Multiple Chronic Conditions and Aging

项目摘要 在美国，大约62%的65至74岁的医疗保险接受者患有多种慢性病 (MCC; ≥ 2种慢性疾病），85岁以上的频率急剧增加至82%。因为 MCC表示，患有MCC的成年人功能衰退的风险增加，并且特别容易受到护理不善的影响 威胁到美国的公共和金融健康。通过以下措施可降低MCC的患病率： 通过改变风险因素延迟单一疾病和疾病组合的发作，或 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， 一次只研究一种疾病，而且为时已晚因此，迫切需要确定 并制定干预措施，以预防MCC及其不良健康状况 结果。这些优先事项在美国的《多种慢性病战略框架》中概述 2010年，卫生与公众服务部（DHHS）。越来越多的文献描述了 在美国和世界范围内流行的MCC的模式;然而，MCC的发病率模式和 对千年挑战委员会的成果仍然知之甚少。此外，国家老龄问题研究所 推荐了一种新的方法，将MCC视为加速的替代指标（临床标志物）。 衰老因此，我们将研究MCC的发病率和累积率以及 MCC贯穿整个生命周期。 罗切斯特流行病学项目（REP）是研究以下疾病的发病率和发生率的理想环境： 千年挑战的积累和千年挑战的成果，因为它包括新的信息， 死亡，无论保险状况或医疗保健设置，并涵盖了全方位的 从初级保健到三级保健。在本申请中，我们建议研究发病率和生命过程 使用18个选定的所有年龄段的身体和心理健康状况（目标1），研究MCC的积累 根据医疗记录，确定MCC事件对健康的短期和长期不良影响（目标2），以及 研究短期和长期患者报告的MCC事件的不良结局（目标3）。 了解MCC的发病率和累积，以及其客观和主观的健康结果， 这对于使临床和公共卫生机构能够预防和治疗MCC以及改善人口健康至关重要。 健康此外，这些研究将确定在生命早期发生MCC的高风险人群（加速 老化）。这些人可以被选择用于生物标志物的未来研究（例如，验血基因检测 成像）或用于预防性干预以减缓衰老（例如，特定药物、饮食调整、生活方式 修改）。研究MCC作为临床标志物将促进我们对衰老的理解。总之， 这里提出的研究是新颖的，可以使用REP有效地进行，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.