The epidemiology of multimorbidity in primary care: a retrospective cohort study.
The epidemiology of multimorbidity in primary care: a retrospective cohort study.
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DOI：
10.3399/bjgp18x695465
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发表时间：
2018-04
期刊：
影响因子：
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通讯作者：
Griffin S
中科院分区：
文献类型：
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作者：
Cassell A;Edwards D;Harshfield A;Rhodes K;Brimicombe J;Payne R;Griffin S
多发病给患者和医疗保健系统带来了很大的负担，但几乎没有当代流行病学数据。描述英格兰成人多发病的流行病学，并量化多发病与卫生服务利用之间的联系。在英国进行的回溯性队列研究。这项研究使用了随机抽样的403985名成年患者(年龄≥18岁)，他们于2012年1月1日在全科注册，并被纳入临床实践研究数据链接。多发病被定义为在患者的医疗记录中记录了36种长期疾病中的两种或两种以上，并量化了4年来多发病与卫生服务利用(全科医生会诊、处方和住院)之间的联系。总体而言，参与研究的患者中有27.2%患有多发病。最常见的疾病是高血压(18.2%)、抑郁或焦虑(10.3%)和慢性疼痛(10.1%)。女性的多发病患病率高于男性(分别为30.0%和24.4%)，以及社会经济地位较低的人群(剥夺程度最高的五分位数为30.0%，剥夺程度最低的五分位数为25.8%)。在较年轻的患者(18-44岁)和社会经济地位较低的患者中，身心共病在总发病率中所占比例要大得多。多发病与卫生服务的使用密切相关。多发病患者占全科医生咨询的52.9%，处方的78.7%，住院的56.1%。多发病是常见的、社会模式的，并与卫生服务利用率的增加有关。这些调查结果支持有必要提高保健服务的质量和效率，在实践和国家一级向多发病患者提供护理。
Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available. To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation. Retrospective cohort study, undertaken in England. The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified. In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions. Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.