Impact of Multimorbidity Subgroups on the Health Care Use and Clinical Outcomes of Patients With Tuberculosis: A Population-Based Cohort Analysis.
Impact of Multimorbidity Subgroups on the Health Care Use and Clinical Outcomes of Patients With Tuberculosis: A Population-Based Cohort Analysis.
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DOI：
10.3389/fpubh.2021.756717
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发表时间：
2021
影响因子：
5.2
通讯作者：
Yang T
中科院分区：
文献类型：
--
作者：
Chen Q;Che Y;Xiao Y;Jiang F;Chen Y;Zhou J;Yang T
背景：多发病是指同一个体同时存在两种或两种以上的慢性健康状况。虽然结核病患者在诊断时通常有多种疾病，如艾滋病毒、糖尿病和抑郁症，但据作者所知，关于多种疾病模式的信息有限，以及疾病的类型和组合如何影响医疗保健利用、支出和结核病结局。研究方法：利用中国疾病预防控制中心（CDC）与宁波区域医疗保健数据库（NRHCD）链接的国家结核病信息系统（NTBIS）对确诊为结核病的成年患者进行了一项观察性队列研究（2015 - 2020）。使用潜在类别分析来识别具有包括TB在内的≥ 2种疾病的子集中的合并症组。使用多变量回归模型将组水平的医疗保健使用、支出和治疗结果与无慢性疾病的患者进行比较。结果如下：共确定了9，651例结核病患者，其中约61.4%无慢性疾病，17.4%有1种慢性疾病，21.3%有≥ 2种慢性疾病。在患有≥ 1种除TB以外的慢性疾病的患者中，出现了4组：（1）一般发病率（54.4%）;（2）无并发症的心血管发病率（34.7%）;（3）有并发症的心血管发病率（5.0%）;（4）呼吸系统发病率（5.9%）。呼吸系统疾病组的支出最高，调整后比无慢性病的结核病患者多16，360 CNY（95% CI，CNY 12，615 - 21，215）。呼吸系统疾病和心血管疾病合并并发症组的有利TB结局的比值也最低[校正比值比（aOR），0.68; 95%CI，0.49 - 0.93]和（aOR 0.59，95%CI 0.42 - 0.83）。无并发症的心血管疾病组成功治疗结核病的几率最高（aOR，1.40; 95%CI，1.15 - 1.71）。结论：结核病患者多发病率高。目前的研究确定了四个不同的合并症亚组，所有这些亚组都经历了高，但差异，医疗保健使用率。这些发现强调了迫切需要进行改革，以改变目前分散的结核病护理服务，并改善获得其他专家和财政援助的机会。
Background: Multimorbidity is defined as the existence of two or more chronic health conditions in the same individual. While patients with tuberculosis commonly have multiple conditions at diagnosis, such as HIV, diabetes, and depression, to the authors' knowledge, there is limited information on the patterns of multimorbidity, and how the types and combinations of conditions could impact the healthcare utilization, expenditure, and TB outcomes. Methods: An observational cohort study of adult patients diagnosed with tuberculosis was conducted using the Chinese Center for Disease Control and Prevention (CDC)'s National TB Information System (NTBIS) linked to the Ningbo Regional Health Care Database (NRHCD) (2015–2020). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions including TB. Group-level health care use, expenditure, and treatment outcomes were compared with patients without chronic conditions using multivariate regression models. Results: A total of 9,651 patients with TB were identified, of whom approximately 61.4% had no chronic conditions, 17.4% had 1 chronic condition, and 21.3% had ≥2 chronic conditions. Among those with ≥1 chronic condition other than TB, 4 groups emerged: (1) general morbidity (54.4%); (2) cardiovascular morbidity without complications (34.7%); (3) cardiovascular morbidity with complications (5.0%); (4) respiratory morbidity (5.9%). The respiratory morbidity group experienced the highest expenditures, at 16,360 CNY more overall (95% CI, CNY 12,615–21,215) after adjustment compared with TB patients without chronic conditions. The respiratory morbidity and cardiovascular morbidity with complications group also had the lowest odds of favorable TB outcomes [adjusted odds ratio (aOR), 0.68; 95% CI, 0.49–0.93] and (aOR 0.59, 95% CI 0.42–0.83), respectively. The cardiovascular morbidity without complications group had the highest odds of successful TB treatment (aOR, 1.40; 95% CI, 1.15–1.71). Conclusions: Multimorbidity is common among patients with TB. The current study identified four distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. These findings highlight the need for urgent reforms to transform current fragmented TB care delivery and improve access to other specialists and financial assistance.
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影响因子：
4.5
作者：
Yang, Tianchi;Chen, Tong;Bo, Dingyi
通讯作者：
Bo, Dingyi
DOI：
10.1016/j.sapharm.2016.11.011
发表时间：
2017-11-01
影响因子：
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作者：
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DOI：
10.2147/dmso.s293557
发表时间：
2021
期刊：
Diabetes, metabolic syndrome and obesity : targets and therapy
影响因子：
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作者：
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DOI：
10.5588/ijtld.20.0458
发表时间：
2020-12-01
期刊：
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
影响因子：
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作者：
Lee G;Scuffell J;Galea JT;Shin SS;Magill E;Jaramillo E;Sweetland AC
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影响因子：
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作者：
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通讯作者：
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