上海社区中青年慢性病多病共存现况研究

Community-based Prevalence of the Coexistence of Multiple Chronic Diseases among Young and Middle-aged People in Shanghai

背景慢性非传染性疾病(慢性病)已成为威胁我国居民健康的头号“杀手”,目前慢性病管理服务已经基本覆盖老龄化人口,研究中青年居民慢性病流行病学趋势及多病共存的现状将为确定下一步慢性病管理服务重点提供依据。目的了解上海社区中青年人群慢性病患病情况及多病共存情况,为中青年的社区慢性病管理提供理论依据和数据支撑。方法收集2017年1月-2019年12月上海某社区医院信息系统(HIS)年龄18~50岁患者的诊疗数据,分析慢性病的患病情况和多病共存病种组合。结果34720例18~50岁中青年患者中,8922例(25.70%)有1种慢性病,3134例(9.03%)有2种慢性病,3484例(10.03%)有≥3种慢性病,6618例(19.06%)患者存在多病共存。不同性别、年龄、签约与否社区中青年慢性病多病共存情况比较,差异有统计学意义(P<0.05);其中,男性多病共存比例高于女性,年龄越大慢性病多病共存比例越高,签约者高于未签约者(P<0.05)。患病率排名前5位的疾病分别为高血压、关节脊椎疾病、胃十二指肠炎症、功能性肠疾患、脑血管病。2种疾病组合多是“高血压”“糖尿病”“关节脊椎疾病”“胃十二指肠炎症”的两两组合,3种及以上的病种组合多为“肝胆疾病”与其他疾病的组合。结论上海社区中青年人群的慢性病多病共存情况不容忽视,病种组合明显区别于老年人群,呈现中青年特异性,需要社区家庭医生提供针对性的慢性病管理服务。

Background Chronic non-communicable diseases(NCDs)have become the leading"killer"of Chinese residents'health.At present,chronic disease management services have basically covered the aging population.The study on the epidemic trend of chronic diseases and coexistence of multiple NCDs among young and middle-aged residents will provide a basis for further development of the focuses of chronic disease management services.Objective To investigate the community-based prevalence of NCD and coexistence of multiple NCDs among young and middle-aged people in Shanghai,to provide theoretical basis and data support for community-based management of NCDs in this population.Methods The data of patients aged 18 to 50 were collected through the hospital information system of a community hospital in Shanghai from January 2017 to December 2019.The prevalence of NCDs and combinations of multiple NCDs were analyzed.Results Among the 34720 participants,8922(25.70%)had one chronic disease,3134(9.03%)had two chronic diseases,and 3484(10.03%)had three or more chronic diseases.The prevalence of multiple NCDs was 19.06%(6618/34720).The prevalence of multiple NCDs differed significantly by sex,age and having contracted healthcare services or not(P<0.05).Men,older age or having contracted services was associated with higher prevalence of multiple NCDs(P<0.05).The top five diseases were hypertension,joint and spinal diseases,gastroduodenal inflammation,functional bowel disorders,and cerebrovascular diseases.The coexisted two NCDs were mainly arbitrary combinations of two of four NCDs(hypertension,diabetes,joint and spinal diseases,and gastroduodenal inflammation).The three or more diseases combinations were mainly the combination of hepatobiliary disease and other diseases.Conclusion The community-based prevalence of multiple NCDs among young and middle-aged people in Shanghai should not be ignored.The disease combinations in them were obviously different from those of elderly population,showing the specificity of the young and middle-aged,which requires community family doctors to provide targeted chronic disease management services.