摘要
背景慢性病共病的情况在老年群体中较为常见,“多病共存”已成为日益严重的公共卫生问题,但目前我国老年人慢性病共病现状及共病模式研究相对缺乏。目的分析我国老年人慢性病患病情况、共病现状及共病模式,旨在为老年人多病共防和共管提供建议。方法于2021年1月采用北京大学国家发展研究院开展的中国健康与养老追踪调查(CHARLS)2018年数据,选取年龄≥60周岁且关键变量(慢性病患病情况、年龄、性别、受教育程度、婚姻状态和户籍类型等)值完整的调查对象10836例作为研究对象。采用χ^(2)检验分析不同性别老年人慢性病患病和共病情况的差异性,采用趋势性χ^(2)检验分析老年人慢性病患病和共病情况随年龄变化的趋势,利用加权网络探索老年人慢性病共病模式,运用Gephi对老年人慢性病共病网络进行可视化。结果10836例老年人中,9344例(86.23%)至少患有1种慢性病,高血压〔46.46%(5034/10836)〕、关节炎或风湿病〔44.68%(4842/10836)〕和胃部或消化系统疾病〔31.64%(3429/10836)〕为患病率排名前3位的慢性病。女性慢性病患病率高于男性〔88.30%(4899/5548)比84.06%(4445/5288),χ^(2)=41.069,P<0.001〕;老年人慢性病患病率随年龄的增长呈升高趋势(χ^(2)趋势=31.953,P<0.001)。7059例(65.14%)老年人同时患有2种及以上慢性病。女性慢性病共病患病率高于男性〔68.71%(3812/5548)比61.40%(3247/5288),χ^(2)=63.650,P<0.001〕;老年人慢性病共病患病率随年龄的增长呈升高趋势(χ^(2)趋势=31.118,P<0.001)。二元慢性病共病组合上,14种常见慢性病共形成91种共病模式。患病率排名前3位的慢性病共病模式分别为高血压+关节炎或风湿病〔22.13%(2398/10836)〕、关节炎或风湿病+胃部或消化系统疾病〔19.15%(2075/10836)〕和关节炎或风湿病+心脏病〔16.67%(1806/10836)〕。不同年龄段老年人的慢性病共病模式具有差异性:低龄老年人中,患病率排名前3位的慢性病共病模式依次为高血压+关节炎或风湿病〔19.81%(1290/6512)〕、关节炎或风湿病+胃部或消化系统疾病〔18.54%(1207/6512)〕和高血压+血脂异常〔16.68%(1086/6512)〕;中龄老年人中,患病率排名前3位的慢性病共病模式顺次为高血压+关节炎或风湿病〔25.33%(813/3209)〕、关节炎或风湿病+胃部或消化系统疾病〔20.91%(671/3209)〕和高血压+心脏病〔19.79%(635/3209)〕;高龄老年人中,患病率排名前3位的慢性病共病模式分别为高血压+关节炎或风湿病〔26.46%(295/1115)〕、高血压+心脏病〔17.67%(197/1115)〕和关节炎或风湿病+胃部或消化系统疾病〔17.67%(197/1115)〕。结论我国老年人慢性病共病问题严峻,不同年龄段老年人的慢性病共病模式存在差异。建议以高血压等重点疾病为突破口,通过整合现有慢性病医疗服务,并制定慢性病共病相关的临床评估和管理指南,从而实现老年人多病共管、共防和共减。
Background Multimorbidity,the coexistence of multiple chronic diseases,is common in older adults,and is an ongoing challenge for public health.However,only a few studies on multimorbidity have been conducted in China.Objective This research was aimed to identify the prevalence and patterns of multimorbidity among Chinese older adults,providing scientific suggestions for the prevention and management of multimorbidity in this population.Methods Data were extracted from the China Health and Retirement Longitudinal Study(CHARLS)2018,involving 10836 adults aged 60 and older with complete information of key variables(chronic disease prevalence,age,sex,education level,marital status,and type of hukou).Chi-square test was used to assess differences in the prevalence of single and multiple chronic diseases by sex.Chi-square test for trend was used to assess the differences in the trend in prevalence of single and multiple chronic diseases by age.Weighted networks were adopted to present the complex patterns of multimorbidity.Gephi was used for visualizing the patterns of associative multimorbidity.Results Up to 86.23%(n=9344)of the participants had at least one chronic disease.Hypertension〔46.46%(5034/10836)〕,arthritis or rheumatism〔44.68%(4842/10836)〕,and gastric or digestive diseases〔31.64%(3429/10836)〕were top three most prevalent chronic conditions.The prevalence of chronic diseases increased with age(χ^(2)=31.953,P<0.001),with a greater prevalence in women than in men〔88.30%(4899/5548)vs 84.06%(4445/5288),χ^(2)=41.069,P<0.001〕.At least two chronic diseases coexisted in 7059 cases(65.14%).Women had higher prevalence of multimorbidity than men〔68.71%(3812/5548)vs 61.40%(3247/5288),χ^(2)=63.650,P<0.001〕.The prevalence of multimorbidity increased with age(χ^(2)=31.118,P<0.001).The 14 chronic conditions among the participants demonstrated 91 pair multimorbidity patterns.The top three pair patterns of multimorbidity with corresponding prevalence were hypertension&arthritis or rheumatism〔22.13%(2398/10836)〕,arthritis or rheumatism&gastric or digestive diseases〔19.15%(2075/10836)〕,and arthritis or rheumatism&heart disease〔16.67%(1806/10836)〕.The age-specific patterns of multimorbidity had certain differences.For those aged 60 to 69,the top three multimorbidity patterns were hypertension&arthritis or rheumatism〔19.81%(1290/6512)〕,arthritis or rheumatism&gastric or digestive diseases〔18.54%(1207/6512)〕,and hypertension&dyslipidemia〔16.68%(1086/6512)〕.For those aged 70 to 79,hypertension&arthritis or rheumatism〔25.33%(813/3209)〕,arthritis or rheumatism&gastric or digestive diseases〔20.91%(671/3209)〕,and hypertension&heart disease〔19.79%(635/3209)〕were the top three patterns with the highest prevalence.For those aged 80 and older,the top three patterns of multimorbidity were hypertension&arthritis or rheumatism〔26.46%(295/1115)〕,hypertension&heart disease〔17.67%(197/1115)〕,arthritis or rheumatism&gastric or digestive diseases〔17.67%(197/1115)〕.Conclusion The prevalence of multimorbidityhy among elderly Chinese population was high.And the patterns of multimorbidity varied by age.To realize the co-management,co-prevention and co-reduction of multiple conditions,public health practitioners should provide integrated healthcare services.Our findings suggest that clinical guidance on the assessment and management of multimorbidity should be developed,taking influential diseases such as hypertension as a breakthrough and along with different strategies by age and gender.
作者
黎艳娜
王艺桥
LI Yanna;WANG Yiqiao(School of Management,Beijing University of Chinese Medicine,Beijing 102488,China)
出处
《中国全科医学》
CAS
北大核心
2021年第31期3955-3962,3978,共9页
Chinese General Practice
基金
国家自然科学基金资助项目(12071048,11671053)。
关键词
慢性病共病
老年人
网络分析
Multiple chronic conditions
Aged
Network analysis
