Association of Multimorbidity with Health Outcomes in the Chinese Middle-aged and Elderly Population / 中山大学学报(医学科学版)

ObjectiveTo analyze the multimorbidity and comorbid disease patterns among middle-aged and older adults aged 50 years and above in China and to study the prevalence， regional distribution， and relationship with health-related outcomes of major comorbid disease patterns. MethodsThe fourth national follow-up data of the China Health and Retirement Longitudinal Study （CHARLS） 2018 was used， including 13 774 respondents aged 50 years and older from 28 provincial units. We analyzed 14 patient-reported physician-diagnosed chronic diseases and multimorbidity combinations， reported prevalence， composition ratio， and regional distribution. Differences in health loss and risk factors between high morbidity groups were analyzed using chi-square tests and logistic regression. ResultsThe prevalence of multimorbidities among participants was 57.3%. The single disease with high prevalence included arthritis/rheumatism （6.47%）， hypertension （5.41%）， and gastric and digestive disorders （4.17%）； the binary multimorbidity combinations were arthritis + digestive disorders （3.06%）， arthritis + hypertension （2.61%）， and hypertension + hyperlipidemia （1.39%）； the triadic combinations were hypertension + digestive disorders + joint disorders （1.00%）. The prevalence of multimorbidity varied greatly between provinces， showing the characteristics of high in the west and north but low in the east and south China. Significant differences in the health loss caused by different multimorbidity combinations were noted， with the highest ADL loss （28.51%） and depression （77.68%） caused by the arthritis multimorbidity combinations （P<0.01）. The number of chronic diseases （OR=6.71， P<0.01）， age （OR=1.96， P<0.01）， and heavy alcohol consumption were comorbid risk factors for physical and mental health； exercise （OR=0.44， P<0.01） and sleep （OR=0.89， P<0.01） were protective factors for physical and mental health， and smoking cessation （OR=0.76， P<0.01） contributed to the relief of anxiety. ConclusionsThe prevalence of comorbid patterns showed a high clustering trend， and the health loss caused by major patterns varied greatly. Relevant health intervention strategies should prioritize the major multimorbidity combinations for targeted disease management and rehabilitation services.

Markers of alcohol use disorder-its impact on the comorbid diseases and outcomes in patients admitted into tertiary care hospital

Background: The treatment for medical complications of alcohol misuse has been restricted by primary care providers recently by referring patients to specialized alcohol treatment. Aim: The proposed study aimed to identify the patients with alcohol use disorder and estimation of selected biomarkers like Gamma-glutamyl transferase (GGT) and Carbohydrate-deficient transferrin (CDT) in selected patients with objective of comparing its impact on co-morbid condition, assessment of its outcomes in selected patients. Materials and Methods: This was a multi-arm observational, interventional study, in which patients of alcohol use disorder were selected as the study population. This study was conducted in Department of General Medicine, Mahatma Gandhi Memorial Hospital, Warangal, Telangana. Results: In alcoholic patients, age in years was 55.1±8.5 and in non-alcoholic patients’ age in years was 58.4±11.6, in alcoholic patients males were 50% and females were 5% and in non-alcoholic patients, males were 40% and females were 4%. In hepatic encephalopathetic alcoholic patients 40% was seen and in hepatic encephalopathetic non-alcoholic patients, 36% was seen. In the alcoholic patients, Ascitis was observed in 49% and 48% of the non-alcoholic patients. 48% of the alcoholic patients had upper gastro-intestinal bleeding and it was 3% in non-alcoholic patients. Conclusion: The heavy use of alcohol prevalence was very high and was associated with poor prognosis in hospitalised patients which further increased the risk of infection and death.

Efficacy and Safety of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients with Comorbid Diseases

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD), a new and potentially curative method for treating gastrointestinal neoplasms, may have longer procedure time and the risk of complications when compared to conventional endoscopic mucosal resection. This study evaluated the efficacy and safety of ESD in patients with comorbid diseases. METHODS: The outcomes of 337 patients who underwent ESD for early gastric cancer at Samsung Medical Center from April 2003 to December 2006 were analyzed retrospectively. The Charlson comorbidity scale was used to divide the patients into low-risk (no risk factor) and high-risk (at least one risk factor) groups. The outcomes and complications were compared between the high- and low-risk groups. RESULTS: The low- and high-risk groups comprised 240 and 97 patients with mean ages of 61.1 and 64.7 years, respectively (p=0.002). Tumor location, tumor size, depth of invasion, procedure duration, and rates of en bloc resection, complete resection, complication, and recurrence did not differ significantly between the two groups (p>0.05). CONCLUSIONS: ESD may be a safe and effective treatment for early gastric cancer in patients with comorbid diseases.