Table_1_Incidence, Progression, and Patterns of Multimorbidity in Community-Dwelling Middle-Aged Men and Women.docx

Background: Determining the incidence, progression, and patterns of multimorbidity are important for the prevention, management, and treatment of concurrence of multiple conditions. This study aimed to analyze major multimorbidity patterns and the association of the onset of a primary condition or combinations of a primary and a secondary condition with the progression to subsequent conditions.Methods: We included 53,867 participants aged 45–64 years from the 45 and Up Study who were free of 10 predefined chronic conditions at baseline (2006–2009). The incidence of multimorbidity (coexistence of ≥2, ≥3, and ≥4 conditions) was identified using the claims database until December 31, 2016. The primary, secondary, tertiary, and quaternary condition for each participant was defined according to its temporal order of onset.Results: During a mean 9-years follow-up, the cumulative incidence of primary, secondary, tertiary, and quaternary conditions was 49.6, 23.7, 9.0, and 2.9%, respectively. The time to develop a subsequent condition decreased with the accumulation of conditions (P < 0.0001). Two concurrent cardiometabolic disorders (CMDs, 30.4%) and CMDs clustered with musculoskeletal disorders (15.2%), mental disorders (13.5%), asthma (12.0%), or cancer (8.7%) were the five most common multimorbidity patterns. CMDs tended to occur prior to mental or musculoskeletal disorders but after the onset of cancers or asthma. Compared with all participants who developed cancer as a primary condition, individuals who experienced mental disorders/neurodegenerative disorders and a comorbidity as cardiovascular disease, hypertension, dyslipidemia, diabetes, asthma, or osteoarthritis were 3.36–10.87 times more likely to develop cancer as a tertiary condition. Individuals with neurodegenerative disorders and a comorbidity as hypertension, dyslipidemia, osteoarthritis, or asthma were 5.14–14.15 times more likely to develop mental disorders as a tertiary condition.Conclusions: A high incidence of multimorbidity in middle-aged adults was observed and CMDs were most commonly seen in multimorbidity patterns. There may be accelerated aging after a primary condition occurs. Our findings also reveal a potential preventative window to obviate the development of secondary or tertiary conditions.

背景：确定多重共病（多种疾病同时存在）的发病率、进展模式和规律对于预防、管理和治疗多种疾病的并发至关重要。本研究旨在分析主要的多重共病模式，以及原发性疾病或原发性与继发性疾病组合的发病与后续疾病进展之间的关联。方法：本研究纳入了来自45岁及以上研究（45 and Up Study）的53,867名45至64岁的参与者，他们在基线时（2006至2009年）未患有10种预定义的慢性疾病。使用索赔数据库，直到2016年12月31日，确定了多重共病的发病率（≥2种、≥3种和≥4种疾病共存）。根据发病的时间顺序，为每位参与者定义了原发性、继发性、三级和四级疾病。结果：在平均9年的随访期间，原发性、继发性、三级和四级疾病的累积发病率分别为49.6%、23.7%、9.0%和2.9%。发生后续疾病的时间随着疾病数量的累积而减少（P < 0.0001）。最常见的五种多重共病模式为同时存在两种心血管代谢性疾病（CMDs，占比30.4%）、CMDs与肌肉骨骼疾病（占比15.2%）、精神疾病（占比13.5%）、哮喘（占比12.0%）或癌症（占比8.7%）。CMDs往往在精神或肌肉骨骼疾病之前、在癌症或哮喘发病之后出现。与所有将癌症作为原发性疾病的患者相比，那些经历精神疾病/神经退行性疾病以及合并心血管疾病（如心血管疾病、高血压、血脂异常、糖尿病、哮喘或骨关节炎）的人，发展为三级癌症的可能性是3.36至10.87倍。那些患有神经退行性疾病以及合并高血压、血脂异常、骨关节炎或哮喘的人，发展为三级精神疾病的可能性是5.14至14.15倍。结论：观察到中年成年人多重共病的发病率较高，CMDs在多重共病模式中最为常见。在发生原发性疾病后可能存在加速衰老的迹象。我们的研究结果还揭示了一个潜在的预防窗口，以避免继发或三级疾病的发生。