| アブストラクト | BACKGROUND: Globally, there is a paucity of multimorbidity and comorbidity data, especially for minority ethnic groups and younger people. We estimated the frequency of common disease combinations and identified non-random disease associations for all ages in a multiethnic population. METHODS: In this population-based study, we examined multimorbidity and comorbidity patterns stratified by ethnicity or race, sex, and age for 308 health conditions using electronic health records from individuals included on the Clinical Practice Research Datalink linked with the Hospital Episode Statistics admitted patient care dataset in England. We included individuals who were older than 1 year and who had been registered for at least 1 year in a participating general practice during the study period (between April 1, 2010, and March 31, 2015). We identified the most common combinations of conditions and comorbidities for index conditions. We defined comorbidity as the accumulation of additional conditions to an index condition over an individual's lifetime. We used network analysis to identify conditions that co-occurred more often than expected by chance. We developed online interactive tools to explore multimorbidity and comorbidity patterns overall and by subgroup based on ethnicity, sex, and age. FINDINGS: We collected data for 3 872 451 eligible patients, of whom 1 955 700 (50.5%) were women and girls, 1 916 751 (49.5%) were men and boys, 2 666 234 (68.9%) were White, 155 435 (4.0%) were south Asian, and 98 815 (2.6%) were Black. We found that a higher proportion of boys aged 1-9 years (132 506 [47.8%] of 277 158) had two or more diagnosed conditions than did girls in the same age group (106 982 [40.3%] of 265 179), but more women and girls were diagnosed with multimorbidity than were boys aged 10 years and older and men (1 361 232 [80.5%] of 1 690 521 vs 1 161 308 [70.8%] of 1 639 593). White individuals (2 097 536 [78.7%] of 2 666 234) were more likely to be diagnosed with two or more conditions than were Black (59 339 [60.1%] of 98 815) or south Asian individuals (93 617 [60.2%] of 155 435). Depression commonly co-occurred with anxiety, migraine, obesity, atopic conditions, deafness, soft-tissue disorders, and gastrointestinal disorders across all subgroups. Heart failure often co-occurred with hypertension, atrial fibrillation, osteoarthritis, stable angina, myocardial infarction, chronic kidney disease, type 2 diabetes, and chronic obstructive pulmonary disease. Spinal fractures were most strongly non-randomly associated with malignancy in Black individuals, but with osteoporosis in White individuals. Hypertension was most strongly associated with kidney disorders in those aged 20-29 years, but with dyslipidaemia, obesity, and type 2 diabetes in individuals aged 40 years and older. Breast cancer was associated with different comorbidities in individuals from different ethnic groups. Asthma was associated with different comorbidities between males and females. Bipolar disorder was associated with different comorbidities in younger age groups compared with older age groups. INTERPRETATION: Our findings and interactive online tools are a resource for: patients and their clinicians, to prevent and detect comorbid conditions; research funders and policy makers, to redesign service provision, training priorities, and guideline development; and biomedical researchers and manufacturers of medicines, to provide leads for research into common or sequential pathways of disease and inform the design of clinical trials. FUNDING: UK Research and Innovation, Medical Research Council, National Institute for Health and Care Research, Department of Health and Social Care, Wellcome Trust, British Heart Foundation, and The Alan Turing Institute. |
|---|
| 投稿者 | Kuan, Valerie; Denaxas, Spiros; Patalay, Praveetha; Nitsch, Dorothea; Mathur, Rohini; Gonzalez-Izquierdo, Arturo; Sofat, Reecha; Partridge, Linda; Roberts, Amanda; Wong, Ian C K; Hingorani, Melanie; Chaturvedi, Nishi; Hemingway, Harry; Hingorani, Aroon D |
|---|
| 組織名 | Institute of Health Informatics, University College London, London, UK; Health;Data Research UK, University College London, London, UK. Electronic address:;v.kuan@ucl.ac.uk.;Data Research UK, University College London, London, UK; UCL BHF Research;Accelerator, University College London, London, UK; Alan Turing Institute,;London, UK; University College London Hospitals NIHR Biomedical Research Centre,;London, UK; British Heart Foundation Data Science Centre, HDR UK, London, UK.;Centre for Longitudinal Studies, University College London, London, UK; MRC Unit;for Lifelong Health and Ageing at UCL, University College London, London, UK.;Department of Non-Communicable Disease Epidemiology, London School of Hygiene &;Tropical Medicine, London, UK.;Tropical Medicine, London, UK; Centre for Primary Care, Wolfson Institute of;Primary Care, Queen Mary University of London, London, UK.;Data Research UK, University College London, London, UK.;Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool,;UK; British Heart Foundation Data Science Centre, HDR UK, London, UK.;Institute of Healthy Ageing, Department of Genetics, Evolution and Environment,;University College London, London, UK; Max Planck Institute for Biology of;Ageing, Cologne, Germany.;Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK.;School of Pharmacy, University College London, London, UK; Centre for Safe;Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS;Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative;Region, China; Aston Pharmacy School, Aston University, Birmingham, UK.;Moorfields Eye Hospital, London, UK.;MRC Unit for Lifelong Health and Ageing at UCL, University College London,;London, UK.;Data Research UK, University College London, London, UK; University College;London Hospitals NIHR Biomedical Research Centre, London, UK.;UCL BHF Research Accelerator, University College London, London, UK; Institute of;Cardiovascular Science, University College London, London, UK; University College |
|---|
