INTRODUCTION Comorbidity is common in elderly patients and it imposes heavy burden on both individual and the whole healthcare system. This study aims to gain insights of comorbidity development by simulating the lifetime trajectory of disease progression from single chronic disease to comorbidity. METHODS Eight health states spanning from no chronic condition to comorbidity are considered in this study. Disease progression network is constructed based on the seven-year retrospective data of around 700,000 residents living in Singapore central region. Microsimulation is applied to simulate the process of aging and disease progression of a synthetic new-born cohort for the entire lifetime. RESULTS Among the 40 unique trajectories observed from the simulation, the top 10 trajectories covers 60% of the cohort. Timespan of most trajectories from birth to death is 80 years. Most people progress to at risk at late 30 s, develop the first chronic condition at 50 s or 60 s, and then progress to complications at 70 s. It is also observed that the earlier one person develops chronic conditions, the more life-year-lost is incurred. DISCUSSION The lifetime disease progression trajectory constructed for each person in the cohort describes how a person starts healthy, becomes at risk, then progresses to one or more chronic conditions, and finally deteriorates to various complications over the years. This study may help us have a better understanding of chronic disease progression and comorbidity development, hence add values to chronic disease prevention and management.

中文翻译：

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终身轨迹模拟慢性疾病的进展和合并症。

引言合并症在老年患者中很常见，它给个人和整个医疗系统都带来沉重的负担。本研究旨在通过模拟疾病从单一慢性疾病到合并症的终生发展轨迹，来获得合并症发展的见识。方法本研究考虑了从无慢性病到合并症的八种健康状态。疾病进展网络是根据居住在新加坡中部地区约700,000居民的7年回顾性数据构建的。微观模拟被用于模拟整个合成生命周期的衰老过程和疾病进展。结果从仿真观察到的40条独特轨迹中，前10条轨迹覆盖了同类人群的60％。从出生到死亡的大多数轨迹的时间跨度为80年。大多数人在30 s晚期发展为有风险，在50 s或60 s出现第一个慢性病，然后在70 s演变为并发症。还观察到，一个人越早发展成慢性病，损失的生命年越多。讨论为队列中的每个人构建的终生疾病进展轨迹描述了一个人如何开始健康，变得有风险，然后发展为一种或多种慢性病，并最终恶化为这些年来的各种并发症。这项研究可以帮助我们更好地了解慢性病的进展和合并症，从而为慢性病的预防和管理增加价值。在50或60 s出现第一个慢性病，然后在70 s发展为并发症。还观察到，一个人越早发展成慢性病，损失的生命年越多。讨论为队列中的每个人构建的终生疾病进展轨迹描述了一个人如何开始健康，变得有风险，然后发展为一种或多种慢性病，并最终恶化为这些年来的各种并发症。这项研究可以帮助我们更好地了解慢性病的进展和合并症，从而为慢性病的预防和管理增加价值。在50或60 s出现第一个慢性病，然后在70 s发展为并发症。还观察到，一个人越早发展成慢性病，损失的生命年越多。讨论为队列中的每个人构建的终生疾病进展轨迹描述了一个人如何开始健康，变得有风险，然后发展为一种或多种慢性病，并最终恶化为这些年来的各种并发症。这项研究可以帮助我们更好地了解慢性病的进展和合并症，从而为慢性病的预防和管理增加价值。讨论为队列中的每个人构建的终生疾病进展轨迹描述了一个人如何开始健康，变得有风险，然后发展为一种或多种慢性病，并最终恶化为这些年来的各种并发症。这项研究可以帮助我们更好地了解慢性病的进展和合并症，从而为慢性病的预防和管理增加价值。讨论为队列中的每个人构建的终生疾病进展轨迹描述了一个人如何开始健康，变得有风险，然后发展为一种或多种慢性病，并最终恶化为这些年来的各种并发症。这项研究可以帮助我们更好地了解慢性病的进展和合并症，从而为慢性病的预防和管理增加价值。