基于疾病协同理论的慢性病共病影响因素与管理策略

doi:10.12114/j.issn.1007-9572.2023.0701

中国全科医学 ›› 2024, Vol. 27 ›› Issue (11): 1288-1295.DOI: 10.12114/j.issn.1007-9572.2023.0701

• 论著·慢性病共病专题研究 • 上一篇下一篇

基于疾病协同理论的慢性病共病影响因素与管理策略

徐志杰¹, 钱熠², 严明³, 陆益婷⁴, 赵洋⁵^,⁶^,^*()

1．310009　浙江省杭州市，浙江大学医学院附属第二医院全科医学科
2．311121　浙江省杭州市，杭州师范大学公共卫生学院
3．310016　浙江省杭州市，浙江大学医学院附属邵逸夫医院全科医学科
4．200092　上海市，同济大学医学院全科医学系
5．2050澳大利亚悉尼，新南威尔士大学乔治全球健康研究院
6．3010澳大利亚墨尔本，墨尔本大学人口与全球健康学院

收稿日期:2023-10-10 修回日期:2023-12-01 出版日期:2024-04-15 发布日期:2024-01-23
通讯作者: 赵洋
作者贡献：徐志杰、赵洋负责文章的构思与设计、可行性分析、论文撰写；钱熠、严明、陆益婷负责文献/资料收集和整理；赵洋对文章整体负责，监督管理。
基金资助:
国家自然科学基金青年项目(72004050); 全球脑健康倡议基金(P01258); 浙江省医药卫生科技计划项目(2023KY748，2024KY1026)

The Influencing Factors and Management Strategies of Multimorbidity Based on Syndemic Theory

XU Zhijie¹, QIAN Yi², YAN Ming³, LU Yiting⁴, ZHAO Yang⁵^,⁶^,^*()

1. Department of General Practice, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
2. School of Public Health, Hangzhou Normal University, Hangzhou 311121, China
3. Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
4. Department of General Practice, Tongji University School of Medicine, Shanghai 200092, China
5. The George Institute for Global Health, University of New South Wales, Sydney 2050, Australia
6. School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia

Received:2023-10-10 Revised:2023-12-01 Published:2024-04-15 Online:2024-01-23
Contact: ZHAO Yang

分享到

摘要/Abstract

摘要： 慢性病共病加重了患者的疾病负担与治疗负担，日益成为公共卫生与初级保健领域的重要研究问题。随着医学研究的进步，有关如何应对共病挑战的认识正在发生深刻转变，其中最显著的变化是关注到社会和环境因素对疾病的聚集和发展产生潜在影响。疾病协同理论为探索多种疾病的聚集及其与社会和环境因素之间的交互作用提供了新的视角，对于从社会和环境层面分析慢性病共病的交互作用和帮助弱势人群改善健康水平具有重要意义，但国内对该理论的介绍和研究较为匮乏。本文重点梳理了疾病协同理论的基本概念与主要观点，回顾了国外学者提出的经典模型，结合既往研究分析常见的疾病协同因素，并为我国全科医生改进慢性病共病的管理质量提出建议和对策。

关键词: 慢性病共病, 疾病协同理论, 影响因素, 管理策略

Abstract:

Multimorbidity increases the burden of disease and treatment for patients, which is becoming an essential research issue in the field of public health and primary care. As medical research advances, the understanding of how to deal with the challenge of multimorbidity is undergoing a profound shift, the most significant of which is the focus on the potential influence of social and environmental factors on disease clustering and development. Syndemic theory provides a new perspective for exploring the clustering of multiple conditions, as well as their interaction with social and environmental factors, which is of great significance for analyzing the interaction of chronic comorbidities at the social and environmental levels, and contributing to improve health outcomes of vulnerable populations. However, there is a lack of introduction and research on this theory in China. This article mainly reviews the basic concepts and viewpoints of the syndemic theory, as well as the classical models proposed by foreign scholars, analyzes the common disease synergistic factors with previous research findings, and puts forwards suggestions and countermeasures for general practitioners in China to improve the quality of managing multimorbidity.

Key words: Multimorbidity, Syndemic theory, Influencing factors, Management strategy

徐志杰,钱熠,严明,等. 基于疾病协同理论的慢性病共病影响因素与管理策略[J]. 中国全科医学, 2024, 27(11): 1288-1295. DOI: 10.12114/j.issn.1007-9572.2023.0701.
XU Zhijie,QIAN Yi,YAN Ming, et al. The Influencing Factors and Management Strategies of Multimorbidity Based on Syndemic Theory[J]. Chinese General Practice, 2024, 27(11): 1288-1295. DOI: 10.12114/j.issn.1007-9572.2023.0701.

参考文献 48

[1]	SKOU S T，MAIR F S，FORTIN M，et al. Multimorbidity[J]. Nat Rev Dis Primers，2022，8（1）：48. DOI：10.1038/s41572-022-00376-4.
[2]	NGUYEN H，MANOLOVA G，DASKALOPOULOU C，et al. Prevalence of multimorbidity in community settings：a systematic review and meta-analysis of observational studies[J]. J Comorb，2019，9：2235042X19870934. DOI：10.1177/2235042X19870934.
[3]	LUTOMSKI J E，HOEKSTRA T，AKKER M V D，et al. Multimorbidity patterns in older persons and their association with self-reported quality of life and limitations in activities of daily living[J]. Arch Gerontol Geriatr，2023，115：105134. DOI：10.1016/j.archger.2023.105134.
[4]	FELEZ-NOBREGA M，KOYANAGI A. Health status and quality of life in comorbid physical multimorbidity and depression among adults aged ≥50 years from low- and middle-income countries[J]. Int J Soc Psychiatry，2023，69（5）：1250-1259. DOI：10.1177/00207640231157253.
[5]	HURST J R，AGARWAL G，VAN BOVEN J F M，et al. Critical review of multimorbidity outcome measures suitable for low-income and middle-income country settings：perspectives from the Global Alliance for Chronic Diseases（GACD）researchers[J]. BMJ Open，2020，10（9）：e037079. DOI：10.1136/bmjopen-2020-037079.
[6]	BASTO-ABREU A，BARRIENTOS-GUTIERREZ T，WADE A N，et al. Multimorbidity matters in low and middle-income countries[J]. J Multimorb Comorb，2022，12：26335565221106074. DOI：10.1177/26335565221106074.
[7]	SINGER M. A dose of drugs，a touch of violence，a case of aids：conceptualizing the Sava syndemic[J]. Free Inq Creat Sociol，1996，24：11-22.
[8]	MENDENHALL E，KOHRT B A，NORRIS S A，et al. Non-communicable disease syndemics：poverty，depression，and diabetes among low-income populations[J]. Lancet，2017，389（10072）：951-963. DOI：10.1016/S0140-6736(17)30402-6.
[9]	PAWLOWSKI A，JANSSON M，SKÖLD M，et al. Tuberculosis and HIV co-infection[J]. PLoS Pathog，2012，8（2）：e1002464. DOI：10.1371/journal.ppat.1002464.
[10]	MOUSSAVI S，CHATTERJI S，VERDES E，et al. Depression，chronic diseases，and decrements in health：results from the World Health Surveys[J]. Lancet，2007，370（9590）：851-858. DOI：10.1016/S0140-6736(07)61415-9.
[11]	HOUSTON A R，LYNCH K，OSTRACH B，et al. United States immigration detention amplifies disease interaction risk：a model for a transnational ICE-TB-DM2 syndemic[J]. Glob Public Health，2022，17（7）：1152-1171. DOI：10.1080/17441692.2021.1919737.
[12]	WILLEN S S，KNIPPER M，ABADÍA-BARRERO C E，et al. Syndemic vulnerability and the right to health[J]. Lancet，2017，389（10072）：964-977. DOI：10.1016/S0140-6736(17)30261-1.
[13]	MENDENHALL E. Beyond comorbidity：a critical perspective of syndemic depression and diabetes in cross-cultural contexts[J]. Med Anthropol Q，2016，30（4）：462-478. DOI：10.1111/maq.12215.
[14]	DIXON J，MENDENHALL E. Syndemic thinking to address multimorbidity and its structural determinants[J]. Nat Rev Dis Primers，2023，9（1）：23. DOI：10.1038/s41572-023-00437-2.
[15]	MENDENHALL E，KOHRT B A，LOGIE C H，et al. Syndemics and clinical science[J]. Nat Med，2022，28（7）：1359-1362. DOI：10.1038/s41591-022-01888-y.
[16]	SULLIVAN K A，MESSER L C，QUINLIVAN E B. Substance abuse，violence，and HIV/AIDS（SAVA）syndemic effects on viral suppression among HIV positive women of color[J]. AIDS Patient Care STDS，2015，29（Suppl 1）：S42-48. DOI：10.1089/apc.2014.0278.
[17]	SINGER M，BULLED N，OSTRACH B，et al. Syndemics and the biosocial conception of health[J]. Lancet，2017，389（10072）：941-950. DOI：10.1016/S0140-6736(17)30003-X.
[18]	RIZA A L，PEARSON F，UGARTE-GIL C，et al. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services[J]. Lancet Diabetes Endocrinol，2014，2（9）：740-753. DOI：10.1016/S2213-8587(14)70110-X.
[19]	WARNECKE R B，OH A，BREEN N，et al. Approaching health disparities from a population perspective：the National Institutes of Health Centers for Population Health and Health Disparities[J]. Am J Public Health，2008，98（9）：1608-1615. DOI：10.2105/AJPH.2006.102525.
[20]	STERNTHAL M J，SLOPEN N，WILLIAMS D R. Racial Disparities in Health：how much does stress really matter?[J]. Du Bois Rev，2011，8（1）：95-113. DOI：10.1017/S1742058X11000087.
[21]	GONZÁLEZ-GUARDA R M，MCCABE B E，FLOROM-SMITH A，et al. Substance abuse，violence，HIV，and depression：an underlying syndemic factor among Latinas[J]. Nurs Res，2011，60（3）：182-189. DOI：10.1097/NNR.0b013e318216d5f4.
[22]	TURAN B，HATCHER A M，WEISER S D，et al. Framing mechanisms linking HIV-related stigma，adherence to treatment，and health outcomes[J]. Am J Public Health，2017，107（6）：863-869. DOI：10.2105/AJPH.2017.303744.
[23]	KATZ I T，RYU A E，ONUEGBU A G，et al. Impact of HIV-related stigma on treatment adherence：systematic review and meta-synthesis[J]. J Int AIDS Soc，2013，16（3 Suppl 2）：18640. DOI：10.7448/IAS.16.3.18640.
[24]	FRIEDMAN M R，LIU Q M，MEANLEY S，et al. Biopsychosocial health outcomes and experienced intersectional stigma in a mixed HIV serostatus longitudinal cohort of aging sexual minority men，United States，2008-2019[J]. Am J Public Health，2022，112（S4）：S452-462. DOI：10.2105/AJPH.2022.306735.
[25]	MCCABE B E，GONZALEZ-GUARDA R，DE TANTILLO L，et al. A mental health-physical health-violence（MPV）syndemic factor in women with mental disorders[J]. Stigma Health，2019，4（4）：383-390. DOI：10.1037/sah0000152.
[26]	GONZALEZ-GUARDA R M，MCCABE B E，NAGY G A，et al. Acculturative stress，resilience，and a syndemic factor among latinx immigrants[J]. Nurs Res，2023，72（4）：249-258. DOI：10.1097/NNR.0000000000000655.
[27]	HUANG C Y，COSTEINES J，AYALA C，et al. Parenting stress，social support，and depression for ethnic minority adolescent mothers：impact on child development[J]. J Child Fam Stud，2014，23（2）：255-262. DOI：10.1007/s10826-013-9807-1.
[28]	EXNER-CORTENS D，ECKENRODE J，ROTHMAN E. Longitudinal associations between teen dating violence victimization and adverse health outcomes[J]. Pediatrics，2013，131（1）：71-78. DOI：10.1542/peds.2012-1029.
[29]	DEVRIES K M，MAK J Y，BACCHUS L J，et al. Intimate partner violence and incident depressive symptoms and suicide attempts：a systematic review of longitudinal studies[J]. PLoS Med，2013，10（5）：e1001439. DOI：10.1371/journal.pmed.1001439.
[30]	HYDE J S，MEZULIS A H，ABRAMSON L Y. The ABCs of depression：integrating affective，biological，and cognitive models to explain the emergence of the gender difference in depression[J]. Psychol Rev，2008，115（2）：291-313. DOI：10.1037/0033-295X.115.2.291.
[31]	GONZÁLEZ-GUARDA R M，MCCABE B E，LEBLANC N，et al. The contribution of stress，cultural factors，and sexual identity on the substance abuse，violence，HIV，and depression syndemic among Hispanic men[J]. Cultur Divers Ethnic Minor Psychol，2016，22（4）：563-571. DOI：10.1037/cdp0000077.
[32]	ILLANGASEKARE S，BURKE J，CHANDER G，et al. The syndemic effects of intimate partner violence，HIV/AIDS，and substance abuse on depression among low-income urban women[J]. J Urban Health，2013，90（5）：934-947. DOI：10.1007/s11524-013-9797-8.
[33]	WADE D T，HALLIGAN P W. The biopsychosocial model of illness：a model whose time has come[J]. Clin Rehabil，2017，31（8）：995-1004. DOI：10.1177/0269215517709890.
[34]	JACK E，MASKREY N，BYNG R. SHERPA：a new model for clinical decision making in patients with multimorbidity[J]. Lancet，2018，392（10156）：1397-1399. DOI：10.1016/S0140-6736(18)31371-0.
[35]	JIN Y Z，LIANG J，HONG C L，et al. Cardiometabolic multimorbidity，lifestyle behaviours，and cognitive function：a multicohort study[J]. Lancet Healthy Longev，2023，4（6）：e265-273. DOI：10.1016/S2666-7568(23)00054-5.
[36]	赵敏君，李双庆. 非药物干预方式改善慢性病共病相关机制研究进展[J]. 中国全科医学，2021，24（26）：3369-3376. DOI：10.12114/j.issn.1007-9572.2021.01.102.
[37]	CORREA J B，LAWRENCE D，MCKENNA B S，et al. Psychiatric comorbidity and multimorbidity in the EAGLES trial：descriptive correlates and associations with neuropsychiatric adverse events，treatment adherence，and smoking cessation[J]. Nicotine Tob Res，2021，23（10）：1646-1655. DOI：10.1093/ntr/ntab056.
[38]	FORTIN M，STEWART M，NGANGUE P，et al. Scaling up patient-centered interdisciplinary care for multimorbidity：a pragmatic mixed-methods randomized controlled trial[J]. Ann Fam Med，2021，19（2）：126-134. DOI：10.1370/afm.2650.
[39]	DAMARELL R A，MORGAN D D，TIEMAN J J. General practitioner strategies for managing patients with multimorbidity：a systematic review and thematic synthesis of qualitative research[J]. BMC Fam Pract，2020，21（1）：131. DOI：10.1186/s12875-020-01197-8.
[40]	潘婉玉，张春慧，张振香，等. 老年慢性病共病患者多重用药管理分析与评论[J]. 中国全科医学，2022，25（13）：1545-1550. DOI：10.12114/j.issn.1007-9572.2022.00.009.
[41]	MILANO N，PETRUZZI L，COVINGTON E，et al. Social workers in integrated care beyond primary care：a scoping review[J]. Transl Behav Med，2022，12（11）：1038-1048. DOI：10.1093/tbm/ibac082.
[42]	MANNING S E，WANG H，DWIBEDI N，et al. Association of multimorbidity with the use of health information technology[J]. Digit Health，2023，9：20552076231163797. DOI：10.1177/20552076231163797.
[43]	AL-ALUSI M A，KHURSHID S，WANG X，et al. Trends in consumer wearable devices with cardiac sensors in a primary care cohort[J]. Circ Cardiovasc Qual Outcomes，2022，15（7）：e008833. DOI：10.1161/CIRCOUTCOMES.121.008833.
[44]	LIANG X J，YAN M，LI H X，et al. WeChat official accounts' posts on medication use of 251 community healthcare centers in Shanghai，China：content analysis and quality assessment[J]. Front Med，2023，10：1155428. DOI：10.3389/fmed.2023.1155428.
[45]	BROWN A，ENTICOTT J，RUSSELL G. How do Australian general practitioners spend their time? A cross-sectional analysis of Medicine in Australia：balancing Employment and Life（MABEL）data examining 'non-billable workload’[J]. Aust J Gen Pract，2021，50（9）：661-666. DOI：10.31128/AJGP-09-20-5631.
[46]	AGARWAL S D，PABO E，ROZENBLUM R，et al. Professional dissonance and burnout in primary care：a qualitative study[J]. JAMA Intern Med，2020，180（3）：395-401. DOI：10.1001/jamainternmed.2019.6326.
[47]	潘萱达，于晓松，单海燕. 国内外全科医生激励机制对比与启示[J]. 中国全科医学，2023，26（1）：14-20. DOI：10.12114/j.issn.1007-9572.2022.0762.
[48]	LEIVA-FERNÁNDEZ F，PRADOS-TORRES J D，PRADOS-TORRES A，et al. Training primary care professionals in multimorbidity management：educational assessment of the eMULTIPAP course[J]. Mech Ageing Dev，2020，192：111354. DOI：10.1016/j.mad.2020.111354.

基于疾病协同理论的慢性病共病影响因素与管理策略

The Influencing Factors and Management Strategies of Multimorbidity Based on Syndemic Theory

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 48

相关文章 15

编辑推荐

Metrics

留言

[1]	金梦龙, 秦晓英, 马力亚·阿米提, 加孜呢·努尔拜, 李建新, 曹杰, 罗思富, 刘成, 张雨晨, 盖敏涛, 李艳鹏, 鲁向锋, 付真彦. 新疆哈萨克族血脂异常、高血压和糖尿病共病现状及影响因素研究[J]. 中国全科医学, 2024, 27(12): 1438-1444.
[2]	康静, 张赐, 张正义. 三级医院全科医学科中年住院患者慢性病共病分布及影响因素研究[J]. 中国全科医学, 2024, 27(11): 1310-1315.
[3]	何海洋, 杨嘉玲, 雷迅. 绝经后女性骨质疏松症患病率及影响因素的Meta分析[J]. 中国全科医学, 2024, 27(11): 1370-1379.
[4]	田纬, 陶梦梦, 李坤坤, 曹文君, 侯国强. 中国老年多重慢性病患者健康相关生命质量及其影响因素研究[J]. 中国全科医学, 2024, 27(11): 1303-1309.
[5]	尚金梦, 邓笑伟. 体检人群保留比值受损肺功能的特点及危险因素分析[J]. 中国全科医学, 2024, 27(11): 1331-1336.
[6]	徐莉, 葛晶, 于鹏, 虞莹. 中国老年人慢性病及共病模式变化研究：基于中国健康与养老追踪调查数据[J]. 中国全科医学, 2024, 27(11): 1296-1302.
[7]	王清玉, 林征, 雷阳, 孙彩云, 王咪, 顾珺怡, 朱展慧, 唐李晨. 儿童青少年回避性/限制性摄食障碍：评估与治疗[J]. 中国全科医学, 2024, 27(09): 1028-1033.
[8]	范晶, 魏珊, 李丽秋, 郑秀丽, 李言, 牛建英, 王玲, 许成燕. 社区老年人群蛋白尿及肾功能异常发生率及其影响因素研究[J]. 中国全科医学, 2024, 27(09): 1048-1053.
[9]	温静, 张悦, 梁旭阳, 吕胜祥. 农村上消化道癌机会性筛查分析的胃癌影响因素研究：基于苏北沿海地区[J]. 中国全科医学, 2024, 27(09): 1042-1047.
[10]	赵茹, 韩晨, 黄泽宇, 王茜, 胡君, 葛智娟, 毕艳, 沈山梅. 孕晚期血清尿酸及血清尿酸/肌酐水平与不良妊娠结局的关系研究[J]. 中国全科医学, 2024, 27(09): 1074-1081.
[11]	武淑琴, 王远涵, 郑凯元, 韩红娟, 康金秀, 余红梅. 恶性黑色素瘤患者的预后及影响因素研究[J]. 中国全科医学, 2024, 27(08): 942-947.
[12]	张亚访, 闻萱, 杨中婷, 杜兴梅, 邓春燕, 叶卿云, 邓睿, 黄源. 不同家庭收入水平对老年人成功老龄化的影响研究[J]. 中国全科医学, 2024, 27(08): 930-935.
[13]	刘影, 姜俊丞, 景汇泉. 我国东、中、西部地区中老年人失能及其影响因素的区域差异研究[J]. 中国全科医学, 2024, 27(07): 877-885.
[14]	杨华杰, 王皓翔, 陈运聪, 梁旭东, 王家骥, 黄翔. 新型冠状病毒感染疫情常态化防控背景下社区医务人员心理健康状况及影响因素分析[J]. 中国全科医学, 2024, 27(07): 834-842.
[15]	孙宇馨, 湛浩然, 阿依夏姆·克依木, 徐婷婷. 中国农村孕妇生命质量现状及影响因素研究[J]. 中国全科医学, 2024, 27(06): 656-662.