The prevalence of complex multimorbidity in Australia

Objective : To measure prevalence of multimorbidity and complex multimorbidity in the Australian population from a nationally representative prospective study and to identify the most prevalent patterns of chronic conditions and body systems affected. Methods : A sub‐study of the nationally representative BEACH program, using a random sample of 8,707 patients at encounters with 290 general practitioners. All diagnosed chronic conditions were recorded for each patient. Multimorbidity was defined as co‐occurrence of 2+ chronic conditions, while complex multimorbidity was defined as 3+ body systems each affected by at least one chronic condition. Results : We estimated: 47.4% of patients at GP encounters and one‐third (32.6%) of the population had multimorbidity; and 27.4% of patients at GP encounters and 17.0% of the Australian population had complex multimorbidity. The most prevalent combination pattern of three conditions was hypertension+hyperlipidaemia+ osteoarthritis (5.5% of patient at encounters and 3.3% of the population). Most prevalent combination of three body systems affected was circulatory+musculoskeletal+endocrine / nutritional/metabolic systems (11.1% of patients at encounters and 7.0% of the population). Conclusions and implications : A significant proportion of Australians have not only multimorbidity, but complex multimorbidity. To meet the challenge posed by complex multimorbidity, the single disease focus of our healthcare system needs to be re‐evaluated.     

锦州市老年人群共病疾病负担研究

目的 了解锦州市65岁及以上人群共病及疾病负担现状,为完善老年人群共病的管理提供理论依据。方法 采用分层整群随机抽样方法,抽取锦州市65岁及以上老年人群为研究对象,描述老年人群共病的流行病学分布特征,采用疾病负担分析指标——伤残调整寿命年（disability adjusted of life years, DALY）,伤残损失寿命年（years lived with disability, YLD）和早逝损失寿命年（years of life lost due to premature death, YLL）计算共病的疾病负担。结果 锦州市65岁及以上的老年人群共病患病率为19.66%,死亡率为14.12%;DALY为3 970.779人年,YLD为1 680.120人年,YLL为2290.695人年;其最主要的共病模式为高血压+冠心病,DALY为968.200人年;各年龄组间共病模式与DALY的差异均具有统计学意义（F = 90.498,P＜0.001）,男性和女性的DALY差异无统计学意义（t = 0.817,P = 0.414）。结论 锦州市老年人群共病模式为冠心病、高血压、脑卒中、糖尿病和肿瘤等疾病中某两种组合;老年人群共病疾病负担以死亡所造成的生命损失为主;共病的疾病负担在85岁及以上的年龄段最高。     

社区老年脑卒中人群共病现况分析

目的 分析天津市中北镇社区60岁及以上老年人群脑卒中共病现况,为脑卒中防治提供依据。方法 回顾性分析2017年1—12月于天津市中北镇社区卫生服务中心进行体检的60岁及以上人群的数据,分析脑卒中人群共病特点。结果 本研究调查11 574名老年人,脑卒中患病率为4.2%。脑卒中人群共病患病率为94.5%,女性共病患病率（97.1%）高于男性共病患病率（92.7%）,差异具有统计学意义（P＜0.001）。脑卒中人群2种共病患病率最高（34.3%）,其共病模式中高血压+肥胖最多（23.2%）,男性与女性最常见的共病模式分别是高血压+贫血（24.0%）、高血压+肥胖（23.5%）。2种共病间相关性分析显示,高血压与肥胖、贫血、脂肪肝相关,肥胖与糖尿病、贫血、脂肪肝相关,贫血与糖尿病相关（P均＜0.05）。结论 天津市中北镇社区老年脑卒中人群共病患病率高,应重视脑卒中共病的管理,并根据不同性别、年龄对脑卒中共病进行有针对性的干预与防治。     

Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden

We explored the role of age, gender, and socioeconomic status in the occurrence of chronic diseases and multimorbidity in 1099 elderly participants in the Kungsholmen Project. Cardiovascular and mental diseases were the most common chronic disorders. Of the participants, 55% had multimorbidity. Advanced age, female gender, and lower education were independently associated with a more than 50% increased risk for multimorbidity. Multimorbidity is the most common clinical picture of the elderly and may be increased by unhealthy behaviors linked to education.     

中国中老年人群慢性病现状调查与共病关联分析

  目的  利用关联规则研究我国中老年人群慢性病共病模式，探索慢性病间的关联性和关联强度。  方法  采用中国健康与养老追踪调查(China health and retirement longitudinal study，CHARLS)2015年的数据，纳入我国9省市45岁以上中老年人患14种慢性病情况，利用R 3.4.3软件中的Apriori算法对数据进行分析，挖掘慢性病共病情况。  结果  17 796名调查对象中，至少患有一种慢性病人数为12 245(68.81%)，同时患有两种及以上慢性病的人数为7 321(41.15%)。在筛选出的关联规则中，按照支持度排序，最常见的三种慢性病共病模式为血脂异常和心脏病、糖尿病和血脂异常、哮喘和慢性肺部疾病，规则支持度分别为6.77%、5.27%、4.28%，规则置信度分别为34.38%、43.14%、70.81%。关联规则结果多项指向心脏病、血脂异常、慢性肺部疾病。75岁以上年龄组强关联规则最多。  结论  心脏病存在于多种共病模式中，应加强对其的筛查与预防。血脂异常与糖尿病、高血压具有强关联性，且男性患者更易共患血脂异常。随着年龄增长，慢性病共患更普遍更复杂。     

广州市中老年人主动脉弓钙化的现患率及其相关特征

目的研究广州市≥50岁居民主动脉弓钙化(AAC)现患率及其相关特征。方法收集10 413名年龄在≥50岁居民的一般资料,体格检查和实验室检查结果;用东芝KSO-15R型X光机拍摄10 305名受检者胸部后前位X线平片,由2名高级放射科医师一起进行X线胸片AAC诊断,同时作独立阅片一致性可靠检验(Kappa值)。结果(1)2名高级放射科医师独立阅片对AAC诊断符合率为85.0%,一致性可靠检验Kappa值为0.68(P<0.001),显示其AAC诊断一致性是可靠的;(2) 10 305名(男3064,女7349)受检者平均年龄男(64.0±6.0)岁,女(66.2±5.8)岁,文化程度以中学或以下为主,从事工人和农民职业占一半以上;(3)AAC检出率为40.6%,女性(41.4%)高于男性(38.6%);(4)AAC随年龄增加而明显增加(P<0.001),但与职业无明显相关;(5)AAC主要发生于弓部(98.7%),长度>10 mm(57.6%)、宽度1-4 mm(74.0%)占多数,提示≥50岁者AAC程度较为严重。结论广州市≥50岁者AAC检出率为40.6%,明显高于国外相关报道,程度也较严重,其原因及机理正在进一步探讨。     

Estimation and projections of cancer prevalence from cancer registry data

A method, PIAMOD (Prevalence, Incidence, Analysis MODel), which allows the estimation and projection of cancer prevalence patterns by using cancer registry incidence and survival data is presented. As a first step the method involves the fit of incidence data by an age, period and cohort model to derive incidence projections. Prevalence is then estimated from modelled incidence and survival estimates. Cancer mortality is derived as a third step from modelled incidence, prevalence and survival. An application to female breast cancer is given for the Connecticut State by using data from the Connecticut Tumor Registry (CTR), 1973-1993. The age, period and cohort model fitted incidence quite well and allowed us to derive long-term projections up to 2030. Patients' survival was also projected to future years according to a scenario approach based on two extreme hypotheses: steady, that is, no more improvements after 1993 (conservative), and continuously improving at the same rate as during the observation period. Age-standardized estimated incidence shows a changing trend around the year 2005, when it starts decreasing. Age-standardized prevalence is expected to increase and change trend at a later date. Breast cancer mortality is projected as decreasing, as the combined result of no further increase in incidence and improving cancer patients' survival. An easy-to-use PIAMOD software package, on which work is in progress, will be made available to individual cancer registries and/or health planning institutions or authorities once it is developed. The use of the PIAMOD method for cancer registries will allow them to provide results of paramount importance for the whole community involved in the assessment of future disease burden scenarios in an evolving society.     

Dairy intakes affect bone density in the elderly

BACKGROUND: Race and sex differences in the effect of diet on bone mineral density (BMD) at the hip in the elderly are unknown. OBJECTIVES: This study related cross-sectional nutrient and dairy product consumption to hip BMD in white and black men and women aged >60 y and evaluated the influence of nutrient and dairy product consumption on changes in BMD in a white cohort participating in a calcium, vitamin D, or placebo trial. DESIGN: The Health Habits and History Questionnaire was used in 289 white women and 116 white men who participated in the trial and in 265 black women and 75 black men to predict total hip and femoral neck BMD or changes in BMD. RESULTS: Blacks had higher calcium intakes than did whites (700 and 654 mg/d, respectively; P = 0.0094), and men had higher calcium intakes than did women (735 and 655 mg/d, respectively; P = 0.0007). For men, the correlation between total hip BMD and dairy calcium intake after adjustment for age, race, and weight was 0.23 (P < 0.005); this relation was not significant in women (r = 0.02, P = 0.12). Similar results were found for femoral neck BMD. In the longitudinal study, calcium supplementation reduced bone loss from the total hip and femoral neck in those who consumed <1.5 servings of dairy products/d and were <72 y old. CONCLUSIONS: Cross-sectional results indicated that higher dairy product consumption is associated with greater hip BMD in men, but not in women. Calcium supplementation protected both men and women from bone loss in the longitudinal study of whites.     

Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study

Data on multimorbidity among the elderly people in Bangladesh are lacking. This paper reports the prevalence and distribution patterns of multimorbidity among the elderly people in rural Bangladesh. This cross-sectional study was conducted among persons aged > or = 60 years in Matlab, Bangladesh. Information on their demographics and literacy was collected through interview in the home. Information about their assets was obtained from a surveillance database. Physicians conducted clinical examinations at a local health centre. Two physicians diagnosed medical conditions, and two senior geriatricians then evaluated the same separately. Multimorbidity was defined as suffering from two or more of nine chronic medical conditions, such as arthritis, stroke, obesity, signs of thyroid hypofunction, obstructive pulmonary symptoms, symptoms of heart failure, impaired vision, hearing impairment, and high blood pressure. The overall prevalence of multimorbidity among the study population was 53.8%, and it was significantly higher among women, illiterates, persons who were single, and persons in the non-poorest quintile. In multivariable logistic regression analyses, female sex and belonging to the non-poorest quintile were independently associated with an increased odds ratio of multimorbidity. The results suggest that the prevalence of multimorbidity is high among the elderly people in rural Bangladesh. Women and the non-poorest group of the elderly people are more likely than men and the poorest people to be affected by multimorbidity. The study sheds new light on the need of primary care for the elderly people with multimorbidity in rural Bangladesh.     

Does multimorbidity still remain a matter of the elderly: Lithuanian national data analysis

IntroductionMultimorbidity – the coexistence of ≥2 chronic conditions in same individual is usually associated with older age. There is an increase in its prevalence at a much younger age, however with very limited research specifying that.ObjectiveTo identify age breaking points for the occurrence of multimorbidity.MethodsThe study included patients, who used any healthcare services between the 01/01/2012 and 30/06/2014. Patients were divided into two groups – with single chronic condition and with multimorbidity. Age-specific proportion of multimorbidity, rate of primary and outpatient visits, number of hospitalizations and prescribed reimbursed medications between these groups were analyzed.ResultsThe study included 452578 patients, 94.63% of them had more than one chronic condition. The risk increase with every consecutive year for developing multimorbidity was between the age of 28 and 39 years. The age breaking point for the rapid increase in hospitalizations was about 29 years in multimorbidity group. The proportion of patients with multimorbidity using expensive medications starts to increase at the age of 41.ConclusionsThe risk of acquiring an additional chronic condition rises exponentially from the age of 29 years and platos between the age of 51 and 57. Patients with multimorbidity require increasing amounts of primary healthcare resources, where patients with single chronic condition require decreasing primary care usage, possibly attributed to successful patient empowerment.     

Changing definitions altered multimorbidity prevalence,but not burden associations,in a musculoskeletal population

ObjectivesThe inclusion of musculoskeletal conditions within multimorbidity research is inconsistent, and working-age populations are largely ignored. We aimed to: (1) estimate multimorbidity prevalence among working-age individuals with a range of musculoskeletal conditions; and (2) better understand the implications of decisions about the number and range of conditions constituting multimorbidity on the strength of associations between multimorbidity and burden (e.g., health status and health care utilization).Study Design and SettingUsing data from the Australian National Health Survey 2007–08, the associations between burden measures and three ways of operationalizing multimorbidity (survey, policy, and research based) within the working-age (18–64 years) musculoskeletal population were estimated using multiple logistic regression (age and gender adjusted).ResultsDepending on definition, from 20.2% to 75.4% of working-age individuals with musculoskeletal conditions have multimorbidity. Irrespective of definition, multimorbidity was associated with increased likelihood of subjective health burden, pain or musculoskeletal medicines use, nonmusculoskeletal specialist and pharmacist (advice only) consultations, and reduced likelihood of not consulting health professionals. A group with intermediate health outcomes was considered multimorbid by some, but not all definitions. With the restrictive policy and research multimorbidity definitions, this intermediate group is included within the reference population (i.e., are considered nonmultimorbid). This worsens the reference group's apparent health status thereby leveling the comparative burden between those with and without multimorbidity. Consequently, dichotomous cut points lead to similar associations with burden measures despite the increasingly restrictive multimorbidity definitions used.ConclusionsAll multimorbidity definitions were associated with burden among the working-age musculoskeletal population. However, dichotomous cut points obscure the gradient of increased burden associated with restrictive definitions.     

Taste and smell perception affect appetite and immunity in the elderly

The losses in taste and smell that occur with advancing age can lead to poor appetite, inappropriate food choices, as well as decreased energy consumption. Decreased energy consumption can be associated with impaired protein and micronutrient status and may induce subclinical deficiencies that directly impact function. Most nutritional interventions in the elderly do not compensate for taste and smell losses and complaints. For example, cancer is a medical condition in which conventional nutritional interventions (that do not compensate for taste and smell losses) are ineffective. Evidence is now emerging that suggests compensation for taste and smell losses with flavor-enhanced food can improve palatability and/or intake, increase salivary flow and immunity, reduce chemosensory complaints in both healthy and sick elderly, and lessen the need for table salt.     

A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology

PURPOSE

We sought to identify and compare studies reporting the prevalence of multimorbidity and to suggest methodologic aspects to be considered in the conduct of such studies.

METHODS

We searched the literature for English- and French-language articles published between 1980 and September 2010 that described the prevalence of multimorbidity in the general population, in primary care, or both. We assessed quality of included studies with a modified version of the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results of individual prevalence studies were adjusted so that they could be compared graphically.

RESULTS

The final sample included 21 articles: 8 described studies conducted in primary care, 12 in the general population, and 1 in both. All articles were of good quality. The largest differences in prevalence of multimorbidity were observed at age 75 in both primary care (with prevalence ranging from 3.5% to 98.5% across studies) and the general population (with prevalence ranging from 13.1% to 71.8% across studies). Apart from differences in geographic settings, we identified differences in recruitment method and sample size (primary care: 980–60,857 patients; general population: 1,099–316,928 individuals), data collection, and the operational definition of multimorbidity used, including the number of diagnoses considered (primary care: 5 to all; general population: 7 to all). This last aspect seemed to be the most important factor in estimating prevalence.

CONCLUSIONS

Marked variation exists among studies of the prevalence of multimorbidity with respect to both methodology and findings. When undertaking such studies, investigators should carefully consider the specific diagnoses included and their number, as well as the operational definition of multimorbidity.     

Informal and formal care for elderly persons: how adult children's characteristics affect the use of formal care in Japan

Informal care by adult children remains the most common source of caregiving for elderly parents in Japan, even after the introduction of long-term care insurance in 2000. We estimate how the potential supply of child caregivers affects the use of formal care of elderly parents, focusing on the differences across children. We find that the effects of children's presence vary substantially with gender, marital status, and opportunity costs of children. The potential supply of daughters-in-law, as the traditional source of informal care, is less important in providing care than that of unmarried children. The opportunity costs of children make a difference in the use of formal long-term care.     

High prevalence of hyperuricemia in elderly Taiwanese

Serum urate status, the prevalence of hyperuricemia and their relationship to the metabolic syndrome in elderly Taiwanese were described using data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000), in which a stratified multi-stage clustered sampling scheme was applied. Complete data from biochemical assays and anthropometric measures for 1225 males and 1167 females were included in the analysis. The mean urate level and 95% confidence interval was 411 (398, 424) microM for males and 357 (347, 367) microM for females. Males had significantly higher serum urate levels than females across all age groups (P<0.05). No significant difference in mean serum urate was found among the four age groups of males. On the other hand, females of 75-79 years had significantly higher serum urate levels (376 microM) than that of the 65-69 and>or=80 age groups. The overall prevalence of hyperuricemia (>or=416.7 microM (7.0 mg/dL) in the elderly was 36% (46% for males and 26% for females). Among the participants, 4.2% of males and 1.1% of females were taking medication to lower uric acid. The elderly (males 455 microM; females 416 microM) of the Mountain areas, mainly indigenes, had the highest mean serum urate overall, however, the highest prevalence of hyperuricemia in males was found in the PengHu islands (62%) and that for females in the Mountain areas (51%). The odds ratio (OR) for hyperuricemia was 2.84 for males in the PengHu islands and 4.33 for females in Mountain areas, compared with their counterparts in the third stratum in the northern areas. Adjusting for obesity, alcohol and other related covariates did not alter the relative rank of the ORs in the various strata. Elderly males (22%) had a significantly lower rate of metabolic syndrome (MS) than females (39%) (P<0.05). For both genders, those with MS had a significantly higher mean serum urate (males 436 microM vs. 405 microM; females 389 microM vs. 338 microM) and prevalence of hyperuricemia (males 56% vs. 43%; females 38% vs.19%) (P<0.05). The population attributable risk for MS from hyperuricemia was 18.8% in men and 15.5% in women. In conclusion, the mean serum urate and prevalence of hyperuricemia in the elderly in Taiwan were higher than those found in other populations and was significantly associated with MS. Gene-environmental interaction may play a key role since great geographical variation exists within various Han Chinese groups in Taiwan and between Han Chinese and Taiwanese indigenes.     

Isolated systolic hypertension: declining prevalence in the elderly

Isolated systolic hypertension is a prevalent condition among elderly U.S. residents of all age, sex, and race groups. In a population-based survey conducted on 4,672 adult residents of Georgia in 1981, prevalence rates were considerably below those noted in earlier surveys, such as Baldwin County, Georgia (1962), National Health Examination Series I (1960-1962), Evans County, Georgia (1967-1969), National Health and Nutrition Examination Survey I (1971-1974) and/or II (1976-1980). The lower 1981 prevalence of isolated systolic hypertension in Georgia was observed in association with a much greater likelihood of anti-hypertensive therapy in adult and elderly patients. The overall trend for early and more aggressive therapy of diastolic hypertension might account for less arterial rigidity and occurrence of isolated systolic hypertension in later life.     

The prevalence of urinary incontinence in elderly women

On the basis of a survey in March 1989 among non institutionalized women aged 60 years and older living in Amstelveen, the prevalence of urinary incontinence was estimated. Also investigated were factors potentially associated with urinary incontinence, as well as the psychosocial impact on daily living activities. The sample comprised 1049 women; 719 postal histories were completed. Statistical analyses involved chi 2 and chi 2 trend tests, and the influence of determinants was assessed with multivariate logistic regression. The prevalence of urinary incontinence was 23.5%, with a slight increase with increasing age. Daily urine loss was reported in 14.0% of all women. Significantly associated with urinary incontinence were an increased diurnal as well as nocturnal voiding frequency, immobility and use of diuretics. Urinary incontinence actually interfered with daily living activities in 65.3% of the women.