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.	曹丰, 王亚斌, 薛万国, 等. 中国老年疾病临床多中心报告. 中华老年多器官疾病杂志, 2018, 17(11): 801-808.
6.	中国居民营养与慢性病状况报告(2020年). 营养学报, 2020, 42(6): 521.
7.	章轶立, 黄馨懿, 齐保玉, 等. 老年人群共病问题现状挑战与应对策略. 中国全科医学, 2022, 25(35): 4363-4368.
8.	王丽敏, 陈志华, 张梅, 等. 中国老年人群慢性病患病状况和疾病负担研究. 中华流行病学杂志, 2019, 40(3): 277-283.
9.	范潇茹, 陈莎, 施予宁, 等. 我国中老年人慢性病共病现状及其对卫生服务利用和医疗费用的影响研究. 中国全科医学, 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.	杨帆. 中国健康与养老追踪调查数据库介绍. 实证社会科学, 2017, 3(1): 115-122.
15.	闫伟, 路云, 张冉, 等. 基于CHARLS数据分析的我国老年人共病现状研究. 中华疾病控制杂志, 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.	时刚, 张开伟. 骨质疏松症和膝关节骨关节炎共病的蛋白组学分析. 中国组织工程研究, 2018, 22(36): 5753-5759.
23.	李俊辰. 基于多组学联合分析中医药治疗银屑病白癜风共病的关键靶点研究. 天津: 天津中医药大学, 2022.
24.	王林. 中国西北欠发达地区人群高血压合并抑郁状态的流行病学与代谢组学研究. 乌鲁木齐: 新疆医科大学, 2021.
25.	孙至佳, 樊俊宁, 余灿清, 等. 中国10个地区成年人共病流行特征分析. 中华流行病学杂志, 2021, 42(5): 755-762.
26.	王姣锋, 张紫欢, 崔月, 等. 上海部分社区老年人共病患病模式及其影响因素分析. 老年医学与保健, 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, Chañi 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 ÂG, 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, Ängquist 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.	李灵艳, 王青, 张少景, 等. 老年住院患者共病及多重用药与衰弱关系的分析. 北京医学, 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, 马海英. 药物经济学的分析方法及主要应用. 中国合理用药探索, 2018, 15(10): 77-80.
41.	陈太平, 吴冬妮, 陈曙东, 等. 药物经济学的评价方法及应用情况. 东南国防医药, 2015, 17(6): 626-628.
42.	郭威. Charlson合并症指数和Elixhauser合并症指数对住院病人发生院内死亡的预测能力的比较研究. 2017年中国卫生统计学学术年会论文集, 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.	蒋红莲, 闫伟, 路云. 老年共病指数的应用与推广问题研究. 中国慢性病预防与控制, 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.	祝世讷. 中医系统论基本原理阐释. 山东中医药大学学报, 2021, 45(1): 7-21.
47.	杜渐, 王昊, 邵祺腾, 等. “心主神明”内涵探析—“总统魂魄, 兼赅意志”. 中国中医基础医学杂志, 2014, 20(1): 11-13.
48.	黄少慧, 陈炜聪, 孙海涛, 等. 吕志平教授辨治肝胆病学术经验. 陕西中医药大学学报, 2022, 45(1): 28-33.
49.	权乾坤, 李玺, 冯建军, 等. 老年综合评估在老年医学临床教学中的实践与思考. 医学教育研究与实践, 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.	吕晓燕, 李蓉, 李雨欣, 等. 共病研究热点及趋势分析. 中国医学科学院学报, 2022, 44(4): 643-653.
53.	国家重点研发计划项目(2020YFC2006100、2018YFC2002400)课题组, 中国老年医学学会医养结合促进委员会. 医养结合机构老年共病患者安全用药专家共识. 中华保健医学杂志, 2021, 23(6): 561-568.
54.	肖平, 田怀谷, 易黎, 等. 浅谈现代医学模式下诊疗方向的发展及特点. 现代医院, 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. 曹丰, 王亚斌, 薛万国, 等. 中国老年疾病临床多中心报告. 中华老年多器官疾病杂志, 2018, 17(11): 801-808.
6. 中国居民营养与慢性病状况报告(2020年). 营养学报, 2020, 42(6): 521.
7. 章轶立, 黄馨懿, 齐保玉, 等. 老年人群共病问题现状挑战与应对策略. 中国全科医学, 2022, 25(35): 4363-4368.
8. 王丽敏, 陈志华, 张梅, 等. 中国老年人群慢性病患病状况和疾病负担研究. 中华流行病学杂志, 2019, 40(3): 277-283.
9. 范潇茹, 陈莎, 施予宁, 等. 我国中老年人慢性病共病现状及其对卫生服务利用和医疗费用的影响研究. 中国全科医学, 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. 杨帆. 中国健康与养老追踪调查数据库介绍. 实证社会科学, 2017, 3(1): 115-122.
15. 闫伟, 路云, 张冉, 等. 基于CHARLS数据分析的我国老年人共病现状研究. 中华疾病控制杂志, 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. 时刚, 张开伟. 骨质疏松症和膝关节骨关节炎共病的蛋白组学分析. 中国组织工程研究, 2018, 22(36): 5753-5759.
23. 李俊辰. 基于多组学联合分析中医药治疗银屑病白癜风共病的关键靶点研究. 天津: 天津中医药大学, 2022.
24. 王林. 中国西北欠发达地区人群高血压合并抑郁状态的流行病学与代谢组学研究. 乌鲁木齐: 新疆医科大学, 2021.
25. 孙至佳, 樊俊宁, 余灿清, 等. 中国10个地区成年人共病流行特征分析. 中华流行病学杂志, 2021, 42(5): 755-762.
26. 王姣锋, 张紫欢, 崔月, 等. 上海部分社区老年人共病患病模式及其影响因素分析. 老年医学与保健, 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, Chañi 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 ÂG, 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, Ängquist 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. 李灵艳, 王青, 张少景, 等. 老年住院患者共病及多重用药与衰弱关系的分析. 北京医学, 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, 马海英. 药物经济学的分析方法及主要应用. 中国合理用药探索, 2018, 15(10): 77-80.
41. 陈太平, 吴冬妮, 陈曙东, 等. 药物经济学的评价方法及应用情况. 东南国防医药, 2015, 17(6): 626-628.
42. 郭威. Charlson合并症指数和Elixhauser合并症指数对住院病人发生院内死亡的预测能力的比较研究. 2017年中国卫生统计学学术年会论文集, 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. 蒋红莲, 闫伟, 路云. 老年共病指数的应用与推广问题研究. 中国慢性病预防与控制, 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. 祝世讷. 中医系统论基本原理阐释. 山东中医药大学学报, 2021, 45(1): 7-21.
47. 杜渐, 王昊, 邵祺腾, 等. “心主神明”内涵探析—“总统魂魄, 兼赅意志”. 中国中医基础医学杂志, 2014, 20(1): 11-13.
48. 黄少慧, 陈炜聪, 孙海涛, 等. 吕志平教授辨治肝胆病学术经验. 陕西中医药大学学报, 2022, 45(1): 28-33.
49. 权乾坤, 李玺, 冯建军, 等. 老年综合评估在老年医学临床教学中的实践与思考. 医学教育研究与实践, 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. 吕晓燕, 李蓉, 李雨欣, 等. 共病研究热点及趋势分析. 中国医学科学院学报, 2022, 44(4): 643-653.
53. 国家重点研发计划项目(2020YFC2006100、2018YFC2002400)课题组, 中国老年医学学会医养结合促进委员会. 医养结合机构老年共病患者安全用药专家共识. 中华保健医学杂志, 2021, 23(6): 561-568.
54. 肖平, 田怀谷, 易黎, 等. 浅谈现代医学模式下诊疗方向的发展及特点. 现代医院, 2016, 16(1): 8-10.

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Practical significance, content, methods and prospects of the study of geriatric comorbidity

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