超越针对单一疾病的目标，有利于引导努力降低这一人群的总体发病率。
Population aging along with the rising burden of chronic medical conditions (CMCs) is challenging the sustainability of health care systems globally. The authors sought to characterize contemporary patterns of multimorbidity among older adults (aged >= 65 years) in high-income countries (HICs). Medline, EMBASE, CINAHL, PsycINFO, and Web of Science were searched in January 2018 for English-language articles that reported the prevalence of multimorbidity (defined as co-occurrence of >= 2 CMCs in an individual without defining an index disease) among older adults in HICs, or the proportions with >= 3 or >= 5 CMCs. Only studies that utilized data collected during January 2007-December 2017 were included. A total of 52 articles (45 studies) that reported data among >60 million older adults in 30 HICs were included. The overall prevalence of multimorbidity was 66.1% (interquartile range [IQR] 54.4-76.6). The multimorbidity prevalence increased with age as well as with the number of CMCs included in the assessment. The prevalence of >= 3 or >= 5 CMCs was 44.2% (IQR 34.0-70.3) and 12.3% (IQR 8.7-19.1), respectively. The multimorbidity prevalence was also higher among females as well as among studies using care-based data rather than self-reported data. The prevalence of hypertension, dyslipidemia, diabetes, pain disorders, depression, heart failure, cancer, and dementia among the older adults was 60.6%, 51.2%, 25.2%, 34.0%, 12.0%, 14.0%, 8.6%, and 8.4%, respectively. The available data suggest a high prevalence of multimorbidity among older adults. There is a need for increased research into understanding the causal mechanisms that underlie multimorbidity toward supporting the development of cost-effective interventions. In addition, the study results reiterate the need for preventive health care to move beyond targeting single diseases in favor of directing efforts toward reducing overall morbidity among this population.