Socioeconomic inequalities in the prevalence of complex multimorbidity in a Norwegian population: findings from the cross-sectional HUNT Study
Socioeconomic inequalities in the prevalence of complex multimorbidity in a Norwegian population: findings from the cross-sectional HUNT Study
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DOI：
10.1136/bmjopen-2020-036851
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发表时间：
2020-06-01
期刊：
影响因子：
2.9
通讯作者：
Sund, Erik R.
中科院分区：
文献类型：
--
作者：
Vinjerui, Kristin Hestmann;Bjerkeset, Ottar;Sund, Erik R.
目的多发性疾病，即多种长期疾病同时发生，是一种常见且日益增加的疾病。定义和评估方法各不相同，导致对患病率和多病严重程度的估计存在差异。社会人口学特征与多重发病的复杂因素有关。我们的目的是调查性别和职业群体在成年期复杂多病的患病率。设计横断面研究。2006-2008年挪威北特隆德拉格健康研究（HUNT）第三次全县调查。参与者年龄在25-100岁之间，有可分类的职业数据，并完成问卷调查和测量。复杂多病定义为“同一个人同时出现三种或三种以上的慢性疾病，影响三个或三个以上不同的身体（器官）系统，但没有明确的慢性疾病指标”。各性别分别指定年龄和职业组Logistic回归模型。结果41 193名成年人中有38 027人（55%为女性）被纳入我们的分析。54%的参与者被确定为患有复杂的多重疾病。30岁时，低职业组（相对于高职业组（参考））的患病率差异（pp）在女性中为19 (95% CI, 16 - 21) pp，在男性中为10 (8 - 13)pp；55岁时，女性为12 (10 ~ 14)pp，男性为13 (11 ~ 15)pp；75岁时，女性为2 (-1 ~ 4)pp，男性为7 (4 ~ 10)pp。结论复杂的多病从成年早期开始就很常见，在一般人群中，社会不平等一直持续到女性75岁和男性90岁。这些发现对公共卫生、医疗保健、组织、治疗、教育和研究都有政策意义，因为复杂的多病打破了今天主导医学的专业化、碎片化范式。
Objectives Multimorbidity, the co-occurrence of multiple long-term conditions, is common and increasing. Definitions and assessment methods vary, yielding differences in estimates of prevalence and multimorbidity severity. Sociodemographic characteristics are associated with complicating factors of multimorbidity. We aimed to investigate the prevalence of complex multimorbidity by sex and occupational groups throughout adulthood.Design Cross-sectional study.Setting The third total county survey of The Nord-Trondelag Health Study (HUNT), 2006-2008, Norway.Participants Individuals aged 25-100 years with classifiable occupational data and complete questionnaires and measurements.Outcome measure Complex multimorbidity defined as `the co-occurrence of three or more chronic conditions affecting three or more different body (organ) systems within one person without defining an index chronic condition'.Analysis Logistic regression models with age and occupational group were specified for each sex separately.Results 38 027 of 41 193 adults (55% women) were included in our analyses. 54% of the participants were identified as having complex multimorbidity. Prevalence differences in percentage points (pp) of those in the low occupational group (vs the high occupational group (reference)) were 19 (95% CI, 16 to 21) pp in women and 10 (8 to 13) pp in men at 30 years; 12 (10 to 14) pp in women and 13 (11 to 15) pp in men at 55 years; and 2 (-1 to 4) pp in women and 7 (4 to 10) pp in men at 75 years.Conclusion Complex multimorbidity is common from early adulthood, and social inequalities persist until 75 years in women and 90 years in men in the general population. These findings have policy implications for public health as well as healthcare, organisation, treatment, education and research, as complex multimorbidity breaks with the specialised, fragmented paradigm dominating medicine today.