Background

A systematic understanding of how multimorbidity has been constructed and measured is unavailable. This review aimed to examine the definition and measurement of multimorbidity in peer-reviewed studies internationally.

Methods

We systematically reviewed studies on multimorbidity, via a search of nine bibliographic databases (Ovid [PsycINFO, Embase, Global Health, and MEDLINE], Web of Science, the Cochrane Library, CINAHL Plus, Scopus, and ProQuest Dissertations & Theses Global), from inception to Jan 21, 2020. Reference lists and tracked citations of retrieved articles were hand-searched. Eligible studies were full-text articles measuring multimorbidity for any purpose in community, primary care, care home, or hospital populations receiving a non-specialist service. Abstracts, qualitative research, and case series were excluded. Two reviewers independently reviewed the retrieved studies with conflicts resolved by discussion or a third reviewer, and a single researcher extracted data from published papers. To assess our objectives of how multimorbidity has been measured and examine variation in the chronic conditions included (in terms of number and type), we used descriptive analysis (frequencies, cross-tabulation, and negative binomial regression) to summarise the characteristics of multimorbidity studies and measures (study setting, source of morbidity data, study population, primary study purpose, and multimorbidity measure type). This systematic review is registered with PROSPERO, CRD420201724090.

Findings

566 studies were included in our review, of which 206 (36·4%) did not report a reference definition for multimorbidity and 73 (12·9%) did not report the conditions their measure included. The number of conditions included in measures ranged from two to 285 (median 17 [IQR 11–23). 452 (79·9%) studies reported types of condition within a single multimorbidity measure; most included at least one cardiovascular condition (441 [97·6%] of 452 studies), metabolic and endocrine condition (440 [97·3%]), respiratory condition (422 [93·4%]), musculoskeletal condition (396 [87·6%]), or mental health condition (355 [78·5%]) in their measure of multimorbidity. Chronic infections (123 [27·2%]), haematological conditions (110 [24·3%]), ear, nose, and throat conditions (107 [23·7%]), skin conditions (70 [15·5%]), oral conditions (19 [4·2%]), and congenital conditions (14 [3·1%]) were uncommonly included. Only eight individual conditions were included by more than half of studies in the multimorbidity measure used (diabetes, stroke, cancer, chronic obstructive pulmonary disease, hypertension, coronary heart disease, chronic kidney disease, and heart failure), with individual mental health conditions under-represented. Of the 566 studies, 419 were rated to be of moderate risk of bias, 107 of high risk of bias, and 40 of low risk of bias according to the Effective Public Health Practice Project quality assessment tool.

Interpretation

Measurement of multimorbidity is poorly reported and highly variable. Consistent reporting of measure definitions should be required by journals, and consensus studies are needed to define core and study-dependent conditions to include in measures of multimorbidity.

Funding

Health Data Research UK.

中文翻译：

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检查研究中多病症测量的变化：对 566 项研究的系统回顾

背景

无法系统地了解如何构建和测量多重发病率。本综述旨在检查国际同行评审研究中多重发病的定义和测量。

方法

我们通过搜索九个书目数据库（Ovid [PsycINFO、Embase、Global Health 和 MEDLINE]、Web of Science、Cochrane Library、CINAHL Plus、Scopus 和 ProQuest Dissertations & Thes Global）系统地回顾了关于多发病的研究，来自开始到 2020 年 1 月 21 日。手动搜索检索到的文章的参考列表和跟踪引用。符合条件的研究是在社区、初级保健、护理院或接受非专科服务的医院人群中出于任何目的测量多种疾病的全文文章。摘要、定性研究和病例系列被排除在外。两名审稿人独立审阅检索到的研究，冲突通过讨论或第三名审稿人解决，一名研究人员从已发表的论文中提取数据。为了评估我们如何测量多重发病率的目标并检查所包括的慢性病的变化（在数量和类型方面），我们使用描述性分析（频率、交叉制表和负二项式回归）来总结多重发病率研究的特征和措施（研究背景、发病率数据来源、研究人群、主要研究目的和多重发病率措施类型）。本系统评价已在 PROSPERO 注册，CRD420201724090。和多病态测量类型）。本系统评价已在 PROSPERO 注册，CRD420201724090。和多病态测量类型）。本系统评价已在 PROSPERO 注册，CRD420201724090。

发现

我们的审查纳入了 566 项研究，其中 206 项 (36·4%) 未报告多发病的参考定义，73 (12·9%) 未报告其测量所包含的条件。措施中包含的条件数量从 2 到 285 不等（中位数 17 [IQR 11–23]）。452 (79·9%) 项研究报告了单一多发病测量中的病症类型；大多数包括至少一种心血管疾病（452 项研究中的 441 [97·6%]）、代谢和内分泌疾病（440 [97·3%]）、呼吸疾病（422 [93·4%]）、肌肉骨骼疾病（396 [87·6%]) 或心理健康状况 (355 [78·5%]) 在他们对多病症的衡量中。慢性感染 (123 [27·2%])、血液病 (110 [24·3%])、耳鼻喉疾病 (107 [23·7%])、皮肤病 (70 [15·5%] ]), 口腔状况 (19 [4·2%]), 罕见地包括先天性疾病 (14 [3·1%])。超过一半的研究在使用的多病症测量中仅包括八种个体疾病（糖尿病、中风、癌症、慢性阻塞性肺病、高血压、冠心病、慢性肾病和心力衰竭），个体心理健康状况低于-代表。根据有效公共卫生实践项目质量评估工具，在 566 项研究中，419 项被评为中等偏倚风险，107 项被评为高偏倚风险，40 项被评为低偏倚风险。慢性肾病和心力衰竭），个人心理健康状况的代表性不足。根据有效公共卫生实践项目质量评估工具，在 566 项研究中，419 项被评为中等偏倚风险，107 项被评为高偏倚风险，40 项被评为低偏倚风险。慢性肾病和心力衰竭），个人心理健康状况的代表性不足。根据有效公共卫生实践项目质量评估工具，在 566 项研究中，419 项被评为中等偏倚风险，107 项被评为高偏倚风险，40 项被评为低偏倚风险。

解释

多病症的测量报告很少，而且变化很大。期刊应要求对测量定义进行一致的报告，并且需要共识研究来定义核心和研究依赖条件，以包括在多重发病的测量中。

资金

英国健康数据研究。