Zhongguo quanke yixue (Apr 2024)
Distribution and Influencing Factors of Chronic Comorbidities among Middle-aged Inpatients in General Practice Department of Tertiary General Hospitals
Abstract
Background Recent studies have found that middle-aged individuals account for over 40% of patients with chronic disease comorbidities, and this percentage is still increasing. This comorbidity not only reduces the quality of life for these patients but can also lead to premature death. However, research on the distribution and influencing factors of chronic comorbidities in middle-aged adults is still limited. Objective To provide a scientific basis for managing such patients by retrospectively analyzing the disease distribution and influencing factors of chronic comorbidities among middle-aged inpatients. Methods From July 1, 2017 to February 28, 2023, a total of 5 931 inpatients were admitted to the Department of General Medicine, the Second Hospital of Lanzhou University. Among them, 1 650 middle-aged patients (aged 45 to 59 years) were included as subjects for this study. General information of the subjects was collected, and the comorbidity conditions of chronic diseases were statistically analyzed. Multifactorial Logistic regression analysis was employed to investigate the influencing factors associated with different chronic disease comorbidities. Results Among the 1 650 middle-aged patients attending the department of general practice, 79 (4.8%), 359 (21.8%), and 1 212 (73.4%) patients suffered from 0, 1, and ≥2 chronic diseases, respectively. Comparison of gender, age, ethnicity, occupation, and route of admission of patients with 0, 1, and ≥2 chronic diseases showed statistically significant differences (P<0.05). The three most common chronic diseases were heart disease (66.1%, 1 091/1 650), hypertension (41.1%, 678/1 650), and cerebrovascular disease (20.7%, 342/1 650). The top three comorbid conditions with other chronic diseases were diabetes or hyperglycemia (97.3%, 215/221), hypertension (98.5%, 668/678), and dyslipidemia (96.1%, 246/256). Of the 1 650 middle-aged patients hospitalized in general practice, 581 (35.2%) had 2 chronic comorbidities and 455 (27.6%) had 3 chronic comorbidities. Among patients with two comorbidities, the most frequent combinations were heart disease+hypertension (22.7%, 132/581), heart disease+chronic lung disease (13.1%, 76/581), and heart disease+cerebrovascular disease (8.4%, 49/581) ; for three comorbidities, the top combinations were hypertension+heart disease+cerebrovascular disease (14.5%, 66/455), hypertension+heart disease+diabetes or hyperglycemia (10.5%, 48/455), and hypertension+heart disease+chronic lung disease (7.9%, 36/455). Multivariate Logistic regression analysis showed that ethnicity of Han (OR=26.778, 95%CI=3.120-229.793), Hui (OR=46.143, 95%CI=3.456-616.090), or Dongxiang (OR=52.966, 95%CI=2.502-1 121.195) were influencing factors for middle-aged inpatients with 1 chronic disease (P<0.05). For ≥2 chronic diseases, influencing factors included 50-54 age group (OR=0.461, 95%CI=0.266-0.801), being of Han (OR=3.783, 95%CI=1.433-9.983) or Hui (OR=6.055, 95%CI=1.107-33.126) ethnicity, occupation of farmer (OR=0.460, 95%CI=0.252-0.839) (P<0.05) . Conclusion Approximately one-third of patients in the general practice department of tertiary hospitals are middle-aged, and most of them present with chronic comorbidities. While focusing on the chronic diseases of the elderly, there is a need for enhanced focus on chronic diseases management and clinical awarenes improvement in middle-aged individuals, enhancing the content of health management services provided by general practitioners, and establishing a more comprehensive model of general practice services. Additionally, research indicates that patients with diabetes are more prone to chronic disease comorbidities. The phenomenon is particularly prevalent among residents of Hui or Han ethnicity. These groups should receive focused attention during screening and management processes.
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