The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The s...The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit(HCU)specifically designed to improve the management of patients with chronic complex conditions.By adopting a multidisciplinary approach,the HCU aims to provide comprehensive,patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services.Utilizing a longitudinal analysis of data from the Basic Minimum Data Set,this study compares hospitalization metrics among the HCU,Internal Medicine,and other departments within a regional hospital throughout 2022.The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices.The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity,emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care.This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.展开更多
Objective: To explore the association between cardiometabolic multimorbidity and frailty among middle- aged and older adults in China. Methods: Data were derived from the 2013 wave of the China Longitudinal Healthy Lo...Objective: To explore the association between cardiometabolic multimorbidity and frailty among middle- aged and older adults in China. Methods: Data were derived from the 2013 wave of the China Longitudinal Healthy Longevity Survey, including a total of 6,179 individuals aged 45 years and above with complete follow-up records. Basic demographic information was collected, and frailty status was assessed using a physical frailty scale. Generalized linear models were employed to analyze the association between the number and combinations of cardiometabolic conditions- such as hypertension, diabetes, heart disease, and stroke-and frailty. Results: The prevalence of cardiometabolic multimorbidity among middle-aged and older adults was 14.23%. After adjusting for sociodemographic covariates, individuals with cardiometabolic multimorbidity had a significantly increased risk of frailty compared to those without such conditions (OR = 1.78, 95% CI: 1.45-2.19), along with higher frailty scale scores (β = 0.26, 95% CI: 0.19-0.34). Compared to individuals without cardiometabolic diseases, those with both hypertension and stroke (OR = 1.18, 95% CI: 1.06-1.31) and those with hypertension, heart disease, and stroke (OR = 1.46, 95% CI: 1.24-1.73) exhibited notably higher frailty risks. Conclusion: There is a significant association between cardiometabolic multimorbidity and frailty in middle- aged and older adults in China, particularly for comorbidity patterns involving hypertension. These findings provide evidence for developing targeted health interventions for aging populations.展开更多
Background:Multimorbidity of intestinal cancer(IC),type 2 diabetes(T2D)and obesity is a complex set of diseases,affected by environmental and genetic risk factors.High-fat diet(HFD)and oral bacterial infection play im...Background:Multimorbidity of intestinal cancer(IC),type 2 diabetes(T2D)and obesity is a complex set of diseases,affected by environmental and genetic risk factors.High-fat diet(HFD)and oral bacterial infection play important roles in the etiology of these diseases through inflammation and various biological mechanisms.Methods:To study the complexity of this multimorbidity,we used the collaborative cross(CC)mouse genetics reference population.We aimed to study the multimorbidity of IC,T2D,and obesity using CC lines,measuring their responses to HFD and oral bacterial infection.The study used 63 mice of both sexes generated from two CC lines(IL557 and IL711).For 12 weeks,experimental mice were maintained on specific dietary regimes combined with co-infection with oral bacteria Porphyromonas gingivalis and Fusobacterium nucleatum,while control groups were not infected.Body weight(BW)and results of a intraperitoneal glucose tolerance test(IPGTT)were recorded at the end of 12 weeks,after which length and size of the intestines were assessed for polyp counts.Results:Polyp counts ranged between 2 and 10 per CC line.The combination of HFD and infection significantly reduced(P<.01)the colon polyp size of IL557 females to 2.5 cm 2,compared to the other groups.Comparing BW gain,IL557 males on HFD gained 18 g,while the females gained 10 g under the same conditions and showed the highest area under curve(AUC)values of 40000-45000(min mg/dL)in the IPGTT.Conclusion:The results show that mice from different genetic backgrounds respond differently to a high fat diet and oral infection in terms of polyp development and glucose tolerance,and this effect is gender related.展开更多
The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh,India and China,and to assess the relationship between multimorbidity and patient's opinion regarding their involvement in...The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh,India and China,and to assess the relationship between multimorbidity and patient's opinion regarding their involvement in healthcare decision-making and overall satisfaction of healthcare system.Cross-sectional data on 18696 men and women aged 18 and above were collected from the World Health Survey of World Health Organization(WHO).Outcome variables were subjective rating of(1)healthcare system's ability to involve patients in decision-making,and(2)satisfaction with the way healthcare system runs in the country.Self-reported chronic conditions were used to measure the prevalence of multimorbidity.Out of 9 chronic conditions,back pain,arthritis,and chronic cough appeared to be the most prevalent ones among majority of the participants.About one-third of the participants in China(30.7%)and two-thirds in Bangladesh(66.1%)and India(66.6%)reported having at least one chronic illness.Prevalence of multimorbidity was highest in India(34.3%)followed by Bangladesh(28.8%)and China(14.3%).In Bangladesh,India and China,respectively 70.5%,41.7%,61.3%women and 54.5%,42.8%and 58.8%men expressed dissatisfaction regarding the way healthcare system runs in their country.In Bangladesh and India,men who were living with multimorbidity were more likely to rate the patient-centeredness as"bad"than those who had no disease illness.This study suggests that the prevalence of multimorbidity was remarkably high especially in Bangladesh and India.Higher likelihood of dissatisfaction about healthcare system among multimorbid patients might be indicative of inadequacy in the provision of care in qualitative and quantitative terms.展开更多
Objectives: Depression may be under-diagnosed and under-treated amongst older adults with multiple chronic illnesses. The current study explores the prevalence of depression diagnosis and Geriatric Depression Scale (G...Objectives: Depression may be under-diagnosed and under-treated amongst older adults with multiple chronic illnesses. The current study explores the prevalence of depression diagnosis and Geriatric Depression Scale (GDS) symptoms amongst older multimorbid outpatients, and agreement between GDS scores and doctor-diagnosed depression. Method: Deidentified data from the files of 452 patients aged over 64, with chronic conditions present in two or more organ domains, were extracted from the clinical database of a tertiary referral hospital multidisciplinary outpatient clinic in South Australia between 2005 and 2011. Frequency calculations determined the prevalence of depression diagnosis and GDS categories. Logistic regression, cross-tabulation, kappa and ROC graphs explored relationships between variables. Results: A depression diagnosis had been recorded for 71 (15.7%) patients. Using the recommended cut-off scores for the GDS, 225 (49.8%) patients met criteria for mild-severe depressive symptoms, and 96 (21.3%) met criteria for moderate-severe symptoms. Poor agreement was found between doctor diagnosis of depression and a positive screen for depression using a GDS cut-off score of either 5, k = 0.112 (p = 0.001), or 9, k = 0.189 (p < 0.001), although logistic regression found an association between severity of depression and depression diagnosis, OR = 1.15, p < 0.001 (CI = 1.08 - 1.22). Con-clusion: A much higher proportion of patients with multimorbidities reported threshold level depression symptoms than had a recorded diagnosis of depression, suggesting that although likelihood of diagnosis increases with symptom severity, depression often goes undetected in this population. Depressions’ negative impact on prognosis calls for further investigation of the barriers to screening and diagnosis of depression in multimorbid patients.展开更多
Patients with multimorbidity are becoming the norm rather than the exception. The management of patients with several chronic diseases is now the most important challenge facing health care systems in developed countr...Patients with multimorbidity are becoming the norm rather than the exception. The management of patients with several chronic diseases is now the most important challenge facing health care systems in developed countries. Based on the actual medical records of ambulatory care visits, this study investigated the prevalence and patterns of multimorbidity in 55 and older population. Among a cohort comprised of 300,000 beneficiaries selected randomly from the National Health Insurance Research Database of Taiwan in 2001, 42,441 were eligible. These were followed longitudinally 10 years. The prevalence of chronic disease rose from 62.3% to 79.8% and multimorbidity rose from 57.4% to 75.7%. Multimorbidity patterns were found fell in-to four clusters: metabolic diseases, cardiac diseases, mental joints and gastrointestinal tract disorders. Hypertension and diabetes mellitus, as well as hyperplasia of the prostate in men, were the most common chronic diseases. The prevalence of chronic disease increased with age, especially high at age 75 - 79. Thought about the health care system for an ageing society is necessary. Applying the concept of customer experience and strengthening people-centered management in an integrated model of health care, enhancing knowledge and skills in the long-term management of chronic disease, revising clinical guidelines and training professionals in caring for the elderly, reinforcing preventive health services, especially in men’s health, modifying the materials for health education, and planning for health manpower resources will provide a better model to ensure the health care for people with multimorbidity.展开更多
Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leadin...Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients;High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.展开更多
Background There are several surrogate indicators of abdominal fat deposition,including tri-ponderal mass index(TMI),lipid accumulation product(LAP),and the Chinese visceral adiposity index(CVAI).In spite of this,it r...Background There are several surrogate indicators of abdominal fat deposition,including tri-ponderal mass index(TMI),lipid accumulation product(LAP),and the Chinese visceral adiposity index(CVAI).In spite of this,it remains unclear whether these indices have a longitudinal relationship with the prevalence of cardiometabolic multimorbidity(CM),a pressing global health issue.This research investigated the association between CVAI and CM compared to other indicators of visceral obesity.Methods 6638 participants(aged>45)from the China Health and Retirement Longitudinal Study(CHARLS)were analyzed for incident CM.Cox proportional models were adopted to explore whether the level of CVAI was correlated with the risk of CM.Harrell's concordance statistic(C-statistic)was applied to compare predictive values.Sensitivity and subgroup analyses were implemented for the steadiness of the results.Results Over 4 years,266(4.01%)participants developed CM.A 1-standard deviation(SD)increase in the levels of CVAI,body mass index(BMI),LAP,and TMI was associated with greater CM risk after adjusting for confounders[hazard ratios(HRs):2.20,95%confidence interval(CI):1.88-2.57,1.92(95%CI:1.55-2.38),1.20(95%CI:1.12-1.27),and 1.50(95%CI:1.35-1.66),respectively].CVAI outperformed other indices in predictive performance.Subgroup analysis revealed younger participants or those living alone were more prone to developing CM.Results were potent after finishing all sensitivity analyses.Conclusions The study highlighted a positive correlation between the level of CVAI and CM risk.CVAI's superior predictive performance positions it as a reliable indicator for identifying individuals at heightened CM risk.展开更多
Background:The prevalence of multimorbidity is increasing,with a notable shift towards younger age groups.Methods:Convenience sampling was employed to select 15,988 young and middle-aged adults in Chongqing as the stu...Background:The prevalence of multimorbidity is increasing,with a notable shift towards younger age groups.Methods:Convenience sampling was employed to select 15,988 young and middle-aged adults in Chongqing as the study population.The Apriori algorithm was used to identify the multimorbidity patterns within this population,while an unordered binary logistic regression model was applied to assess the association between sleep,diet and the risk of multimorbidity.Results:The study population had an average age of 39.2±10.1 years.Apriori association rules revealed that the most prevalent binary chronic disease multimorbidity pattern was dyslipidaemia+hypertension(14.78%),while the most common ternary chronic disease multimorbidity pattern was diabetes+dyslipidaemia+hypertension(9.66%).The logistic regression analysis revealed that a lower rating of sleep quality was associated with an elevated risk of multimorbidity(odds ratio(OR)=1.17,95%confidence interval(CI):1.01,1.36).Individuals who adhere to a meat-based diet(OR=1.45,95%CI:1.25,1.68)and those with elevated salt intake(OR=1.22,95%CI:1.01,1.47)were also observed to have an increased risk of multimorbidity.Additionally,a greater likelihood of multimorbidity was observed among those following a spicy diet(OR=1.3,95%CI:1.11,1.52)and consuming more oil(OR=1.16,95%CI:1.01,1.33).Conclusion:A poor sleep quality and a dietary preference for meat-based,salt,spicy and oils were found to be associated with an increased risk of multimorbidity progression among young and middle-aged populations.It is recommended that young and middle-aged adults should pay attention not only to sleep duration but also to sleep quality and improve dietary habits to reduce the likelihood of multimorbidity.展开更多
Objective:To review the research status and progress of minimally disruptive medicine(MDM)with a view and to provide a theoretical basis for reducing the treatment burden of patients with multimorbidity.Methods:"...Objective:To review the research status and progress of minimally disruptive medicine(MDM)with a view and to provide a theoretical basis for reducing the treatment burden of patients with multimorbidity.Methods:"Minimal Destructive Medicine"was used as searching term in HowNet Database and Wanfang Database,and"Minimally Disruptive Medicine"was used as searching term in PubMed database.The literature was reviewed for a review of the concepts of minimally destructive medicine(MDM),four basic principles,care models,and tools and strategies for clinical implementation.Results:MDM was developed for the coexistence burden of chronic diseases.It had formed a detailed and detailed application of basic principles and care models.The tools and strategies developed by MDM have been applied in clinical practice with good Results.Conclusion:MDM has a positive effect on reducing the burden of treatment for the multimorbidity and it is worthy of further research and promotion.展开更多
Objective To investigate the impact of multimorbidity on China’s healthcare utilization and expenditure.Methods A two-part model was used to analyze the outpatient cares based on the data from CHARLS 2015 wave.Result...Objective To investigate the impact of multimorbidity on China’s healthcare utilization and expenditure.Methods A two-part model was used to analyze the outpatient cares based on the data from CHARLS 2015 wave.Results and Conclusion As the prevalence of multimorbidity was 36.6%among 15523 middle-aged and elderly respondents in China,the multimorbidity increased the likelihood of outpatient service,while the total outpatient expenditure did not increase significantly as well as the OOP expenditure.Secondly,although there was a similar probability of outpatient visit,the patients with multimorbidity excluding diabetes and(or)hypertension,had not been concerned by China’s Chronic Condition Management Programs(CCCMP)yet.Thirdly,the patients with multimorbidity increased the outpatient visits to different types of hospitals.Under CCCMP intervention,the patients did not switch from the county/city hospital to primary healthcare centers and township hospital.A costeffective strategy for providing services to patients with multimorbid conditions is needed,the focus of CCCMP should be switched from the single chronic disease to the multimorbidity.展开更多
Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries(LMICs),though their effectiveness in multimorbidity management rem...Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries(LMICs),though their effectiveness in multimorbidity management remains unclear.This study synthesised evidence on task-shifting and task-sharing strategies globally and assessed the impact on core health outcomes in multimorbidity management.Methods We conducted a systematic review and meta-analysis of global studies evaluating task-shifting and sharing interventions for individuals with multimorbidity.Six databases,including PubMed,Embase,Web of Science,Ovid(Medline),CINAHL and Cochrane Library,were searched for studies reporting the core outcomes of multimorbidity management in quality of life,mortality,hospitalisation,emergency department visits and symptoms of depression and anxiety.Random-effects models were used to calculate pooled effect sizes with heterogeneity assessed through subgroup and meta-regression analyses.Results From 8471 records,36 studies from 14 countries were included,with only 5 conducted in LMICs.Twenty-one studies,encompassing 20989 participants,were eligible for meta-analysis.More than half of the studies involved nurses as delegates,with some sharing the tasks with health professionals and about 10%of studies involved non-health professionals,including community healthcare workers as delegates to share the responsibility in caring for individuals with multimorbidity.Most studies were multicomponent,with 16.7%addressing all guideline-recommended aspects of multimorbidity management.By pooling the findings,task-shifting and task-sharing interventions were associated with a 27%reduction in mortality(OR:0.73,95%CI:0.55 to 0.97,I2=0%),a modest improvement in quality of life(standardised mean difference(SMD):0.1,95%CI:0.03 to 0.17,I2=47%)and reduced symptoms of depression(SMD:0.27,95%CI:−0.52 to–0.02,I2=90%),but showed no significant effect on hospitalisation,emergency visits or anxiety-related symptoms.展开更多
Comprehensive,life-course multimorbidity data derived from linked outpatient and inpatient electronic health records(EHRs)remain scarce globally.We analyzed integrated EHRs(2016–2023)from approximately 3.2 million in...Comprehensive,life-course multimorbidity data derived from linked outpatient and inpatient electronic health records(EHRs)remain scarce globally.We analyzed integrated EHRs(2016–2023)from approximately 3.2 million individuals in Yichang,a prefecture-level city in Central China,to characterize disease co-occurrence during this observation window by identifying both the most frequent combinations and significant non-random associations across all ages.Multimorbidity was defined as the presence of≥2 distinct lifetime conditions recorded for an individual.We identified the 50 most common disease triads and constructed disease networks using partial correlation analysis,ranking hub conditions with the Multimorbidity Coefficient(MMC).Overall,74.5%of the population experienced multimorbidity(mean 5.29 conditions;women 5.59,men 4.98),with the burden rising steeply with age.Triad analysis revealed a clear life-course pattern,beginning with respiratory clusters in childhood and diverging by sex in young adulthood,female gynaecological versus male musculoskeletal/urological clusters,followed by cardiometabolic and cardiovascular dominance in mid-to-late life.Gastritis(K29)and sleep disorders(G47)were notably frequent components in adult triads.Network analysis identified K29,heart failure(I50),hypoproteinaemia(E88),anaemia(D64),and dermatitis(L30)as the top five hubs.Hub importance also varied by sex,with conditions such as osteoporosis(M81)being more central for women and benign prostatic hyperplasia(N40)for men.This study details a high multimorbidity burden and reveals a distinctive architecture characterized by a diverse,multi-system core where digestive,cardiometabolic,and systemic conditions co-dominate.Mapping these constellations provides critical insights for clinical anticipation,public health prevention,and research into shared pathways.展开更多
Objective As populations age,multimorbidity and frailty have emerged as major health challenges.While their associations with disability and mortality are well documented,their impact on quality of life(QoL)in sub-Sah...Objective As populations age,multimorbidity and frailty have emerged as major health challenges.While their associations with disability and mortality are well documented,their impact on quality of life(QoL)in sub-Saharan Africa remains underexplored.We examined the associations between frailty,multimorbidity and QoL among older adults in Rwanda.Design A cross-sectional population-based study.Multimorbidity was defined as having two or more chronic conditions,including hypertension,diabetes,heart disease and mental health conditions.Frailty scores were derived using the Fried phenotype,and QoL was measured using the European Health Instrument Survey-Quality of Life index(scaled 0%–100%).Sequential linear regression models were used to examine independent associations.Setting Rural and urban settings of Rwanda.Participant We analysed data from 4369 adults(≥40 years).Results The mean QoL score was 48.2%(±15.6).Frailty and multimorbidity prevalence were 14.5%(95%CI 13.5 to 15.6)and 55.2%(95%CI 53.7 to 56.6),respectively,while 55.0%(95%CI 53.3 to 56.3)were classified as prefrail.Frailty and multimorbidity are independently associated with poorer QoL.Compared with robust individuals,prefrail and frail individuals experienced a 3.66(95%CI−4.63 to–2.70)and 7.30(95%CI−8.76 to–5.83)percentage point reduction in QoL,respectively.Multimorbidity was associated with a 4.66%(95%CI−5.54 to–3.79)point decrease in QoL.Impairments in activities of daily living partly mediated these associations.Conclusions Frailty and multimorbidity showed a strong negative association with QoL,with frailty having a stronger effect.These findings underscore the need for age-responsive healthcare strategies,including frailty screening and integrated chronic care,to enhance QoL among older adults in Rwanda.展开更多
Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be use...Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be used alongside the MultiMorbidity Questionnaire part 1(MMQ1)without overwhelming the target population with redundant items.Methods We conducted a systematic literature review to identify all existing PROMs measuring treatment burden.If no suitable PROM was found,our plan was to:(1)develop a draft PROM using items from existing instruments,(2)carry out group and individual interviews with patients with multimorbidity to ensure the PROM’s understandability,clarity,completeness and relevance and(3)undertake psychometric validation with a diverse sample of primary care patients with chronic conditions.Results We did not identify an eligible PROM in the literature review.The draft PROM consisted of 30 items divided into six domains;Information about treatment,Challenges with medication,Medical appointments,Self-monitoring,Health behaviour and Challenges in the contact to the health system.In the psychometric validation,neither these domains nor any other theoretical constellation of items had adequate psychometric properties.Individual items had good criterion validity and sensitivity to change.Conclusions In this study,we developed a 30-item PROM with high content validity where various individual items showed adequate criterion validity and sensitivity to change,making these items useful as a supplemental measure to the MMQ1.Trial registration number NCT05676541 Registration Date:16 December 2022.展开更多
To the Editor:Adiposity is a prominent global health issue,imposing a considerable burden on cardiometabolic diseases(CMDs,including cardiovascular diseases[CVDs]and diabetes).Beyond the focus on one single CMD,there ...To the Editor:Adiposity is a prominent global health issue,imposing a considerable burden on cardiometabolic diseases(CMDs,including cardiovascular diseases[CVDs]and diabetes).Beyond the focus on one single CMD,there has been a growing emphasis on their co-occurrence,termed cardiometabolic multimorbidity(CMM).The rising prevalence of CMM poses substantial risks to both individuals and healthcare systems.Notably,the prevalence of CMM has increased from 9%to 14%in the United States between 1999 and 2018,whereas in China,it has nearly tripled,from 2%to 6%,between 2010 and 2016.展开更多
Introduction:Chronic diseases and multimorbidity are increasingly prevalent among older adults in China,contributing substantially to hospitalization burden.However,real-world evidence on their direct medical expendit...Introduction:Chronic diseases and multimorbidity are increasingly prevalent among older adults in China,contributing substantially to hospitalization burden.However,real-world evidence on their direct medical expenditures remains limited.Methods:This study employed a retrospective analysis by using hospital discharge data from Guangzhou during 2017–2019,and adopted generalized linear models(GLMs)to estimate hospitalization expenditures across chronic disease and multimorbidity patterns.Results:Older patients with multimorbidity incurred nearly double the median annual hospitalization expenditures(3,708 USD vs.1,844 USD)and 45%higher costs per additional condition compared to single diseases.Hospitalization cost varied by specific diseases and multimorbidity patterns.Schizophrenia(7,421.3 USD)has the highest annual total hospitalization expenditure(THE)among single chronic diseases while the combination of cancer+CVD+heart disease(10,698.8 USD for THE,4,024.6 USD for out-of-pocket expenditure)ranked the top expenditures among multimorbidity patterns.Approximately 57.1%of disease combinations exhibited super-additive spending.Conclusion:This study provides robust evidence of the substantial economic burden of chronic diseases and multimorbidity.The findings underscore the need for an integrated care model,evidence-based strategies to optimize healthcare resource allocation and health outcomes in aging populations.展开更多
Coronary heart disease and ischemic stroke are common cardiovascular and cerebrovascular diseases with a high multimorbidity rate.According to the theory of traditional Chinese medicine(TCM),the phlegm and blood stasi...Coronary heart disease and ischemic stroke are common cardiovascular and cerebrovascular diseases with a high multimorbidity rate.According to the theory of traditional Chinese medicine(TCM),the phlegm and blood stasis obstructing the LuòMàis pattern is the pathological basis,and the formation of phlegm and blood stasis is the key pathological factor for cardiocerebral vascular multimorbidity,implying that the treatment of cardiocerebral vascular multimorbidity should focus on eliminating phlegm and blood stasis simultaneously.Based on the discovery of modern medicine that cardiocerebral vascular multimorbidity is mostly related to lipid deposition,inflammation,atherosclerosis,microcirculation disorders,and hemodynamics,it is believed that the core pathological features of cardiocerebral vascular multimorbidity include atherosclerosis and microcirculation disorders,coinciding with the pathological mechanism that phlegm and blood stasis are formed and then obstruct the Luò Màis in the heart and brain in TCM.This paper combined modern medicine and TCM theories,analyzed the pathogenesis of coronary heart disease and ischemic stroke from the perspective of phlegm and blood stasis obstructing the Luò Màis pattern,and discussed the multimorbidity mechanism so as to provide theoretical basis for clinical treatment.展开更多
Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimor...Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.展开更多
Objective:To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship,time since cancer diagnosis,and self-reported fair/poor health,self-rated worse health i...Objective:To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship,time since cancer diagnosis,and self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.Methods:We used the 2010-2012 Health and Retirement Study.Cancer survivors were indi-viduals who reported a(nonskin)cancer diagnosis 2 years or more before the interview.We defined complex multimorbidity as the co-occurrence of chronic conditions,functional limitations,and/or geriatric syndromes.In addition to descriptive analyses,we used logistic regression to evaluate the independent association between cancer survivor status and health outcomes.We also examined whether cancer survivorship differed by the number of years since diagnosis.Results:Among 15,808 older adults(age≥50 years),11.8%were cancer survivors.Compared with cancer-free individuals,a greater percentage of cancer survivors had complex multimorbidity:co-occurring chronic conditions,functional limitations,and geriatric syndromes.Cancer survivor-ship was significantly associated with self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.These effects declined with the number of years since diagnosis for fair/poor health and mortality but not for self-rated worse health.Conclusion:Cancer survivor status is independently associated with more complex multi-morbidity,and with worse health outcomes.These effects attenuate with time,except for patient perception of being in worse health.展开更多
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287.
文摘The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems,necessitating the development of innovative management strategies to optimize patient care and system efficiency.The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit(HCU)specifically designed to improve the management of patients with chronic complex conditions.By adopting a multidisciplinary approach,the HCU aims to provide comprehensive,patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services.Utilizing a longitudinal analysis of data from the Basic Minimum Data Set,this study compares hospitalization metrics among the HCU,Internal Medicine,and other departments within a regional hospital throughout 2022.The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices.The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity,emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care.This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.
文摘Objective: To explore the association between cardiometabolic multimorbidity and frailty among middle- aged and older adults in China. Methods: Data were derived from the 2013 wave of the China Longitudinal Healthy Longevity Survey, including a total of 6,179 individuals aged 45 years and above with complete follow-up records. Basic demographic information was collected, and frailty status was assessed using a physical frailty scale. Generalized linear models were employed to analyze the association between the number and combinations of cardiometabolic conditions- such as hypertension, diabetes, heart disease, and stroke-and frailty. Results: The prevalence of cardiometabolic multimorbidity among middle-aged and older adults was 14.23%. After adjusting for sociodemographic covariates, individuals with cardiometabolic multimorbidity had a significantly increased risk of frailty compared to those without such conditions (OR = 1.78, 95% CI: 1.45-2.19), along with higher frailty scale scores (β = 0.26, 95% CI: 0.19-0.34). Compared to individuals without cardiometabolic diseases, those with both hypertension and stroke (OR = 1.18, 95% CI: 1.06-1.31) and those with hypertension, heart disease, and stroke (OR = 1.46, 95% CI: 1.24-1.73) exhibited notably higher frailty risks. Conclusion: There is a significant association between cardiometabolic multimorbidity and frailty in middle- aged and older adults in China, particularly for comorbidity patterns involving hypertension. These findings provide evidence for developing targeted health interventions for aging populations.
文摘Background:Multimorbidity of intestinal cancer(IC),type 2 diabetes(T2D)and obesity is a complex set of diseases,affected by environmental and genetic risk factors.High-fat diet(HFD)and oral bacterial infection play important roles in the etiology of these diseases through inflammation and various biological mechanisms.Methods:To study the complexity of this multimorbidity,we used the collaborative cross(CC)mouse genetics reference population.We aimed to study the multimorbidity of IC,T2D,and obesity using CC lines,measuring their responses to HFD and oral bacterial infection.The study used 63 mice of both sexes generated from two CC lines(IL557 and IL711).For 12 weeks,experimental mice were maintained on specific dietary regimes combined with co-infection with oral bacteria Porphyromonas gingivalis and Fusobacterium nucleatum,while control groups were not infected.Body weight(BW)and results of a intraperitoneal glucose tolerance test(IPGTT)were recorded at the end of 12 weeks,after which length and size of the intestines were assessed for polyp counts.Results:Polyp counts ranged between 2 and 10 per CC line.The combination of HFD and infection significantly reduced(P<.01)the colon polyp size of IL557 females to 2.5 cm 2,compared to the other groups.Comparing BW gain,IL557 males on HFD gained 18 g,while the females gained 10 g under the same conditions and showed the highest area under curve(AUC)values of 40000-45000(min mg/dL)in the IPGTT.Conclusion:The results show that mice from different genetic backgrounds respond differently to a high fat diet and oral infection in terms of polyp development and glucose tolerance,and this effect is gender related.
文摘The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh,India and China,and to assess the relationship between multimorbidity and patient's opinion regarding their involvement in healthcare decision-making and overall satisfaction of healthcare system.Cross-sectional data on 18696 men and women aged 18 and above were collected from the World Health Survey of World Health Organization(WHO).Outcome variables were subjective rating of(1)healthcare system's ability to involve patients in decision-making,and(2)satisfaction with the way healthcare system runs in the country.Self-reported chronic conditions were used to measure the prevalence of multimorbidity.Out of 9 chronic conditions,back pain,arthritis,and chronic cough appeared to be the most prevalent ones among majority of the participants.About one-third of the participants in China(30.7%)and two-thirds in Bangladesh(66.1%)and India(66.6%)reported having at least one chronic illness.Prevalence of multimorbidity was highest in India(34.3%)followed by Bangladesh(28.8%)and China(14.3%).In Bangladesh,India and China,respectively 70.5%,41.7%,61.3%women and 54.5%,42.8%and 58.8%men expressed dissatisfaction regarding the way healthcare system runs in their country.In Bangladesh and India,men who were living with multimorbidity were more likely to rate the patient-centeredness as"bad"than those who had no disease illness.This study suggests that the prevalence of multimorbidity was remarkably high especially in Bangladesh and India.Higher likelihood of dissatisfaction about healthcare system among multimorbid patients might be indicative of inadequacy in the provision of care in qualitative and quantitative terms.
文摘Objectives: Depression may be under-diagnosed and under-treated amongst older adults with multiple chronic illnesses. The current study explores the prevalence of depression diagnosis and Geriatric Depression Scale (GDS) symptoms amongst older multimorbid outpatients, and agreement between GDS scores and doctor-diagnosed depression. Method: Deidentified data from the files of 452 patients aged over 64, with chronic conditions present in two or more organ domains, were extracted from the clinical database of a tertiary referral hospital multidisciplinary outpatient clinic in South Australia between 2005 and 2011. Frequency calculations determined the prevalence of depression diagnosis and GDS categories. Logistic regression, cross-tabulation, kappa and ROC graphs explored relationships between variables. Results: A depression diagnosis had been recorded for 71 (15.7%) patients. Using the recommended cut-off scores for the GDS, 225 (49.8%) patients met criteria for mild-severe depressive symptoms, and 96 (21.3%) met criteria for moderate-severe symptoms. Poor agreement was found between doctor diagnosis of depression and a positive screen for depression using a GDS cut-off score of either 5, k = 0.112 (p = 0.001), or 9, k = 0.189 (p < 0.001), although logistic regression found an association between severity of depression and depression diagnosis, OR = 1.15, p < 0.001 (CI = 1.08 - 1.22). Con-clusion: A much higher proportion of patients with multimorbidities reported threshold level depression symptoms than had a recorded diagnosis of depression, suggesting that although likelihood of diagnosis increases with symptom severity, depression often goes undetected in this population. Depressions’ negative impact on prognosis calls for further investigation of the barriers to screening and diagnosis of depression in multimorbid patients.
文摘Patients with multimorbidity are becoming the norm rather than the exception. The management of patients with several chronic diseases is now the most important challenge facing health care systems in developed countries. Based on the actual medical records of ambulatory care visits, this study investigated the prevalence and patterns of multimorbidity in 55 and older population. Among a cohort comprised of 300,000 beneficiaries selected randomly from the National Health Insurance Research Database of Taiwan in 2001, 42,441 were eligible. These were followed longitudinally 10 years. The prevalence of chronic disease rose from 62.3% to 79.8% and multimorbidity rose from 57.4% to 75.7%. Multimorbidity patterns were found fell in-to four clusters: metabolic diseases, cardiac diseases, mental joints and gastrointestinal tract disorders. Hypertension and diabetes mellitus, as well as hyperplasia of the prostate in men, were the most common chronic diseases. The prevalence of chronic disease increased with age, especially high at age 75 - 79. Thought about the health care system for an ageing society is necessary. Applying the concept of customer experience and strengthening people-centered management in an integrated model of health care, enhancing knowledge and skills in the long-term management of chronic disease, revising clinical guidelines and training professionals in caring for the elderly, reinforcing preventive health services, especially in men’s health, modifying the materials for health education, and planning for health manpower resources will provide a better model to ensure the health care for people with multimorbidity.
文摘Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients;High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.
基金supported by the National Natural Science Foundation of China(No.82074295)the Science and Technology Program of Tibet Grant(No.XZ202201ZY0051G)。
文摘Background There are several surrogate indicators of abdominal fat deposition,including tri-ponderal mass index(TMI),lipid accumulation product(LAP),and the Chinese visceral adiposity index(CVAI).In spite of this,it remains unclear whether these indices have a longitudinal relationship with the prevalence of cardiometabolic multimorbidity(CM),a pressing global health issue.This research investigated the association between CVAI and CM compared to other indicators of visceral obesity.Methods 6638 participants(aged>45)from the China Health and Retirement Longitudinal Study(CHARLS)were analyzed for incident CM.Cox proportional models were adopted to explore whether the level of CVAI was correlated with the risk of CM.Harrell's concordance statistic(C-statistic)was applied to compare predictive values.Sensitivity and subgroup analyses were implemented for the steadiness of the results.Results Over 4 years,266(4.01%)participants developed CM.A 1-standard deviation(SD)increase in the levels of CVAI,body mass index(BMI),LAP,and TMI was associated with greater CM risk after adjusting for confounders[hazard ratios(HRs):2.20,95%confidence interval(CI):1.88-2.57,1.92(95%CI:1.55-2.38),1.20(95%CI:1.12-1.27),and 1.50(95%CI:1.35-1.66),respectively].CVAI outperformed other indices in predictive performance.Subgroup analysis revealed younger participants or those living alone were more prone to developing CM.Results were potent after finishing all sensitivity analyses.Conclusions The study highlighted a positive correlation between the level of CVAI and CM risk.CVAI's superior predictive performance positions it as a reliable indicator for identifying individuals at heightened CM risk.
基金supported by Chongqing Natural Science Foundation General Project(cstc2021jcyi msxmX0069)Chongqing Social Science Planning Project(2022NDYB196).
文摘Background:The prevalence of multimorbidity is increasing,with a notable shift towards younger age groups.Methods:Convenience sampling was employed to select 15,988 young and middle-aged adults in Chongqing as the study population.The Apriori algorithm was used to identify the multimorbidity patterns within this population,while an unordered binary logistic regression model was applied to assess the association between sleep,diet and the risk of multimorbidity.Results:The study population had an average age of 39.2±10.1 years.Apriori association rules revealed that the most prevalent binary chronic disease multimorbidity pattern was dyslipidaemia+hypertension(14.78%),while the most common ternary chronic disease multimorbidity pattern was diabetes+dyslipidaemia+hypertension(9.66%).The logistic regression analysis revealed that a lower rating of sleep quality was associated with an elevated risk of multimorbidity(odds ratio(OR)=1.17,95%confidence interval(CI):1.01,1.36).Individuals who adhere to a meat-based diet(OR=1.45,95%CI:1.25,1.68)and those with elevated salt intake(OR=1.22,95%CI:1.01,1.47)were also observed to have an increased risk of multimorbidity.Additionally,a greater likelihood of multimorbidity was observed among those following a spicy diet(OR=1.3,95%CI:1.11,1.52)and consuming more oil(OR=1.16,95%CI:1.01,1.33).Conclusion:A poor sleep quality and a dietary preference for meat-based,salt,spicy and oils were found to be associated with an increased risk of multimorbidity progression among young and middle-aged populations.It is recommended that young and middle-aged adults should pay attention not only to sleep duration but also to sleep quality and improve dietary habits to reduce the likelihood of multimorbidity.
文摘Objective:To review the research status and progress of minimally disruptive medicine(MDM)with a view and to provide a theoretical basis for reducing the treatment burden of patients with multimorbidity.Methods:"Minimal Destructive Medicine"was used as searching term in HowNet Database and Wanfang Database,and"Minimally Disruptive Medicine"was used as searching term in PubMed database.The literature was reviewed for a review of the concepts of minimally destructive medicine(MDM),four basic principles,care models,and tools and strategies for clinical implementation.Results:MDM was developed for the coexistence burden of chronic diseases.It had formed a detailed and detailed application of basic principles and care models.The tools and strategies developed by MDM have been applied in clinical practice with good Results.Conclusion:MDM has a positive effect on reducing the burden of treatment for the multimorbidity and it is worthy of further research and promotion.
基金the Youth Fund of Humanities and Social Sciences Project of Ministry of Education[Grant Number:18YJC630022].
文摘Objective To investigate the impact of multimorbidity on China’s healthcare utilization and expenditure.Methods A two-part model was used to analyze the outpatient cares based on the data from CHARLS 2015 wave.Results and Conclusion As the prevalence of multimorbidity was 36.6%among 15523 middle-aged and elderly respondents in China,the multimorbidity increased the likelihood of outpatient service,while the total outpatient expenditure did not increase significantly as well as the OOP expenditure.Secondly,although there was a similar probability of outpatient visit,the patients with multimorbidity excluding diabetes and(or)hypertension,had not been concerned by China’s Chronic Condition Management Programs(CCCMP)yet.Thirdly,the patients with multimorbidity increased the outpatient visits to different types of hospitals.Under CCCMP intervention,the patients did not switch from the county/city hospital to primary healthcare centers and township hospital.A costeffective strategy for providing services to patients with multimorbid conditions is needed,the focus of CCCMP should be switched from the single chronic disease to the multimorbidity.
基金supported by the National Key R&D programprogramme of China(Grant No.2023 YFC 3605002)Noncommunicable Chronic Disease National Science and Technology Major Project(Grant No.2023ZD0506001)+1 种基金the CAMS Innovation Fund for Medical Sciences(ClFMS)(Grant No.2025-I2M-KJ-029)the non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(Grant No.2022-ZHCH330-01).
文摘Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries(LMICs),though their effectiveness in multimorbidity management remains unclear.This study synthesised evidence on task-shifting and task-sharing strategies globally and assessed the impact on core health outcomes in multimorbidity management.Methods We conducted a systematic review and meta-analysis of global studies evaluating task-shifting and sharing interventions for individuals with multimorbidity.Six databases,including PubMed,Embase,Web of Science,Ovid(Medline),CINAHL and Cochrane Library,were searched for studies reporting the core outcomes of multimorbidity management in quality of life,mortality,hospitalisation,emergency department visits and symptoms of depression and anxiety.Random-effects models were used to calculate pooled effect sizes with heterogeneity assessed through subgroup and meta-regression analyses.Results From 8471 records,36 studies from 14 countries were included,with only 5 conducted in LMICs.Twenty-one studies,encompassing 20989 participants,were eligible for meta-analysis.More than half of the studies involved nurses as delegates,with some sharing the tasks with health professionals and about 10%of studies involved non-health professionals,including community healthcare workers as delegates to share the responsibility in caring for individuals with multimorbidity.Most studies were multicomponent,with 16.7%addressing all guideline-recommended aspects of multimorbidity management.By pooling the findings,task-shifting and task-sharing interventions were associated with a 27%reduction in mortality(OR:0.73,95%CI:0.55 to 0.97,I2=0%),a modest improvement in quality of life(standardised mean difference(SMD):0.1,95%CI:0.03 to 0.17,I2=47%)and reduced symptoms of depression(SMD:0.27,95%CI:−0.52 to–0.02,I2=90%),but showed no significant effect on hospitalisation,emergency visits or anxiety-related symptoms.
基金supported by the non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2021-RC330-004 and 2022-ZHCH330-01)the Disciplines Construction Project:Population Medicine(WH10022022010)the Special Research Fund for Central Universities,Peking Union Medical College(3332025142).
文摘Comprehensive,life-course multimorbidity data derived from linked outpatient and inpatient electronic health records(EHRs)remain scarce globally.We analyzed integrated EHRs(2016–2023)from approximately 3.2 million individuals in Yichang,a prefecture-level city in Central China,to characterize disease co-occurrence during this observation window by identifying both the most frequent combinations and significant non-random associations across all ages.Multimorbidity was defined as the presence of≥2 distinct lifetime conditions recorded for an individual.We identified the 50 most common disease triads and constructed disease networks using partial correlation analysis,ranking hub conditions with the Multimorbidity Coefficient(MMC).Overall,74.5%of the population experienced multimorbidity(mean 5.29 conditions;women 5.59,men 4.98),with the burden rising steeply with age.Triad analysis revealed a clear life-course pattern,beginning with respiratory clusters in childhood and diverging by sex in young adulthood,female gynaecological versus male musculoskeletal/urological clusters,followed by cardiometabolic and cardiovascular dominance in mid-to-late life.Gastritis(K29)and sleep disorders(G47)were notably frequent components in adult triads.Network analysis identified K29,heart failure(I50),hypoproteinaemia(E88),anaemia(D64),and dermatitis(L30)as the top five hubs.Hub importance also varied by sex,with conditions such as osteoporosis(M81)being more central for women and benign prostatic hyperplasia(N40)for men.This study details a high multimorbidity burden and reveals a distinctive architecture characterized by a diverse,multi-system core where digestive,cardiometabolic,and systemic conditions co-dominate.Mapping these constellations provides critical insights for clinical anticipation,public health prevention,and research into shared pathways.
文摘Objective As populations age,multimorbidity and frailty have emerged as major health challenges.While their associations with disability and mortality are well documented,their impact on quality of life(QoL)in sub-Saharan Africa remains underexplored.We examined the associations between frailty,multimorbidity and QoL among older adults in Rwanda.Design A cross-sectional population-based study.Multimorbidity was defined as having two or more chronic conditions,including hypertension,diabetes,heart disease and mental health conditions.Frailty scores were derived using the Fried phenotype,and QoL was measured using the European Health Instrument Survey-Quality of Life index(scaled 0%–100%).Sequential linear regression models were used to examine independent associations.Setting Rural and urban settings of Rwanda.Participant We analysed data from 4369 adults(≥40 years).Results The mean QoL score was 48.2%(±15.6).Frailty and multimorbidity prevalence were 14.5%(95%CI 13.5 to 15.6)and 55.2%(95%CI 53.7 to 56.6),respectively,while 55.0%(95%CI 53.3 to 56.3)were classified as prefrail.Frailty and multimorbidity are independently associated with poorer QoL.Compared with robust individuals,prefrail and frail individuals experienced a 3.66(95%CI−4.63 to–2.70)and 7.30(95%CI−8.76 to–5.83)percentage point reduction in QoL,respectively.Multimorbidity was associated with a 4.66%(95%CI−5.54 to–3.79)point decrease in QoL.Impairments in activities of daily living partly mediated these associations.Conclusions Frailty and multimorbidity showed a strong negative association with QoL,with frailty having a stronger effect.These findings underscore the need for age-responsive healthcare strategies,including frailty screening and integrated chronic care,to enhance QoL among older adults in Rwanda.
基金supported by the public agreement between the Danish Regions and the General Practitioners’Organization 2022–2024.
文摘Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure(PROM)to assess treatment burden related to general practice for patients with multimorbidity,which can be used alongside the MultiMorbidity Questionnaire part 1(MMQ1)without overwhelming the target population with redundant items.Methods We conducted a systematic literature review to identify all existing PROMs measuring treatment burden.If no suitable PROM was found,our plan was to:(1)develop a draft PROM using items from existing instruments,(2)carry out group and individual interviews with patients with multimorbidity to ensure the PROM’s understandability,clarity,completeness and relevance and(3)undertake psychometric validation with a diverse sample of primary care patients with chronic conditions.Results We did not identify an eligible PROM in the literature review.The draft PROM consisted of 30 items divided into six domains;Information about treatment,Challenges with medication,Medical appointments,Self-monitoring,Health behaviour and Challenges in the contact to the health system.In the psychometric validation,neither these domains nor any other theoretical constellation of items had adequate psychometric properties.Individual items had good criterion validity and sensitivity to change.Conclusions In this study,we developed a 30-item PROM with high content validity where various individual items showed adequate criterion validity and sensitivity to change,making these items useful as a supplemental measure to the MMQ1.Trial registration number NCT05676541 Registration Date:16 December 2022.
基金supported by grants from the National Natural Science Foundation of China(No.82304223)the National Key Research&Development Program of China(No.2023YFC3606300)+5 种基金the National Natural Science Foundation of China(Nos.82192901,82192904,82192900)The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong KongThe long-term follow-up is supported by grants from the UK Wellcome Trust(Nos.212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,088158/Z/09/Z)grants from the National Key Research&Development Program of China(No.2016YFC0900500)National Natural Science Foundation of China(No.81390540)Chinese Ministry of Science and Technology(No.2011BAI09B01).
文摘To the Editor:Adiposity is a prominent global health issue,imposing a considerable burden on cardiometabolic diseases(CMDs,including cardiovascular diseases[CVDs]and diabetes).Beyond the focus on one single CMD,there has been a growing emphasis on their co-occurrence,termed cardiometabolic multimorbidity(CMM).The rising prevalence of CMM poses substantial risks to both individuals and healthcare systems.Notably,the prevalence of CMM has increased from 9%to 14%in the United States between 1999 and 2018,whereas in China,it has nearly tripled,from 2%to 6%,between 2010 and 2016.
基金Supported by the National Natural Science Foundation(Grant No.:72174098).The funding organization had no role in study design,data collection,analysis,interpretation,or manuscript preparation.
文摘Introduction:Chronic diseases and multimorbidity are increasingly prevalent among older adults in China,contributing substantially to hospitalization burden.However,real-world evidence on their direct medical expenditures remains limited.Methods:This study employed a retrospective analysis by using hospital discharge data from Guangzhou during 2017–2019,and adopted generalized linear models(GLMs)to estimate hospitalization expenditures across chronic disease and multimorbidity patterns.Results:Older patients with multimorbidity incurred nearly double the median annual hospitalization expenditures(3,708 USD vs.1,844 USD)and 45%higher costs per additional condition compared to single diseases.Hospitalization cost varied by specific diseases and multimorbidity patterns.Schizophrenia(7,421.3 USD)has the highest annual total hospitalization expenditure(THE)among single chronic diseases while the combination of cancer+CVD+heart disease(10,698.8 USD for THE,4,024.6 USD for out-of-pocket expenditure)ranked the top expenditures among multimorbidity patterns.Approximately 57.1%of disease combinations exhibited super-additive spending.Conclusion:This study provides robust evidence of the substantial economic burden of chronic diseases and multimorbidity.The findings underscore the need for an integrated care model,evidence-based strategies to optimize healthcare resource allocation and health outcomes in aging populations.
基金supported by the Special Fund for the Inheritance and Innovation of Traditional Chinese Medicine Theories under the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences[Grant number:KYG-202404].
文摘Coronary heart disease and ischemic stroke are common cardiovascular and cerebrovascular diseases with a high multimorbidity rate.According to the theory of traditional Chinese medicine(TCM),the phlegm and blood stasis obstructing the LuòMàis pattern is the pathological basis,and the formation of phlegm and blood stasis is the key pathological factor for cardiocerebral vascular multimorbidity,implying that the treatment of cardiocerebral vascular multimorbidity should focus on eliminating phlegm and blood stasis simultaneously.Based on the discovery of modern medicine that cardiocerebral vascular multimorbidity is mostly related to lipid deposition,inflammation,atherosclerosis,microcirculation disorders,and hemodynamics,it is believed that the core pathological features of cardiocerebral vascular multimorbidity include atherosclerosis and microcirculation disorders,coinciding with the pathological mechanism that phlegm and blood stasis are formed and then obstruct the Luò Màis in the heart and brain in TCM.This paper combined modern medicine and TCM theories,analyzed the pathogenesis of coronary heart disease and ischemic stroke from the perspective of phlegm and blood stasis obstructing the Luò Màis pattern,and discussed the multimorbidity mechanism so as to provide theoretical basis for clinical treatment.
基金supported by grants from the National Natural Science Foundation of China(No.81941018)The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong,China.The long-term follow-up is supported by grants from the UK Wellcome Trust(Nos.212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,and 088158/Z/09/Z)+2 种基金grants from the National Key R&D Program of China(Nos.2016YFC0900500 and 2016YFC1303904)National Natural Science Foundation of China(No.81390540)Chinese Ministry of Science and Technology(No.2011BAI09B01)。
文摘Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.
基金This study was funded in part by Case Comprehensive Cancer Center support grant(P30 CA043703)。
文摘Objective:To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship,time since cancer diagnosis,and self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.Methods:We used the 2010-2012 Health and Retirement Study.Cancer survivors were indi-viduals who reported a(nonskin)cancer diagnosis 2 years or more before the interview.We defined complex multimorbidity as the co-occurrence of chronic conditions,functional limitations,and/or geriatric syndromes.In addition to descriptive analyses,we used logistic regression to evaluate the independent association between cancer survivor status and health outcomes.We also examined whether cancer survivorship differed by the number of years since diagnosis.Results:Among 15,808 older adults(age≥50 years),11.8%were cancer survivors.Compared with cancer-free individuals,a greater percentage of cancer survivors had complex multimorbidity:co-occurring chronic conditions,functional limitations,and geriatric syndromes.Cancer survivor-ship was significantly associated with self-reported fair/poor health,self-rated worse health in 2 years,and 2-year mortality.These effects declined with the number of years since diagnosis for fair/poor health and mortality but not for self-rated worse health.Conclusion:Cancer survivor status is independently associated with more complex multi-morbidity,and with worse health outcomes.These effects attenuate with time,except for patient perception of being in worse health.
