中国老年住院患者共病疾病谱：一项基于深圳市的横断面研究

The spectrum of multimorbidity in elderly Chinese inpatients: a cross-sectional study based in Shenzhen

关键词:  共病  疾病谱  中国老年人  慢性病

Key words:  multimorbidity  spectrum  elderly chinese  chronic diseases

摘要:

目的　探讨深圳市老年住院患者的共病疾病谱及其基于性别的差异。方法　收集 130 564 名 2017-2018 年 深圳市老年住院患者的资料，根据患慢性病的数量将共病疾病谱设为一、二、三、四型，再依性别-模式交叉分组进行分类 统计分析。结果　83.15%的深圳老年住院患者存在共病情况，其中二型占 18.76%，三型占 17.44%，四型占 14.71%，四型 以上占 32.24%。一型中占比最高的 3 种慢性病是老年性白内障、高血压和心脏病；二型最常见的 3 种共病组合是（高血 压、老年性白内障）（高血压、心脏病）和（高血压、脑血管病）；三型的前 3 位组合是（高血压、糖尿病、老年性白内障）（高血 压、脑血管病、心脏病）（高血压、糖尿病、心脏病）。四型前 3 顺位的组合是（高血压、糖尿病、脑血管病、心脏病）（高血压、 脑血管病、外周血管疾病、心脏病）（高血压、糖尿病、脑血管病、外周血管疾病）。部分疾病或共病组合存在性别差异，如女 性患老年性白内障、骨质疏松和（高血压、老年性白内障）的比例高于男性；男性患（高血压、慢阻肺、心脏病）和（高血压、 糖尿病、慢性肾病、心脏病）的比例高于女性。结论　深圳市老年住院患者慢性病共病疾病谱较复杂，男女之间存在差异， 高血压及与其他慢性病共病组合较为常见。

Abstract:

Objective　To identify a multimorbidity spectrum of elderly inpatients grouped by gender to provide scientific basis for rational allocation of health resources, clinical decision-making, and policy development. Methods　The multimorbidity spectrum of elderly inpatients in Shenzhen China, from 2017 to 2018 was statistically analyzed based on the ICD-10 classification system, including single, dyad, triad, and quartet combinations. Results　Multimorbidity was present in 83.15% of the participants, of which 18.76% were dyads model, 17.44% were triads model, and 14.71% were quartets model. The most prevalent three chronic diseases in single model are senile cataract, hypertension, and heart disease; the most common three combinations of multimorbidity in dyads model are （hypertension, senile cataract）, （hypertension, heart disease）, and （hypertension, cerebrovascular disease）; and the top three disease combinations in triads model are （hypertension, diabetes mellitus, senile cataract）,（hypertension, cerebrovascular disease, heart disease）, and （hypertension, diabetes mellitus, heart disease）. The top three disease combinations for quartets model are （hypertension, diabetes mellitus, cerebrovascular disease, heart disease）,（hypertension, cerebrovascular disease, peripheral vascular disease, heart disease）, and （hypertension, diabetes mellitus, cerebrovascular disease, peripheral vascular disease）. Some diseases or combinations showed gender differences, for example, females had higher proportions of senile cataract, osteoporosis, and the combination （hypertension, senile cataract） compared to males; while the proportions of male suffering from （hypertension, chronic obstructive pulmonary disease, heart disease） and （hypertension, diabetes mellitus, chronic kidney disease , heart disease） were higher than that of female. Conclusion　This study revealed the complexity of the spectrum of chronic disease multimorbidity, the differences between men and women, and the combinations of hypertension with other chronic diseases, which should be the focus of multimorbidity research and prevention.