Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults
Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults
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DOI：
10.1371/journal.pone.0218462
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发表时间：
2019-06-17
期刊：
影响因子：
3.7
通讯作者：
Allore, Heather G.
中科院分区：
文献类型：
--
作者：
Quinones, Ana R.;Botoseneanu, Anda;Allore, Heather G.
背景：多重发病——两种或两种以上并存的慢性疾病——对老年人来说是非常普遍、昂贵且致残的。关于慢性疾病随时间积累以及这是否因种族和民族背景而有所不同的问题仍然存在。为了填补这一知识空白，本研究确定了非西班牙裔白人、非西班牙裔黑人和西班牙裔研究参与者在慢性疾病积累率和多病发展方面的差异，这些参与者从中年开始随访至16年。方法和发现我们分析了来自健康与退休研究（HRS）的数据，这是一项两年进行的、公开的、具有全国代表性的对美国中老年成年人的纵向研究。我们评估了8872名非西班牙裔黑人、非西班牙裔白人和西班牙裔参与者慢性疾病负担的变化，这些参与者在研究期间（1998-2014年）的任何时间进行第一次访谈时年龄在51-55岁之间，并进行了所有后续随访观察，直到2014年。多病被定义为患有七种躯体慢性疾病中的两种或两种以上：关节炎、癌症、心脏病（心肌梗死、冠心病、心绞痛、充血性心力衰竭或其他心脏问题）、糖尿病、高血压、肺病和中风。我们使用负二项广义估计方程模型来评估非西班牙裔黑人、非西班牙裔白人和西班牙裔参与者的多病负担随时间的轨迹。在协变量调整模型中，非西班牙裔黑人应答者的初始慢性病计数比非西班牙裔白人应答者高28% (IRR 1.279, 95% CI 1.201, 1.361)，而西班牙裔应答者的初始慢性病计数比非西班牙裔白人应答者低15% （IRR 0.852, 95% CI 0.775, 0.938）。非西班牙裔黑人应答者的慢性病积累率比非西班牙裔白人慢1.1% (IRR 0.989, 95% CI 0.981, 0.998)，西班牙裔应答者的慢性病积累率比非西班牙裔白人应答者快1.5% （IRR 1.015, 95% CI 1.002, 1.028）。使用边际效应命令，这转化为白人受访者的慢性病预测值，研究期间开始时为0.98种慢性病，结束时为2.8种慢性病；研究开始时有1.3种慢性病，结束时有3.3种慢性病的黑人应答者；西班牙裔受访者在研究开始时有0.84种慢性病，结束时有2.7种慢性病。结论：与非西班牙裔白人相比，非西班牙裔黑人中年成年人的慢性疾病负担水平较高，平均发病年龄更早。另一方面，相对于非西班牙裔白人成年人，西班牙裔人积累慢性病的速度更快。我们的发现对于改善非西班牙裔黑人和西班牙裔美国人的原发性和继发性慢性疾病预防工作，以避免更大的多种疾病相关的健康影响具有重要意义。
BackgroundMultimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.Methods and findingsWe analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.ConclusionsMiddle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.