The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort
The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort
复制标题
DOI：
10.1186/s12916-019-1373-y
复制
发表时间：
2019-07-25
期刊：
影响因子：
9.3
通讯作者：
Kontopantelis, Evangelos
中科院分区：
文献类型：
--
作者：
Nowakowska, Magdalena;Zghebi, Salwa S.;Kontopantelis, Evangelos
背景2型糖尿病（T2 DM）的治疗和管理受到其他慢性疾病的显著影响。对这一人群中的合并症模式知之甚少。本研究的目的是量化合并症模式的人与2型糖尿病，估计在2027年的患病率的六种慢性疾病，并确定集群的类似conditions.MethodsWe使用的临床实践研究数据链（CPRD）与指数的多重痴呆症（IMD）的数据，以确定诊断为2型糖尿病患者之间的2007年和2017年。102，394人符合研究入选标准。我们计算了T2 DM诊断时和诊断后18种慢性疾病的粗患病率和年龄标准化患病率。我们纵向分析了6种最常见的疾病，并使用线性回归预测了2027年的患病率。我们使用凝聚层次聚类来确定共病集群。这些分析在按性别和贫困程度分层的亚组中重复进行。结果与最富裕地区（67%的女性;男性的64%）相比，生活在最贫困地区的人在诊断时患有>= 1种合并症的人数更多（72%的女性;男性的64%）。59%的男性）。抑郁症的患病率在所有阶层都有所增加，在最贫困的地区更为常见。预计到2027年，抑郁症将影响33%的女性和15%的男性T2 DM患者。温和的聚类趋势进行了观察，与一致的条件分组在一起，不同的人口统计学.ConclusionsComorbidities组之间的一些变化是常见的，在这个人群中，高患者之间的变异性的comorbidities模式强调需要以患者为中心的医疗保健。心理健康是一个日益令人关切的问题，有必要针对这一人群的身心健康采取干预措施。
BackgroundThe presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions.MethodsWe used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation.ResultsMore people living in the most deprived areas had >= 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics.ConclusionsComorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.