Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries
Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries
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DOI：
10.1093/ageing/afw044
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发表时间：
2016-05-01
期刊：
影响因子：
6.7
通讯作者：
Millett, Christopher
中科院分区：
文献类型：
--
作者：
Palladino, Raffaele;Lee, John Tayu;Millett, Christopher
背景：随着人口老龄化和慢性病危险因素的增加，全球慢性病多重发病率正在上升。关于欧洲多发病的决定因素及其对医疗保健利用率和健康状况的影响，几乎没有证据。方法：我们使用了 2011-12 年欧洲健康、老龄化和退休调查 (SHARE) 的横断面数据，其中包括来自 16 个欧洲国家的 50 岁及以上人群的全国代表性样本。使用负二项式和逻辑回归模型来评估慢性病数量与医疗保健利用、自我感知健康、抑郁和功能能力下降之间的关联。结果：总体而言，37.3% 的参与者报告患有多种疾病；患病率最低的是瑞士（24.7%），最高的是匈牙利（51.0%）。随着年龄的增长，患有多种疾病的可能性大大增加。在所有分析的国家中，慢性病的数量与初级医疗机构（就诊回归系数 = 0.29，95% CI = 0.27-0.30）和二级医疗机构（去年住院治疗的调整比值比 (AOR) = 1.49，95% CI = 1.42-1.55）的医疗保健利用率较高相关。慢性病的数量与健康状况一般/较差（AOR 2.13，95% CI = 2.03-2.24）、抑郁（AOR 1.48，95% CI = 1.42-1.54）和功能能力下降（AOR 2.12，95% CI = 2.02-2.22）相关。结论：多病与医疗保健利用程度越高、情况越差相关。欧洲国家自我报告的健康状况、抑郁症和功能能力下降。欧洲卫生系统应优先改善对多种疾病患者的管理，以改善他们的健康状况并提高医疗保健效率。
Background: with ageing populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and health status in Europe.Methods: we used cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011-12, which included nationally representative samples of persons aged 50 and older from 16 European nations. Negative binomial and logistic regression models were used to assess the association between number of chronic diseases and healthcare utilisation, self-perceived health, depression and reduction of functional capacity.Results: overall, 37.3% of participants reported multimorbidity; the lowest prevalence was in Switzerland (24.7%), the highest in Hungary (51.0%). The likelihood of having multimorbidity increased substantially with age. Number of chronic conditions was associated with greater healthcare utilisation in both primary (regression coefficient for medical doctor visits = 0.29, 95% CI = 0.27-0.30) and secondary setting (adjusted odds ratio (AOR) for having any hospitalisation in the last year = 1.49, 95% CI = 1.42-1.55) in all countries analysed. Number of chronic diseases was associated with fair/poor health status (AOR 2.13, 95% CI = 2.03-2.24), being depressed (AOR 1.48, 95% CI = 1.42-1.54) and reduced functional capacity (AOR 2.12, 95% CI = 2.02-2.22).Conclusion: multimorbidity is associated with greater healthcare utilisation, worse self-reported health status, depression and reduced functional capacity in European countries. European health systems should prioritise improving the management of patients with multimorbidity to improve their health status and increase healthcare efficiency.