| Objective: Considering the growing prevalence of multimorbidity among the elderly,research on multimorbidity has recently attracted increasing attention.The aim of this study was to understand the current status of multimorbidity research among Chinses adults and to understand its prevalence,explore common multimorbidity combinations and patterns.To provide a reference for research,management and development of prevention and control strategies for multimorbidity.Methods: 1.Pub Med,Embase,Web of Science,Cochrane Library,CINAHL,Wan Fang Data,CNKI and CBM database were searched to collect cross-sectional studies on multimorbidity in Chinese adults from 1 January 2010 to 1 June 2022.The literature was screened according to the established inclusion criteria.Quality assessment of the included literature was conducted using Joanna Briggs Institute(JBI)Evidence-based health care center for prevalence studies.The literature which meet the requirements were chosen for further statistical analysis.Meta-analysis was conducted using Stata 17.0 software,including tests for heterogeneity,combining effect sizes and analyzing sources of heterogeneity and publication bias.Effect sizes were combined using a random effects model if heterogeneity between studies was large and a fixed effects model if heterogeneity was low.Subgroup analyses and meta-regressions were conducted by sex,age,number of chronic diseases included,population source,data collection methods and time of survey to explore sources of heterogeneity,sensitivity analyses were conducted to assess the robustness of the overall effect,and publication bias was assessed and examined using Egger’s method and funnel plots.The number and type of chronic conditions included in the multimorbidity study,common combinations and patterns were qualitatively analyzed.2.The second section used data from the 2015 China Adult Chronic Disease and Nutrition Surveillance to analyze the prevalence of multimorbidity among 175,544 people aged 18 years and older,using the frequency counting method to analyze common dyad and triad of multimorbidity and exploratory factor analysis to identify patterns of multimorbidity among people aged 18 years and older in China.Results: 1.A total of 9,925 literature were found,of which 106 were finally included after screening,for a total of 386,438 people included in the study.There was a high degree of heterogeneity between studies,and a random effects model was used to pool effect sizes,which showed a prevalence of multimorbidity in the Chinese adult population of 45.0%(95% CI: 40.0-50.0%).The results of the subgroup analysis showed that the prevalence of multimorbidity was 44.4%(95% CI: 36.4-52.4%)in men and 44.0%(95% CI: 36.6-51.3%)in women;for those aged <60 years,the prevalence of multimorbidity was 36.8%(95%CI: 28.3-45.3%),for those aged 60-73 years,44.7%(95% CI: 36.8-52.6%),and 59.7%(95%CI: 47.7-71.7%)for those >73 years old;the prevalence of multimorbidity was 33.3%(95%CI: 28.2-38.3%)for those included in the study with <12 chronic diseases,48.3%(95%CI: 40.2-56.3%)for those included with 12-20 chronic diseases,and > 20 chronic diseases was 55.5%(95% CI: 41.4-69.7%);for study populations that were community-based,the multimorbidity prevalence was 42.3%(95% CI: 36.7-47.9%),and for those originated from health care facilities,the prevalence was 60.4%(95% CI: 45.8-75.0%);the multimorbidity prevalence collected through self-reporting was 41.2%(95% CI: 36.2-46.2%)and 51.0%(95% CI: 44.1-57.9%)collected through electronic medical records.In addition,the prevalence of multimorbidity was 45.9%(95% CI: 36.8-55.0%)for those investigated before 2017 and 46.0%(95% CI: 38.3-53.8%)for 2017 to 2022.74 chronic conditions were included in the multimorbidity study.Most of the 106 studies included at least one cardiovascular(92%),metabolic and endocrine(92%),respiratory(72%),and musculoskeletal(59%)disease,and more than 90% studies included hypertension and diabetes.Among 33 studies reporting multimorbidity combinations,12 reported hypertension+diabetes combination.13 of 16 studies reporting patterns of multimorbidity patterns reported a "cardiovascular-metabolic pattern".2.In 2015,the prevalence of multimorbidity among Chinese adults was 43.73%(95% CI:42.83-44.63%),and the average number of chronic conditions was 1.57±1.46.Men,Han Chinese,widowed/divorced/separated,annual income < (?)15,000,education level of primary school and below had higher prevalence of multimorbidity.Multimorbidity prevalence decreased with increasing age and decreases with increasing annual income and education.Northern regions have more severe multimorbidity than the south,with Jilin Province having the highest prevalence and the Tibet Autonomous Region having the lowest.The most prevalent multimorbidity combination of two chronic conditions was hypertension and dyslipidemia.Among people with three chronic conditions,hypertension,dyslipidemia,and obesity were the most prevalent.Exploratory factor analysis revealed three common multimorbidity patterns: musculoskeletal-digestive-urinary,cardiovascularrespiratory and metabolic.Conclusion:1.There has a lack of standardized criteria for multimorbidity studies in China,with significant methodological heterogeneity,including the type and number of chronic diseases incorporated and the definition of multimorbidity,etc.The findings suggest that,to improve study comparability and quality of reporting,future studies should use a common core conditions set for multimorbidity measurement and report multimorbidity prevalence stratified by sociodemographic.2.The results of the two parts of the study showed that the prevalence of multimorbidity in China is not optimistic.Men,Han Chinese,widowed/divorced/separated,annual income<(?)15,000,education level of primary school and below had higher prevalence of multimorbidity.It is recommended to strengthen the intervention and management of these populations.3.Hypertension with other chronic conditions were the most observed combination.Cardiovascular,metabolic and musculoskeletal diseases tend to cluster to form specific multimorbidity patterns.Future research needs to understand the common pathogenic mechanisms behind specific multimorbidity patterns to develop efficient prevention and control strategies for multimorbidity and to simplify the treatment and management process. |
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