英国皇家爱丁堡医院Lucy E Stirland团队分析了衡量疾病计数之外的多发病指标。该项研究成果发表在2020年2月18日出版的《英国医学杂志》上。

为了识别和总结现有的除疾病计数外衡量多发病的指标，建立包括心理健康合并症或预后在内的新指标，并基于适用性、效果和用途提出建议，研究组对Medline等7个医学研究数据库从成立到2018年10月的文献进行了系统筛选，检索出描述新的多发病指标，包含比疾病计数更多的信息，且不关注某种特定疾病合并症的文章。

最终在7128个检索结果中，识别出5560个独特标题。根据标准进行筛选后，最终纳入35篇论文。就指标组成而言，有25个指标使用了健康状况，5个指标使用了诊断类别，4个指标使用了用药情况，1个指标使用了生理措施。

预测结局包括死亡率（18个指标）、医疗保健使用或费用（13个）、住院（13个）和健康相关生活质量（7个）。29个指标考虑了心理健康的某些方面，其中大部分将其作为合并症纳入。12个指标被建议使用。

总之，共有35种多发病指标，其组成和结局均不同。研究人员和临床医生应在创建新指标之前检查现有指标的适用性。

附：英文原文

Title: Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice

Author: Lucy E Stirland, Laura González-Saavedra, Donncha S Mullin, Craig W Ritchie, Graciela Muniz-Terrera, Tom C Russ

Issue&Volume: 2020/02/18

Abstract: Objectives To identify and summarise existing indices for measuring multimorbidity beyond disease counts, to establish which indices include mental health comorbidities or outcomes, and to develop recommendations based on applicability, performance, and usage.Design Systematic review.Data sources Seven medical research databases (Medline, Web of Science Core Collection, Cochrane Library, Embase, PsycINFO, Scopus, and CINAHL Plus) from inception to October 2018 and bibliographies and citations of relevant papers. Searches were limited to English language publications.Eligibility criteria for study selection Original articles describing a new multimorbidity index including more information than disease counts and not focusing on comorbidity associated with one specific disease. Studies were of adults based in the community or at population level.Results Among 7128 search results, 5560 unique titles were identified. After screening against eligibility criteria the review finally included 35 papers. As index components, 25 indices used conditions (weighted or in combination with other parameters), five used diagnostic categories, four used drug use, and one used physiological measures. Predicted outcomes included mortality (18 indices), healthcare use or costs (13), hospital admission (13), and health related quality of life (7). 29 indices considered some aspect of mental health, with most including it as a comorbidity. 12 indices are recommended for use.Conclusions 35 multimorbidity indices are available, with differing components and outcomes. Researchers and clinicians should examine existing indices for suitability before creating new ones.

DOI: 10.1136/bmj.m160

Source: https://www.bmj.com/content/368/bmj.m160