Household clustering of multimorbidity and associations with health and social care need

背景在英国，超过四分之一的人患有两种或两种以上的长期疾病(“多发病”)。老年人和生活在不太富裕地区的人更有可能患有多种长期疾病。患有多种长期疾病的人往往发现很难在生活中做他们想做的一切，更有可能虚弱和摔倒，而且经常需要住院等紧急护理。临床服务和健康研究主要集中在个人身上。然而，人们居住的地方也会影响他们的健康。生活在同一个家庭或邻里的人可能有相似的饮食和生活方式，因此也可能有罹患长期疾病的风险。人们如何应对疾病可能取决于他们和谁住在一起。独居或与同样患病的人生活在一起，往往会影响一个人管理自己健康的能力。我们没有正确地理解患有长期疾病的人是如何在家庭和邻里之间“聚集”在一起的。此外，我们也不了解其他因素对他们对卫生和社会保健服务的需求的影响，例如与谁住在一起，他们住在哪里。这一点很重要，因为为了满足患有多种长期疾病的人的需求，我们必须了解如何最好地组织服务。目的通过观察个人、家庭和社区，调查患有多种长期疾病的人在哪里生活的模式，以及这与人们如何使用卫生和社会护理服务(例如，紧急入院或疗养院)以及他们过早死亡的可能性有何关系。目的1.回顾已发表的关于多种长期疾病患者如何按家庭和邻里进行分组的研究，以及这与人们使用卫生保健和社会护理的关系。使用英国国民健康保险制度洛锡安(苏格兰)人口的数据：2.检查个人、居住在同一家庭的人和生活在同一社区的人的多种长期状况的地理模式。3.检查患有多种长期疾病的人的分布模式是否与他们在研究期间使用卫生和社会护理以及过早死亡的可能性有关。并使用威尔士人口的数据：4.将目标2和目标3应用于威尔士人口，并与苏格兰的调查结果进行比较，以确定它们是否相同或不同。这将有助于建立对长期条件和地点之间关系的理解。对患者和英国国民健康保险制度的潜在益处这项研究将提高我们对患有多种长期疾病的人在个人、家庭和邻里层面上生活在哪里的理解。它将研究这些模式如何与人们使用医疗和社会护理的方式以及他们过早死亡的可能性相关联。了解这一点将有助于我们设计更好地支持患有多种长期疾病的人的医疗和社会护理服务。患有多种长期疾病的人是社会上最脆弱的人之一，由于人口老龄化，他们的人数正在增加，这使这一问题变得非常重要。

Background More than one in four people in the UK live with two or more long-term conditions ("multimorbidity"). Older people and people living in less affluent areas are more likely to have multiple long-term conditions. People with multiple long-term conditions often find it hard to do everything they want in their lives, are more likely to be frail and have falls, and frequently require emergency care such as hospital admissions. Clinical services and health research focuses mainly on individuals. However, where people live will also influence their health. People living in the same household or neighbourhood may have similar diets and lifestyles and may therefore also be at risk of developing long-term conditions. How people cope with illness may depend on who they live with. Living alone, or living with someone who is also ill, often affects how well a person can manage their own health. We do not properly understand how people with long-term conditions 'group' together in households and in neighbourhoods. Also, we do not understand the effect of other factors, such as who someone lives with and where they live, on their need for health and social care services. This is important because in order to address the needs of people with multiple long-term conditions, we must understand how to best organise services. Aim The aim is to investigate patterns of where people with multiple long-term conditions live by looking at individuals, households, and neighbourhoods, and in what ways this relates to how people use health and social care services (for example, emergency admission to hospital or a care home) and their likelihood of premature death. Objectives 1. To review the published research on how people with multiple long-term conditions are grouped by household and neighbourhood, and how this relates to people's use of health and social care. Using data from the population of NHS Lothian (Scotland): 2. To examine geographical patterns of multiple long-term conditions in individuals, people living in the same household, and people living in the same neighbourhood. 3. To examine whether patterns in the distribution of people with multiple long-term conditions are related to their use of health and social care and their likelihood of premature death over the study period. And using data from the population of Wales: 4. To apply objectives 2 & 3 to the population of Wales and compare with the findings from Scotland to identify if these are the same or different. This will help build understanding of how long-term conditions and place are related. Potential benefits to patients and the NHS This study will improve our understanding of where people with multiple long-term conditions live at the individual, household and neighbourhood level. It will examine how these patterns are associated with the ways in which people use health and social care, and their likelihood of premature death. Understanding this will help us design health and social care services that better support people with multiple long-term conditions. People with multiple long-term conditions are among the most vulnerable people in society and their numbers are increasing due to an ageing population, making this an issue of great importance.