多病共存定义研究进展及概念体系设计

石尚; 陶舒曼; 童浩杰; 李婷婷; 陶芳标

doi:10.16835/j.cnki.1000-9817.2025045

多病共存定义研究进展及概念体系设计

doi: 10.16835/j.cnki.1000-9817.2025045

石尚^{1, 2},
陶舒曼^{2, 3},
童浩杰^{1, 2},
李婷婷^{1, 2},
陶芳标^{1, 2, ,}

1.
安徽医科大学公共卫生学院儿少卫生与妇幼保健学系，合肥 230032
2.
出生人口健康教育部重点实验室/环境与人口健康安徽省重点实验室
3.
安徽医科大学第二附属医院眼科

基金项目:

安黴省科技创新平台重大科技项目 202305a12020015

详细信息

作者简介:
石尚(2002-)，男，安徽淮北人，在读硕士，主要研究方向为儿童青少年健康

通讯作者:
陶芳标，E-mail：fbtao@126.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R366 R193
计量
- 文章访问数: 126
- HTML全文浏览量: 63
- PDF下载量: 37
- 被引次数: 0
出版历程
- 收稿日期: 2024-11-26
- 修回日期: 2024-12-24
- 网络出版日期: 2025-03-05
- 刊出日期: 2025-02-25

Research progress on the definition of multimorbidity and the design of conceptual frameworks

SHI Shang^{1, 2},
TAO Shuman^{2, 3},
TONG Haojie^{1, 2},
LI Tingting^{1, 2},
TAO Fangbiao^{1, 2
, ,}

1.
Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei (230032), Anhui Province, China

摘要

摘要: 儿童青少年多病共存问题日益凸显，但多病共存的定义尚未达成共识。随着研究的深入，相关成果在可比性和规范性等方面的问题逐渐显现。为此，对国内外关于多病共存的研究进行了系统梳理，并提出一种多病共存概念界定的分类体系，为后续研究的深入开展和成果间的相互借鉴提供更加便捷的条件。
- 共病现象 /
- 研究 /
- 儿童 /
- 青少年
Abstract: The issue of multimorbidity in children and adolescents is becoming increasingly prominent, but there is no consensus on the definition of multimorbidity. As research deepens, issues related to the comparability and standardization of relevant findings are gradually emerging. As a solution, a systematic review of both domestic and international research on multimorbidity is conducted, and a classification system for defining the concept of multimorbidity is proposed, offering more convenient conditions for the advancement of future research and cross-study exchange.
- Comorbidity /
- Research /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

参考文献(58)

[1]	邵瑞太, 宫恩莹, 韩莎莎, 等. 积极应对共病的挑战[J]. 中华医学杂志, 2024, 104(22): 2015-2021. SHAO R T, GONG E Y, HAN S S, et al. Proactively embracing the challenges of multimorbidity[J]. Natl Med J China, 2024, 104(22): 2015-2021. (in Chinese)
[2]	HAFEZPARAST N, TURNER E B, DUNBAR-REES R, et al. Adapting the definition of multimorbidity-development of a locality-based consensus for selecting included long term conditions[J]. BMC Fam Pract, 2021, 22(1): 124. doi: 10.1186/s12875-021-01477-x
[3]	SKOU S T, MAIR F S, FORTIN M, et al. Multimorbidity[J]. Nat Rev Dis Primers, 2022, 8(1): 48. doi: 10.1038/s41572-022-00376-4
[4]	SALIVE M E, SULS J, FARHAT T, et al. National institutes of health advancing multimorbidity research[J]. Med Care, 2021, 59(7): 622-624. doi: 10.1097/MLR.0000000000001565
[5]	CHOWDHURY S R, CHANDRA D D, SUNNA T C, et al. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and Meta-analysis[J]. EClinicalMedicine, 2023, 57: 101860. doi: 10.1016/j.eclinm.2023.101860
[6]	陶舒曼, 伍晓艳, 陶芳标. 《学生常见病多病共防技术指南》专题解读[J]. 中国学校卫生, 2024, 45(10): 1372-1377. doi: 10.16835/j.cnki.1000-9817.2024305 TAO S M, WU X Y, TAO F B. Expert interpretation on the Technical Guidelines for the Joint Prevention of Common Disease Multimorbidity among Students[J]. Chin J Sch Health, 2024, 45(10): 1372-1377. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2024305
[7]	CHEN T J, DONG B, DONG Y, et al. Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents[J]. Lancet, 2024, 403(10438): 1808-1820. doi: 10.1016/S0140-6736(23)02894-5
[8]	宋逸, 张秀红, 马军. 儿童青少年主要健康问题"共病-共因-共防"机制建立与探索[J]. 中国学校卫生, 2023, 44(9): 1281-1285. doi: 10.16835/j.cnki.1000-9817.2023.09.001 SONG Y, ZHANG X H, MA J. Establishment and exploration of the mechanism of Co-morbidity, Shared Etiology, and Shared Prevention of major health problems of children and adolescents[J]. Chin J Sch Health, 2023, 44(9): 1281-1285. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2023.09.001
[9]	CHUDASAMA Y V, KHUNTI K, GILLIES C L, et al. Healthy lifestyle and life expectancy in people with multimorbidity in the UK Biobank: a longitudinal cohort study[J]. PLoS Med, 2020, 17(9): e1003332. doi: 10.1371/journal.pmed.1003332
[10]	SUKUMARAN L, SABIN C A. Defining multimorbidity in people with HIV: what matters most?[J]. Curr Opin HIV AIDS, 2023, 18(2): 59-67. doi: 10.1097/COH.0000000000000778
[11]	RAJOO S S, WEE Z J, LEE P S S, et al. A systematic review of the patterns of associative multimorbidity in Asia[J]. Biomed Res Int, 2021, 2021: 6621785. doi: 10.1155/2021/6621785
[12]	FEINSTEIN A R. The pre-therapeutic classification of co-morbidity in chronic disease[J]. J Chron Dis, 1970, 23(7): 455-468. doi: 10.1016/0021-9681(70)90054-8
[13]	KRAEMER H C. Statistical issues in assessing comorbidity[J]. Stat Med, 1995, 14(8): 721-733. doi: 10.1002/sim.4780140803
[14]	HWANG W, WELLER W, IREYS H, et al. Out-of-pocket medical spe-nding for care of chronic conditions[J]. Health Aff (Millwood), 2001, 20(6): 267-278.
[15]	BONAVITA V, DE SIMONE R. Towards a definition of comorbidity in the light of clinical complexity[J]. Neurol Sci, 2008, 29(Suppl 1): S99-S102.
[16]	NORDGAARD J, NIELSEN K M, RASMUSSEN A R, et al. Psychiatric comorbidity: a concept in need of a theory[J]. Psychol Med, 2023, 53(13): 5902-5908. doi: 10.1017/S0033291723001605
[17]	LUBRANO E, SCRIFFIGNANO S, PERROTTA F M. Multimorbidity and comorbidity in psoriatic arthritis: a perspective[J]. Exp Rev Clin Immunol, 2020, 16(10): 963-972. doi: 10.1080/1744666X.2021.1825941
[18]	BROGLIE L, FRIEND B D, CHHABRA S, et al. Expanded HCT-CI definitions capture comorbidity better for younger patients of allogeneic HCT for nonmalignant diseases[J]. Transplant Cell Ther, 2023, 29(2): 121-125. doi: 10.1016/S2666-6367(23)00219-1
[19]	BRANDLMEIER P. Multimorbidity among elderly patients in an urban general practice[J]. ZFA (Stuttgart), 1976, 52(25): 1269-1275.
[20]	FRANKE H, GALL L, CHOWANETZ W. The so-called aging heart in 50- to 100-year-old subjects[J]. Z Kardiol, 1976, 65(11): 945-963.
[21]	VAN DEN AKKER M, BUNTINX F, KNOTTNERUS J A. Comorbidity or multimorbidity[J]. Eur J Gen Pract, 1996, 2(2): 65-70. doi: 10.3109/13814789609162146
[22]	RUSSO K. Assessment and treatment of adolescents with chronic medical conditions[J]. J Health Serv Psychol, 2022, 48(2): 69-78. doi: 10.1007/s42843-022-00059-4
[23]	WHO. The world health report 2008: primary health care now more than ever: introduction and overview[Z]. Geneva: WHO, 2008.
[24]	FARMER C, FENU E, O'FLYNN N, et al. Clinical assessment and management of multimorbidity: summary of NICE guidance[J]. BMJ, 2016, 354: i4843.
[25]	GULLIFORD M C, GREEN J M. Is multimorbidity a useful concept for public health?[J]. Lancet Public Health, 2024, 9(4): e210-e211. doi: 10.1016/S2468-2667(24)00050-1
[26]	PORTER T, ONG B N, SANDERS T. Living with multimorbidity? The lived experience of multiple chronic conditions in later life[J]. Health (London), 2020, 24(6): 701-718. doi: 10.1177/1363459319834997
[27]	BOYD C M, FORTIN M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design?[J]. Public Health Rev, 2010, 32(2): 451-474. doi: 10.1007/BF03391611
[28]	CHUA Y P, XIE Y, LEE P S S, et al. Definitions and prevalence of multimorbidity in large database studies: a scoping review[J]. Int J Environl Res Public Health, 2021, 18(4): 1673. doi: 10.3390/ijerph18041673
[29]	VAN OOSTROM S H, PICAVET H S, DE BRUIN S R, et al. Multimorbidity of chronic diseases and health care utilization in general practice[J]. BMC Fam Pract, 2014, 15: 61. doi: 10.1186/1471-2296-15-61
[30]	SATARIANO W A, BOYD C M. Improving the evidence base on multimorbidities through better research: a commentary on the U.S. HHS initiative. Multiple chronic conditions: a strategic framework[J]. J Comorb, 2013, 3(Spec Issue): 18-21.
[31]	ALFREDSSON J, ALEXANDER K P. Multiple chronic conditions in older adults with acute coronary syndromes[J]. Clin Geriatr Med, 2016, 32(2): 291-303. doi: 10.1016/j.cger.2016.01.009
[32]	ROMANO I, BUCHAN C, BAIOCCO-ROMANO L, et al. Physical-mental multimorbidity in children and youth: a scoping review[J]. BMJ Open, 2021, 11(5): e043124. doi: 10.1136/bmjopen-2020-043124
[33]	VAN DEN AKKER M, DIECKELMANN M, HUSSAIN M A, et al. Children and adolescents are not small adults: toward a better understanding of multimorbidity in younger populations[J]. J Clin Epidemiol, 2022, 149: 165-171. doi: 10.1016/j.jclinepi.2022.07.003
[34]	DIEDERICHS C, BERGER K, BARTELS D B. The measurement of multiple chronic diseases: a systematic review on existing multimorbidity indices[J]. J Gerontol A Biol Sci Med Sci, 2011, 66(3): 301-311.
[35]	JOHNSTON M C, CRILLY M, BLACK C, et al. Defining and measuring multimorbidity: a systematic review of systematic reviews[J]. Eur J Public Health, 2019, 29(1): 182-189. doi: 10.1093/eurpub/cky098
[36]	BÄHLER C, HUBER C A, BRVNGGER B, et al. Multimorbidity, heal-th care utilization and costs in an elderly community-dwelling population: a claims data based observational study[J]. BMC Health Serv Res, 2015, 15: 23. doi: 10.1186/s12913-015-0698-2
[37]	WHO. Multimorbidity[M]. Geneva: WHO, 2016.
[38]	FORTIN M, STEWART M, POITRAS M E, et al. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology[J]. Ann Fam Med, 2012, 10(2): 142-151. doi: 10.1370/afm.1337
[39]	CHARLSON M E, POMPEI P, ALES K L, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation[J]. J Chron Dis, 1987, 40(5): 373-383. doi: 10.1016/0021-9681(87)90171-8
[40]	BARNETT K, MERCER S W, NORBURY M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study[J]. Lancet, 2012, 380(9836): 37-43. doi: 10.1016/S0140-6736(12)60240-2
[41]	CASSELL A, EDWARDS D, HARSHFIELD A, et al. The epidemiology of multimorbidity in primary care: a retrospective cohort study[J]. Br J Gen Pract, 2018, 68(669): e245-e251. doi: 10.3399/bjgp18X695465
[42]	PRAZERES F, SANTIAGO L. Measuring multimorbidity in family practice: a comparison of two methods[J]. Fam Pract, 2018, 35(5): 571-575. doi: 10.1093/fampra/cmy014
[43]	CANIZARES M, HOGG-JOHNSON S, GIGNAC M A M, et al. Increasing trajectories of multimorbidity over time: birth cohort differences and the role of changes in obesity and income[J]. J Gerontol B Psychol Sci Soc Sci, 2018, 73(7): 1303-1314. doi: 10.1093/geronb/gbx004
[44]	RYAN A, MURPHY C, BOLAND F, et al. What is the impact of physical activity and physical function on the development of multimorbidity in older adults over time? a population-based cohort study[J]. Gerontol A Biol Sci Med Sci, 2018, 73(11): 1538-1544. doi: 10.1093/gerona/glx251
[45]	VOS R, VAN DEN AKKER M, BOESTEN J, et al. Trajectories of multimorbidity: exploring patterns of multimorbidity in patients with more than ten chronic health problems in life course[J]. BMC Fam Pract, 2015, 16: 2. doi: 10.1186/s12875-014-0213-6
[46]	吴耿茂, 廖伟斌, 郑耿彬, 等. 真实世界研究视角下社区多病共存患者全科医疗照顾模式应用效果分析[J]. 中国医药科学, 2020, 10(7): 14-18. WU G M, LIAO W B, ZHENG G B. et al. Analysis on effects of application of general medical care mode in community patients with multiple diseases from the perspective of real world study[J]. China Med Pharm, 2020, 10(7): 14-18. (in Chinese)
[47]	SIMARD M, RAHME E, CALFAT A C, et al. Multimorbidity measures from health administrative data using ICD system codes: a systematic review[J]. Pharmacoepidemiol Drug Saf, 2022, 31(1): 1-12. doi: 10.1002/pds.5368
[48]	HO I S, AZCOAGA-LORENZO A, AKBARI A, et al. Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies[J]. Lancet Public Health, 2021, 6(8): e587-e597. doi: 10.1016/S2468-2667(21)00107-9
[49]	LEE Y A J, XIE Y, LEE P S S, et al. Comparing the prevalence of multimorbidity using different operational definitions in primary care in Singapore based on a cross-sectional study using retrospective, large administrative data[J]. BMJ Open, 2020, 10(12): e039440. doi: 10.1136/bmjopen-2020-039440
[50]	PRIOR A, FENGER-GRØN M, LARSEN K K, et al. The association between perceived stress and mortality among people with multimorbidity: a prospective population-based cohort study[J]. Am J Epidemiol, 2016, 184(3): 199-210. doi: 10.1093/aje/kwv324
[51]	VASSILAKI M, AAKRE J A, MIELKE M M, et al. Multimorbidity and neuroimaging biomarkers among cognitively normal persons[J]. Neurology, 2016, 86(22): 2077-2084. doi: 10.1212/WNL.0000000000002624
[52]	LIM R, WEE W K, FOR W C, et al. Correlates, facilitators and barriers of physical activity among primary care patients with prediabetes in Singapore: a mixed methods approach[J]. BMC Public Health, 2020, 20(1): 1. doi: 10.1186/s12889-019-7969-5
[53]	HAUSWALDT J, SCHMALSTIEG-BAHR K, HIMMEL W. Different definitions of multimorbidity and their effect on prevalence rates: a retrospective study in German general practices[J]. Prim Health Care Res Dev, 2022, 23: e25. doi: 10.1017/S146342362200010X
[54]	LOW L L, KWAN Y H, KO M, et al. Epidemiologic characteristics of multimorbidity and sociodemographic factors associated with multimorbidity in a rapidly aging Asian country[J]. JAMA Netw Open, 2019, 2(11): e1915245. doi: 10.1001/jamanetworkopen.2019.15245
[55]	EXCOFFIER S, HERZIG L, N'GORAN A A, et al. Prevalence of multimorbidity in general practice: a cross-sectional study within the Swiss sentinel surveillance system (Sentinella)[J]. BMJ Open, 2018, 8(3): e019616. doi: 10.1136/bmjopen-2017-019616
[56]	WETTERLING T. Pathogenesis of multimorbidity: what is known?[J]. Z Gerontol Geriatr, 2021, 54(6): 590-596. doi: 10.1007/s00391-020-01752-z
[57]	JAIN S, ROSENBAUM P R, REITER J G, et al. Defining multimorbidity in older patients hospitalized with medical conditions[J]. J Gen Intern Med, 2023, 38(6): 1449-1458. doi: 10.1007/s11606-022-07897-4
[58]	JOHNSTON M C, CRILLY M, BLACK C, et al. Defining and measuring multimorbidity: a systematic review of systematic reviews[J]. Eur J Public Health, 2019, 29(1): 182-189. doi: 10.1093/eurpub/cky098