Practical significance, content, methods and prospects of the study of geriatric comorbidity_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Yili ¹ , HUANG Xinyi ² , QI Baoyu ³ , XU Aili ³ , SUN Kai ³ , SHEN Hao ⁴ , CHAI Yan ⁵ , XIE Yanming ⁶ , ZHU Liguo ³ ,  WEI Xu ³

1. School of Traditional Chinese Medicine & School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China;
2. School of Public Health, Nanjing Medical University, Nanjing 210029, P. R. China;
3. Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, P. R. China;
4. Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P. R. China;
5. School of Public Health, University of California, Los Angeles 90001, USA;
6. Institute of Basic Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, P. R. China;

Corresponding?author：

WEI Xu, Email: weixu.007@163.com

Keywords：

Comorbidity; Aging society; Healthy China; Policy decision

DOI：

10.7507/1672-2531.202302103

Video：

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Abstract Full text Figures/Tables Video References Cited by

Comorbidity is a prominent public health problem in the elderly population. To carry out research on the comorbidity of the elderly is not only an important breakthrough to realize the national strategy of actively responding to the aging population, but also a vivid practice of earnestly implementing the "Healthy China" and other action programs. Based on the major public health issues of elderly comorbidity, this paper lists the main contents and methods of elderly comorbidity research from the perspective of secondary research and empirical research, and holds that this field contains both the profound thought of "holistic concept" and the advanced idea of "integrative medicine". At the same time, under the background of the new era, the gradual deepening of the research in this field may give birth to a brand-new discipline - geriatric comorbidity.

Citation： ZHANG Yili, HUANG Xinyi, QI Baoyu, XU Aili, SUN Kai, SHEN Hao, CHAI Yan, XIE Yanming, ZHU Liguo, WEI Xu. Practical significance, content, methods and prospects of the study of geriatric comorbidity. Chinese Journal of Evidence-Based Medicine, 2023, 23(7): 862-868. doi: 10.7507/1672-2531.202302103 Copy

1.	Chen X, Giles J, Yao Y, et al. The path to healthy ageing in China: a Peking University-Lancet Commission. Lancet, 2022, 400(10367): 1967-2006.
2.	Whitty CJM, MacEwen C, Goddard A, et al. Rising to the challenge of multimorbidity. BMJ, 2020, 368: l6964.
3.	Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis, 1970, 23(7): 455-468.
4.	World Health Organization. Multimorbidity: technical series on safer primary care. Geneva: World Health Organization, 2016.
5.	曹豐, 王亞斌, 薛萬國, 等. 中國老年疾病臨床多中心報告. 中華老年多器官疾病雜志, 2018, 17(11): 801-808.
6.	中國居民營養與慢性病狀況報告(2020年). 營養學報, 2020, 42(6): 521.
7.	章軼立, 黃馨懿, 齊保玉, 等. 老年人群共病問題現狀挑戰與應對策略. 中國全科醫學, 2022, 25(35): 4363-4368.
8.	王麗敏, 陳志華, 張梅, 等. 中國老年人群慢性病患病狀況和疾病負擔研究. 中華流行病學雜志, 2019, 40(3): 277-283.
9.	范瀟茹, 陳莎, 施予寧, 等. 我國中老年人慢性病共病現狀及其對衛生服務利用和醫療費用的影響研究. 中國全科醫學, 2022, 25(19): 2371-2378.
10.	Petrova D, Catena A, Rodríguez-Barranco M, et al. Physical comorbidities and depression in recent and long-term adult cancer survivors: NHANES 2007-2018. Cancers (Basel), 2021, 13(13): 3368.
11.	Wang X, Mukherjee B, Park SK. Associations of cumulative exposure to heavy metal mixtures with obesity and its comorbidities among U. S. adults in NHANES 2003-2014. Environ Int, 2018, 121(Pt 1): 683-694.
12.	Teagle WL, Norris ET, Rishishwar L, et al. Comorbidities and ethnic health disparities in the UK biobank. JAMIA Open, 2022, 5(3): ooac057.
13.	Vanent KN, Leasure AC, Acosta JN, et al. Association of chronic kidney disease with risk of intracerebral hemorrhage. JAMA Neurol, 2022, 79(9): 911-918.
14.	楊帆. 中國健康與養老追蹤調查數據庫介紹. 實證社會科學, 2017, 3(1): 115-122.
15.	閆偉, 路云, 張冉, 等. 基于CHARLS數據分析的我國老年人共病現狀研究. 中華疾病控制雜志, 2019, 23(4): 426-430.
16.	Kim K, Kim S, Myung W, et al. Shared genetic background between Parkinson's disease and schizophrenia: a two-sample Mendelian randomization study. Brain Sci, 2021, 11(8): 1042.
17.	Patrick MT, Li Q, Wasikowski R, et al. Shared genetic risk factors and causal association between psoriasis and coronary artery disease. Nat Commun, 2022, 13(1): 6565.
18.	Lin L, Luo P, Yang M, et al. Causal relationship between osteoporosis and osteoarthritis: a two-sample Mendelian randomized study. Front Endocrinol (Lausanne), 2022, 13: 1011246.
19.	Musso G, Saba F, Cassader M, et al. Angiotensin Ⅱ type 1 receptor rs5186 gene variant predicts incident NAFLD and associated hypertension: role of dietary fat-induced pro-inflammatory cell activation. Am J Gastroenterol, 2019, 114(4): 607-619.
20.	de Gracia Hahn D, Duret A, Mann JP. An AGTR1 variant worsens nonalcoholic fatty liver disease and the metabolic syndrome. Am J Gastroenterol, 2019, 114(4): 556-559.
21.	Strausz S, Ruotsalainen S, Ollila HM, et al. Genetic analysis of obstructive sleep apnoea discovers a strong association with cardiometabolic health. Eur Respir J, 2021, 57(5): 2003091.
22.	時剛, 張開偉. 骨質疏松癥和膝關節骨關節炎共病的蛋白組學分析. 中國組織工程研究, 2018, 22(36): 5753-5759.
23.	李俊辰. 基于多組學聯合分析中醫藥治療銀屑病白癜風共病的關鍵靶點研究. 天津: 天津中醫藥大學, 2022.
24.	王林. 中國西北欠發達地區人群高血壓合并抑郁狀態的流行病學與代謝組學研究. 烏魯木齊: 新疆醫科大學, 2021.
25.	孫至佳, 樊俊寧, 余燦清, 等. 中國10個地區成年人共病流行特征分析. 中華流行病學雜志, 2021, 42(5): 755-762.
26.	王姣鋒, 張紫歡, 崔月, 等. 上海部分社區老年人共病患病模式及其影響因素分析. 老年醫學與保健, 2017, 23(2): 97-101.
27.	Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. Eur Respir J, 2014, 44(4): 1055-1068.
28.	Fabbri E, Zoli M, Gonzalez-Freire M, et al. Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. J Am Med Dir Assoc, 2015, 16(8): 640-647.
29.	Olivares DE, Chambi FR, Cha?i EM, et al. Risk factors for chronic diseases and multimorbidity in a primary care context of central Argentina: a web-based interactive and cross-sectional study. Int J Environ Res Public Health, 2017, 14(3): 251.
30.	Carvalho JN, Roncalli ?G, Cancela MC, et al. Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics. PLoS One, 2017, 12(4): e0174322.
31.	Gu J, Chao J, Chen W, et al. Multimorbidity in the community-dwelling elderly in urban China. Arch Gerontol Geriatr, 2017, 68: 62-67.
32.	Lee Y, Kim H, Jeong H, et al. Patterns of multimorbidity in adults: an association rules analysis using the Korea health panel. Int J Environ Res Public Health, 2020, 17(8): 2618.
33.	Marengoni A, Roso-Llorach A, Vetrano DL, et al. Patterns of multimorbidity in a population-based cohort of older people: sociodemographic, lifestyle, clinical, and functional differences. J Gerontol A Biol Sci Med Sci, 2020, 75(4): 798-805.
34.	Brian Everitt. Cluster analysis. Qual Quant, 1980, 14(1): 75-100.
35.	Hansen NS, ?ngquist L, Lange P, et al. Comorbidity clusters and healthcare use in individuals with COPD. Respir Care, 2020, 65(8): 1120-1127.
36.	Testelmans D, Spruit MA, Vrijsen B, et al. Comorbidity clusters in patients with moderate-to-severe OSA. Sleep Breath, 2022, 26(1): 195-204.
37.	李靈艷, 王青, 張少景, 等. 老年住院患者共病及多重用藥與衰弱關系的分析. 北京醫學, 2018, 40(1): 8-11.
38.	Zhao Y, Atun R, Oldenburg B, et al. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health, 2020, 8(6): e840-e849.
39.	Marthias T, Anindya K, Ng N, et al. Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study. BMJ Open, 2021, 11(2): e041870.
40.	高子晴, 馬海英. 藥物經濟學的分析方法及主要應用. 中國合理用藥探索, 2018, 15(10): 77-80.
41.	陳太平, 吳冬妮, 陳曙東, 等. 藥物經濟學的評價方法及應用情況. 東南國防醫藥, 2015, 17(6): 626-628.
42.	郭威. Charlson合并癥指數和Elixhauser合并癥指數對住院病人發生院內死亡的預測能力的比較研究. 2017年中國衛生統計學學術年會論文集, 2017: 70.
43.	Canaslan K, Ates Bulut E, Kocyigit SE, et al. Predictivity of the comorbidity indices for geriatric syndromes. BMC Geriatr, 2022, 22(1): 440.
44.	蔣紅蓮, 閆偉, 路云. 老年共病指數的應用與推廣問題研究. 中國慢性病預防與控制, 2020, 28(7): 548-551.
45.	Zhang N, Ning XH, Zhu ML, et al. Attitudes towards advance care planning and healthcare autonomy among community-dwelling older adults in Beijing, China. Biomed Res Int, 2015, 2015: 453932.
46.	祝世訥. 中醫系統論基本原理闡釋. 山東中醫藥大學學報, 2021, 45(1): 7-21.
47.	杜漸, 王昊, 邵祺騰, 等. “心主神明”內涵探析—“總統魂魄, 兼賅意志”. 中國中醫基礎醫學雜志, 2014, 20(1): 11-13.
48.	黃少慧, 陳煒聰, 孫海濤, 等. 呂志平教授辨治肝膽病學術經驗. 陜西中醫藥大學學報, 2022, 45(1): 28-33.
49.	權乾坤, 李璽, 馮建軍, 等. 老年綜合評估在老年醫學臨床教學中的實踐與思考. 醫學教育研究與實踐, 2020, 28(3): 552-555.
50.	Muth C, van den Akker M, Blom JW, et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med, 2014, 12: 223.
51.	Palmer K, Marengoni A, Forjaz MJ, et al. Multimorbidity care model: recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Health Policy, 2018, 122(1): 4-11.
52.	呂曉燕, 李蓉, 李雨欣, 等. 共病研究熱點及趨勢分析. 中國醫學科學院學報, 2022, 44(4): 643-653.
53.	國家重點研發計劃項目(2020YFC2006100、2018YFC2002400)課題組, 中國老年醫學學會醫養結合促進委員會. 醫養結合機構老年共病患者安全用藥專家共識. 中華保健醫學雜志, 2021, 23(6): 561-568.
54.	肖平, 田懷谷, 易黎, 等. 淺談現代醫學模式下診療方向的發展及特點. 現代醫院, 2016, 16(1): 8-10.

1. Chen X, Giles J, Yao Y, et al. The path to healthy ageing in China: a Peking University-Lancet Commission. Lancet, 2022, 400(10367): 1967-2006.
2. Whitty CJM, MacEwen C, Goddard A, et al. Rising to the challenge of multimorbidity. BMJ, 2020, 368: l6964.
3. Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis, 1970, 23(7): 455-468.
4. World Health Organization. Multimorbidity: technical series on safer primary care. Geneva: World Health Organization, 2016.
5. 曹豐, 王亞斌, 薛萬國, 等. 中國老年疾病臨床多中心報告. 中華老年多器官疾病雜志, 2018, 17(11): 801-808.
6. 中國居民營養與慢性病狀況報告(2020年). 營養學報, 2020, 42(6): 521.
7. 章軼立, 黃馨懿, 齊保玉, 等. 老年人群共病問題現狀挑戰與應對策略. 中國全科醫學, 2022, 25(35): 4363-4368.
8. 王麗敏, 陳志華, 張梅, 等. 中國老年人群慢性病患病狀況和疾病負擔研究. 中華流行病學雜志, 2019, 40(3): 277-283.
9. 范瀟茹, 陳莎, 施予寧, 等. 我國中老年人慢性病共病現狀及其對衛生服務利用和醫療費用的影響研究. 中國全科醫學, 2022, 25(19): 2371-2378.
10. Petrova D, Catena A, Rodríguez-Barranco M, et al. Physical comorbidities and depression in recent and long-term adult cancer survivors: NHANES 2007-2018. Cancers (Basel), 2021, 13(13): 3368.
11. Wang X, Mukherjee B, Park SK. Associations of cumulative exposure to heavy metal mixtures with obesity and its comorbidities among U. S. adults in NHANES 2003-2014. Environ Int, 2018, 121(Pt 1): 683-694.
12. Teagle WL, Norris ET, Rishishwar L, et al. Comorbidities and ethnic health disparities in the UK biobank. JAMIA Open, 2022, 5(3): ooac057.
13. Vanent KN, Leasure AC, Acosta JN, et al. Association of chronic kidney disease with risk of intracerebral hemorrhage. JAMA Neurol, 2022, 79(9): 911-918.
14. 楊帆. 中國健康與養老追蹤調查數據庫介紹. 實證社會科學, 2017, 3(1): 115-122.
15. 閆偉, 路云, 張冉, 等. 基于CHARLS數據分析的我國老年人共病現狀研究. 中華疾病控制雜志, 2019, 23(4): 426-430.
16. Kim K, Kim S, Myung W, et al. Shared genetic background between Parkinson's disease and schizophrenia: a two-sample Mendelian randomization study. Brain Sci, 2021, 11(8): 1042.
17. Patrick MT, Li Q, Wasikowski R, et al. Shared genetic risk factors and causal association between psoriasis and coronary artery disease. Nat Commun, 2022, 13(1): 6565.
18. Lin L, Luo P, Yang M, et al. Causal relationship between osteoporosis and osteoarthritis: a two-sample Mendelian randomized study. Front Endocrinol (Lausanne), 2022, 13: 1011246.
19. Musso G, Saba F, Cassader M, et al. Angiotensin Ⅱ type 1 receptor rs5186 gene variant predicts incident NAFLD and associated hypertension: role of dietary fat-induced pro-inflammatory cell activation. Am J Gastroenterol, 2019, 114(4): 607-619.
20. de Gracia Hahn D, Duret A, Mann JP. An AGTR1 variant worsens nonalcoholic fatty liver disease and the metabolic syndrome. Am J Gastroenterol, 2019, 114(4): 556-559.
21. Strausz S, Ruotsalainen S, Ollila HM, et al. Genetic analysis of obstructive sleep apnoea discovers a strong association with cardiometabolic health. Eur Respir J, 2021, 57(5): 2003091.
22. 時剛, 張開偉. 骨質疏松癥和膝關節骨關節炎共病的蛋白組學分析. 中國組織工程研究, 2018, 22(36): 5753-5759.
23. 李俊辰. 基于多組學聯合分析中醫藥治療銀屑病白癜風共病的關鍵靶點研究. 天津: 天津中醫藥大學, 2022.
24. 王林. 中國西北欠發達地區人群高血壓合并抑郁狀態的流行病學與代謝組學研究. 烏魯木齊: 新疆醫科大學, 2021.
25. 孫至佳, 樊俊寧, 余燦清, 等. 中國10個地區成年人共病流行特征分析. 中華流行病學雜志, 2021, 42(5): 755-762.
26. 王姣鋒, 張紫歡, 崔月, 等. 上海部分社區老年人共病患病模式及其影響因素分析. 老年醫學與保健, 2017, 23(2): 97-101.
27. Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. Eur Respir J, 2014, 44(4): 1055-1068.
28. Fabbri E, Zoli M, Gonzalez-Freire M, et al. Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. J Am Med Dir Assoc, 2015, 16(8): 640-647.
29. Olivares DE, Chambi FR, Cha?i EM, et al. Risk factors for chronic diseases and multimorbidity in a primary care context of central Argentina: a web-based interactive and cross-sectional study. Int J Environ Res Public Health, 2017, 14(3): 251.
30. Carvalho JN, Roncalli ?G, Cancela MC, et al. Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics. PLoS One, 2017, 12(4): e0174322.
31. Gu J, Chao J, Chen W, et al. Multimorbidity in the community-dwelling elderly in urban China. Arch Gerontol Geriatr, 2017, 68: 62-67.
32. Lee Y, Kim H, Jeong H, et al. Patterns of multimorbidity in adults: an association rules analysis using the Korea health panel. Int J Environ Res Public Health, 2020, 17(8): 2618.
33. Marengoni A, Roso-Llorach A, Vetrano DL, et al. Patterns of multimorbidity in a population-based cohort of older people: sociodemographic, lifestyle, clinical, and functional differences. J Gerontol A Biol Sci Med Sci, 2020, 75(4): 798-805.
34. Brian Everitt. Cluster analysis. Qual Quant, 1980, 14(1): 75-100.
35. Hansen NS, ?ngquist L, Lange P, et al. Comorbidity clusters and healthcare use in individuals with COPD. Respir Care, 2020, 65(8): 1120-1127.
36. Testelmans D, Spruit MA, Vrijsen B, et al. Comorbidity clusters in patients with moderate-to-severe OSA. Sleep Breath, 2022, 26(1): 195-204.
37. 李靈艷, 王青, 張少景, 等. 老年住院患者共病及多重用藥與衰弱關系的分析. 北京醫學, 2018, 40(1): 8-11.
38. Zhao Y, Atun R, Oldenburg B, et al. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health, 2020, 8(6): e840-e849.
39. Marthias T, Anindya K, Ng N, et al. Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study. BMJ Open, 2021, 11(2): e041870.
40. 高子晴, 馬海英. 藥物經濟學的分析方法及主要應用. 中國合理用藥探索, 2018, 15(10): 77-80.
41. 陳太平, 吳冬妮, 陳曙東, 等. 藥物經濟學的評價方法及應用情況. 東南國防醫藥, 2015, 17(6): 626-628.
42. 郭威. Charlson合并癥指數和Elixhauser合并癥指數對住院病人發生院內死亡的預測能力的比較研究. 2017年中國衛生統計學學術年會論文集, 2017: 70.
43. Canaslan K, Ates Bulut E, Kocyigit SE, et al. Predictivity of the comorbidity indices for geriatric syndromes. BMC Geriatr, 2022, 22(1): 440.
44. 蔣紅蓮, 閆偉, 路云. 老年共病指數的應用與推廣問題研究. 中國慢性病預防與控制, 2020, 28(7): 548-551.
45. Zhang N, Ning XH, Zhu ML, et al. Attitudes towards advance care planning and healthcare autonomy among community-dwelling older adults in Beijing, China. Biomed Res Int, 2015, 2015: 453932.
46. 祝世訥. 中醫系統論基本原理闡釋. 山東中醫藥大學學報, 2021, 45(1): 7-21.
47. 杜漸, 王昊, 邵祺騰, 等. “心主神明”內涵探析—“總統魂魄, 兼賅意志”. 中國中醫基礎醫學雜志, 2014, 20(1): 11-13.
48. 黃少慧, 陳煒聰, 孫海濤, 等. 呂志平教授辨治肝膽病學術經驗. 陜西中醫藥大學學報, 2022, 45(1): 28-33.
49. 權乾坤, 李璽, 馮建軍, 等. 老年綜合評估在老年醫學臨床教學中的實踐與思考. 醫學教育研究與實踐, 2020, 28(3): 552-555.
50. Muth C, van den Akker M, Blom JW, et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med, 2014, 12: 223.
51. Palmer K, Marengoni A, Forjaz MJ, et al. Multimorbidity care model: recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Health Policy, 2018, 122(1): 4-11.
52. 呂曉燕, 李蓉, 李雨欣, 等. 共病研究熱點及趨勢分析. 中國醫學科學院學報, 2022, 44(4): 643-653.
53. 國家重點研發計劃項目(2020YFC2006100、2018YFC2002400)課題組, 中國老年醫學學會醫養結合促進委員會. 醫養結合機構老年共病患者安全用藥專家共識. 中華保健醫學雜志, 2021, 23(6): 561-568.
54. 肖平, 田懷谷, 易黎, 等. 淺談現代醫學模式下診療方向的發展及特點. 現代醫院, 2016, 16(1): 8-10.

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