Multiple Chronic Conditions and Aging

项目总结 在美国，65岁至74岁的医疗保险接受者中约有62%患有多种慢性病 (微囊癌；≥2慢性病)，而且这种频率急剧增加到85岁以上的82%。因为 患有MCC的成年人功能衰退的风险增加，尤其容易受到不良护理的影响 威胁着美国的公众和金融健康。MCC患病率可通过以下方式降低 通过修改风险因素或推迟单一条件和条件组合的出现 疾病的决定因素。然而，目前的预防努力在一定程度上失败了，因为他们把重点放在了 一次治疗一种疾病，但为时已晚。出于这个原因，迫切需要确定 在生命早期处于危险中的个人，并制定干预措施以预防MCC及其不良健康 结果。这些优先事项在美国的多种慢性病战略框架中得到了概述 卫生与公众服务部(DHHS)2010年。越来越多的文学作品描述了 MCC在美国和全世界的流行模式；然而，MCC和MCC的发病模式 MCC的结果仍然鲜为人知。此外，国家老龄研究所已经 推荐将MCC作为加速的替代指标(临床标记物)的新方法 衰老。因此，我们将研究MCC的发病率和积累率以及 MCC贯穿整个生命周期。 罗切斯特流行病学项目(REP)是研究霍乱发病率和发病率的理想环境。 MCC的累积和MCC的结果，因为它包括来自新的- 出生至死亡，无论保险状况或医疗保健环境，并涵盖所有范围的 从初级护理到三级护理。在这个应用中，我们建议研究发病率和生活史 使用18种选定的各个年龄段的躯体和精神健康状况来研究MCC的累积(目标1) MCC事件的短期和长期基于病历的不良健康后果(目标2)，以及 研究MCC事件的短期和长期患者报告的不良后果(目标3)。 了解MCC的发生率和累积，以及其客观和主观的健康后果 对于使临床和公共卫生机构能够预防和治疗MCC并改善人口状况至关重要 健康。此外，这些研究将确定早期罹患MCC的高风险人群(加速 老化)。这些人可以被选择用于未来的生物标记物研究(例如，血液测试，基因测试， 成像)或用于延缓衰老的预防性干预(例如，特定药物、改变饮食习惯、生活方式 修改)。研究MCC作为一种临床标志物将有助于我们对衰老的认识。总而言之， 这里提出的研究是新颖的，可以有效地使用REP进行，并且是迫切需要的。

PROJECT SUMMARY In the United States, about 62% of Medicare recipients ages 65 to 74 years have multiple chronic conditions (MCC; ≥ 2 chronic conditions), and the frequency increases dramatically to 82% above age 85. Because adults with MCC are at increased risk of functional decline and are particularly vulnerable to poor care, MCC threatens both the public and financial health of the United States. MCC prevalence may be reduced by delaying the onset of single conditions and combinations of conditions through modification of risk factors or determinants of diseases. However, current preventive efforts have partly failed because they have focused on one disease at a time and too late in life. For this reason, there is a critical need to identify groups of individuals at risk earlier in life, and to develop interventions to prevent MCC and their adverse health outcomes. These priorities were outlined in the Multiple Chronic Conditions Strategic Framework of the US Department of Health and Human Services (DHHS) of 2010. A growing body of literature has described patterns of prevalent MCC in the United States and worldwide; however, the patterns of incidence of MCC and the outcomes of MCC remain poorly understood. In addition, the National Institute on Aging has recommended the novel approach of considering MCC as a proxy measure (clinical marker) of accelerated aging. Therefore, we will study the incidence and the rate of accumulation of MCC and the health outcomes of MCC across the entire life span. The Rochester Epidemiology Project (REP) is an ideal environment to study the incidence and rate of accumulation of MCC, and the outcomes of MCC because it includes information for all ages from new- borns to death, regardless of insurance status or health care setting, and encompasses the full spectrum of care, from primary to tertiary care. In this application, we propose to study the incidence and life course accumulation of MCC using 18 selected somatic and mental health conditions across all ages (Aim 1), to study the short-term and long-term medical-records-based adverse health outcomes of incident MCC (Aim 2), and to study the short-term and long-term patient reported adverse outcomes of incident MCC (Aim 3). Understanding the incidence and accumulation of MCC, and its objective and subjective health outcomes is critical to enabling clinical and public health agencies to prevent and treat MCC, and to improve population health. In addition, these studies will identify persons at high risk of developing MCC early in life (accelerated aging). These persons may be selected for future studies of biomarkers (e.g., blood tests, genetic tests, imaging) or for preventive interventions to slow aging (e.g., specific drugs, dietary modification, lifestyle modification). Studying MCC as a clinical marker will advance our understanding of aging. In summary, the studies proposed here are novel, can be efficiently conducted using the REP, and are urgently needed.