Prevalence pattern and component correlation of chronic disease comorbidity among the elderly in China
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摘要:
目的 了解中国老年人慢性病共病患病现状、患病模式及高发共病组合中慢性病疾病间的相关性，为优先建立高发共病模式的治疗指南、优化共病管理、制定共病防治措施提供切入点。 方法 收集2015年中国健康与养老追踪调查（CHARLS）中11 707名 ≥ 60岁老年人的数据资料，分析老年人的慢性病共病患病现状和患病模式，并计算慢性病共病的相对风险比（RR）和实际预期比（O/E）以衡量疾病间的相关性。 结果 中国11 707名 ≥ 60岁老年人的慢性病共病患病率为43.6 %；高血压、血脂异常、糖尿病或血糖升高、恶性肿瘤、慢性肺部疾患、肝脏疾病、心脏病、中风、肾脏疾病、胃部疾病、情感及精神方面疾病、与记忆相关疾病、关节炎或风湿病、哮喘等14种慢性病共形成804种共病组合，其中二元共病组合76种，三元共病组合169种；14种慢性病中，哮喘（RR = 31.77）、中风（RR = 22.60）、心脏病（RR = 18.88）、糖尿病或血糖升高（RR = 17.47）、血脂异常（RR = 17.05）、与记忆相关疾病（RR = 16.61）、肾脏疾病（RR = 14.04）、肝脏疾病（RR = 13.46）和慢性肺部疾患（RR = 11.97）为高共病风险疾病；共存疾病相关性分析结果显示，二元共病组合中“肺部疾病 + 哮喘”O/E值最高为162.15，三元共病组合中“中风 + 情感及精神方面疾病 + 与记忆相关疾病”O/E值最高为10 287.72。 结论 哮喘、中风、心脏病、糖尿病或血糖升高、血脂异常、与记忆相关疾病、肾脏疾病、肝脏疾病和慢性肺部疾患具有高度的共病风险，应当引起临床诊疗、疫病预防和疾病护理领域重点关注。 Abstract:Objective To examine the prevalence and the pattern of chronic disease comorbidity and the correlation among chronic disease comorbidity components among elderly residents in China and to provide evidences for developing treatment and prevention strategies and optimizing management of chronic disease comorbidities. Methods We extracted the data on 11 707 community residents aged ≥ 60 years from China Health and Retirement Longitudinal Study (CHARLS) conducted in 28 province-level regions across China in 2015. The prevalence and pattern of chronic disease comorbidity among the elderly were analyzed and the correlation among chronic disease comorbidity components was estimated by calculating the relative risk ratio (RR) and the observed-to-expected ratio (O/E) of the comorbidy. Results Among all the elderly, the prevalence rate of chronic disease comorbidity was 43.6% and totally 804 comorbid combinations of 14 chronic diseases (hypertension, dyslipidemia, diabetes or high blood sugar, cancer or malignant tumor, chronic lung diseases, liver disease, heart attack, stroke, kidney disease, stomach or other digestive disease, emotional/nervous or psychiatric problems, memory-related disease, arthritis or rheumatism, and asthma) were observed, with 76 kinds of dyad comorbidity and 169 kinds of triad comorbidity. For the 14 chronic diseases in the observed comorbidity combinations, following conditions are among the diseases with higher risk of comorbidity: asthma (RR = 31.77), stroke (RR = 22.60), heart disease (RR = 18.88), diabetes or elevated blood glucose (RR = 17.47), dyslipidemia (RR = 17.05), memory-related diseases (RR = 16.61), kidney disease (RR = 14.04), liver disease (RR = 13.46), and chronic lung disease (RR = 11.97). The results of correlation analysis revealed the dyad comorbidity with the highest O/E (162.15) was pulmonary disease plus asthma and the triad comorbidity with the highest O/E (10 287.72) was stroke plus emotional and mental illness plus memory related diseases. Conclusion Asthma, stroke, heart disease, diabetes or high blood suga, dyslipidemia, memory-related disease, kidney disease, liver disease and chronic lung disease are the diseases with a higher risk of comorbidity among elderly residents in China and the diseases need to be concerned by clinic and public health professionals. -
表 1 中国老年人患病率居前10位的二元共病组合和三元共病组合
顺位 二元共病组合 三元共病组合 患病模式 患病数 患病率（%） 占二元共病组合
患病数比例患病模式 患病数 患病率（%） 占三元共病组合
患病数比例1 关节炎或风湿病 + 胃部疾病 554 4.73 23.33 关节炎或风湿病 + 胃部疾病 + 高血压 139 1.19 10.14 2 关节炎或风湿病 + 高血压 334 2.85 14.06 关节炎或风湿病 + 胃部疾病 + 慢性肺部疾患 96 0.82 7.00 3 关节炎或风湿病 + 慢性肺部疾患 132 1.13 5.56 关节炎或风湿病 + 心脏病 + 高血压 74 0.63 5.40 4 高血压 + 心脏病 121 1.03 5.05 关节炎或风湿病 + 心脏病 + 胃部疾病 69 0.59 5.03 5 高血压 + 胃部疾病 104 0.89 4.38 关节炎或风湿病 + 高血压 + 血脂异常 52 0.44 3.79 6 高血压 + 血脂异常 101 0.86 4.25 高血压 + 血脂异常 + 心脏病 49 0.42 3.57 7 关节炎或风湿病 + 心脏病 89 0.76 3.75 关节炎或风湿病 + 肾脏疾病 + 胃部疾病 49 0.42 3.57 8 关节炎或风湿病 + 肾脏疾病 75 0.64 3.16 关节炎或风湿病 + 哮喘 + 慢性肺部疾患 47 0.40 3.43 9 高血压 + 糖尿病或血糖升高 68 0.58 2.86 高血压 + 血脂常 + 糖尿病或血糖升高 41 0.35 2.99 10 慢性肺部疾患 + 哮喘 62 0.53 2.61 关节炎或风湿病 + 胃部疾病 + 肝脏疾病 62 0.53 2.61 
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表 2 中国老年人O/E值前10位慢性病二元共病组合和三元共病组合
顺位 二元共病组合 O/E值 三元共病组合 O/E值 1 慢性肺部疾患 + 哮喘 162.15 中风 + 情感及精神方面疾病 + 与记忆相关疾病 10 287.72 2 情感及精神方面疾病 + 与记忆相关疾病 97.73 情感及精神方面疾病 + 与记忆相关疾病 + 哮喘 8 498.56 3 血脂异常 + 糖尿病或血糖升高 38.39 情感及精神方面疾病 + 慢性肺部疾患 + 哮喘 2 274.26 4 心脏病 + 与记忆相关疾病 25.69 心脏病 + 中风 + 与记忆相关疾病 2 253.50 5 中风 + 与记忆相关疾病 23.66 慢性肺部疾患 + 心脏病 + 哮喘 1 992.69 6 高血压 + 中风 22.85 血脂异常 + 心脏病 + 与记忆相关疾病 1 443.25 7 高血压 + 糖尿病或血糖升高 20.64 高血压 + 血脂异常 + 糖尿病或血糖升高 1 398.31 8 恶性肿瘤 + 中风 19.55 高血压 + 中风 + 与记忆相关疾病 1 387.35 9 与记忆相关疾病 + 哮喘 19.55 慢性肺部疾患 + 与记忆相关疾病 + 哮喘 1 376.53 10 中风 + 哮喘 19.55 慢性肺部疾患 + 关节炎或风湿病 + 哮喘 1 265.95
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