加拿大不列颠哥伦比亚省多重疾病患病率的区域差异：2015/16 年加拿大社区健康调查数据的横断面分析。
Regional variation in multimorbidity prevalence in British Columbia, Canada: a cross-sectional analysis of Canadian Community Health Survey data, 2015/16.
机构信息
University of British Columbia, Vancouver, British Columbia, Canada.
Provincial TB Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
出版信息
Health Promot Chronic Dis Prev Can. 2020 Aug;40(7-8):225-234. doi: 10.24095/hpcdp.40.7/8.02.
INTRODUCTION
Multimorbidity represents a major concern for population health and service delivery planners. Information about the population prevalence (absolute numbers and proportions) of multimorbidity among regional health service delivery populations is needed for planning for multimorbidity care. In Canada, health region-specific estimates of multimorbidity prevalence are not routinely presented. The Canadian Community Health Survey (CCHS) is a potentially valuable source of data for these estimates.
METHODS
Data from the 2015/16 cycle of the CCHS for British Columbia (BC) were used to estimate and compare multimorbidity prevalence (3+ chronic conditions) through survey-weighted analyses. Crude frequencies and proportions of multimorbidity prevalence were calculated by BC Health Service Delivery Area (HSDA). Logistic regression was used to estimate differences in multimorbidity prevalence by HSDA, adjusting for known confounders. Multiple imputation using chained equations was performed for missing covariate values as a sensitivity analysis. The definition of multimorbidity was also altered as an additional sensitivity analysis.
RESULTS
A total of 681 921 people were estimated to have multimorbidity in BC (16.9% of the population) in 2015/16. Vancouver (adj-OR = 0.65; 95% CI: 0.44-0.97) and Richmond (adj-OR = 0.55; 95% CI: 0.37-0.82) had much lower prevalence of multimorbidity than Fraser South (reference HSDA). Missing data analysis and sensitivity analysis showed results consistent with the main analysis.
CONCLUSION
Multimorbidity prevalence estimates varied across BC health regions, and were lowest in Vancouver and Richmond after controlling for multiple potential confounders. There is a need for provincial and regional multimorbidity care policy development and priority setting. In this context, the CCHS represents a valuable source of information for regional multimorbidity analyses in Canada.
简介
多病共存是人口健康和服务提供规划者的主要关注点。为了规划多病共存护理，需要了解区域卫生服务提供人群中多病共存的人群流行率（绝对数量和比例）。在加拿大，健康区域特有的多病共存流行率估计值通常不会呈现。加拿大社区健康调查（CCHS）是这些估计值的潜在有价值的数据来源。
方法
使用不列颠哥伦比亚省（BC）2015/16 周期的 CCHS 数据，通过调查加权分析来估计和比较多病共存的流行率（3 种及以上慢性疾病）。通过 BC 卫生服务提供区域（HSDA）计算多病共存流行率的粗频率和比例。使用逻辑回归来估计 HSDA 之间多病共存流行率的差异，调整已知的混杂因素。对于缺失协变量值，采用链式方程进行多重插补作为敏感性分析。还进行了缺失协变量值的敏感性分析，即改变多病共存的定义。
结果
2015/16 年，BC 共有 681921 人被估计患有多病共存（占总人口的 16.9%）。温哥华（调整后的优势比[OR] = 0.65；95%置信区间[CI]：0.44-0.97）和列治文（调整后的 OR = 0.55；95%CI：0.37-0.82）的多病共存流行率明显低于弗雷泽南（参考 HSDA）。缺失数据分析和敏感性分析结果与主要分析一致。
结论
BC 各卫生区域的多病共存流行率估计值存在差异，在控制了多个潜在混杂因素后，温哥华和列治文的流行率最低。需要制定省级和区域多病共存护理政策并确定重点。在这种情况下，CCHS 是加拿大区域多病共存分析的宝贵信息来源。
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