Recent studies have found that middle-aged individuals account for over 40% of patients with chronic disease comorbidities, and this percentage is still increasing. This comorbidity not only reduces the quality of life for these patients but can also lead to premature death. However, research on the distribution and influencing factors of chronic comorbidities in middle-aged adults is still limited.

To provide a scientific basis for managing such patients by retrospectively analyzing the disease distribution and influencing factors of chronic comorbidities among middle-aged inpatients.

From July 1, 2017 to February 28, 2023, a total of 5 931 inpatients were admitted to the Department of General Medicine, the Second Hospital of Lanzhou University. Among them, 1 650 middle-aged patients (aged 45 to 59 years) were included as subjects for this study. General information of the subjects was collected, and the comorbidity conditions of chronic diseases were statistically analyzed. Multifactorial Logistic regression analysis was employed to investigate the influencing factors associated with different chronic disease comorbidities.

Among the 1 650 middle-aged patients attending the department of general practice, 79 (4.8%), 359 (21.8%), and 1 212 (73.4%) patients suffered from 0, 1, and ≥2 chronic diseases, respectively. Comparison of gender, age, ethnicity, occupation, and route of admission of patients with 0, 1, and ≥2 chronic diseases showed statistically significant differences (P<0.05). The three most common chronic diseases were heart disease (66.1%, 1 091/1 650), hypertension (41.1%, 678/1 650), and cerebrovascular disease (20.7%, 342/1 650). The top three comorbid conditions with other chronic diseases were diabetes or hyperglycemia (97.3%, 215/221), hypertension (98.5%, 668/678), and dyslipidemia (96.1%, 246/256). Of the 1 650 middle-aged patients hospitalized in general practice, 581 (35.2%) had 2 chronic comorbidities and 455 (27.6%) had 3 chronic comorbidities. Among patients with two comorbidities, the most frequent combinations were heart disease+hypertension (22.7%, 132/581), heart disease+chronic lung disease (13.1%, 76/581), and heart disease+cerebrovascular disease (8.4%, 49/581) ; for three comorbidities, the top combinations were hypertension+heart disease+cerebrovascular disease (14.5%, 66/455), hypertension+heart disease+diabetes or hyperglycemia (10.5%, 48/455), and hypertension+heart disease+chronic lung disease (7.9%, 36/455). Multivariate Logistic regression analysis showed that ethnicity of Han (OR=26.778, 95%CI=3.120-229.793), Hui (OR=46.143, 95%CI=3.456-616.090), or Dongxiang (OR=52.966, 95%CI=2.502-1 121.195) were influencing factors for middle-aged inpatients with 1 chronic disease (P<0.05). For ≥2 chronic diseases, influencing factors included 50-54 age group (OR=0.461, 95%CI=0.266-0.801), being of Han (OR=3.783, 95%CI=1.433-9.983) or Hui (OR=6.055, 95%CI=1.107-33.126) ethnicity, occupation of farmer (OR=0.460, 95%CI=0.252-0.839) (P<0.05) .

Approximately one-third of patients in the general practice department of tertiary hospitals are middle-aged, and most of them present with chronic comorbidities. While focusing on the chronic diseases of the elderly, there is a need for enhanced focus on chronic diseases management and clinical awarenes improvement in middle-aged individuals, enhancing the content of health management services provided by general practitioners, and establishing a more comprehensive model of general practice services. Additionally, research indicates that patients with diabetes are more prone to chronic disease comorbidities. The phenomenon is particularly prevalent among residents of Hui or Han ethnicity. These groups should receive focused attention during screening and management processes.

近年来研究发现，慢性病共病患者中中年人约占40%以上，且仍呈上升趋势，其降低了患者的生活质量，甚至造成其过早死亡。然而，目前中年慢性病共病分布及其影响因素的研究甚少。

分析中年慢性病共病住院患者的疾病分布及其影响因素，为该类患者的管理提供科学依据。

2017-07-01—2023-02-28于兰州大学第二医院全科医学科住院患者共5 931例，纳入其中中年（45~59岁）患者1 650例为研究对象，收集研究对象的一般资料，并统计慢性病共病情况。采用多因素Logistic回归分析探究不同慢性病共病的影响因素。

1 650例就诊全科医学科的中年患者中，患0、1、≥2种慢性病患者分别有79例（4.8%）、359例（21.8%）、1 212例（73.4%）。患0、1、≥2种慢性病患者的性别、年龄、民族、职业、入院途径比较，差异有统计学意义（P<0.05）。慢性病患病率居前3位的分别是：心脏疾病（66.1%，1 091/1 650）、高血压（41.1%，678/1 650）、脑血管病（20.7%，342/1 650）。发生慢性病共病前3位的慢性病为糖尿病或血糖升高（97.3%，215/221）、高血压（98.5%，668/678）、血脂异常（96.1%，246/256）。1 650例全科医学科住院的中年患者中，2种慢性病共病的患者为581例（35.2%），3种慢性病共病的患者为455例（27.6%）。2种慢性病共病组合发生率居前3位的分别是心脏疾病+高血压（22.7%，132/581）、心脏疾病+慢性肺部疾病（13.1%，76/581）、心脏疾病+脑血管病（8.4%，49/581）；3种慢性病共病发生率居前3位的分别是高血压+心脏疾病+脑血管病（14.5%，66/455）、高血压+心脏疾病+糖尿病或血糖升高（10.5%，48/455）、高血压+心脏疾病+慢性肺部疾病（7.9%，36/455）。多因素Logistic回归分析结果显示民族为汉族（OR=26.778，95%CI=3.120~229.793）、回族（OR=46.143，95%CI=3.456~616.090）、东乡族（OR=52.966，95%CI=2.502~1 121.195）是中年住院患者患1种慢性病的影响因素（P<0.05）；年龄50~54岁（OR=0.461，95%CI=0.266~0.801），民族为汉族（OR=3.783，95%CI=1.433~9.983）、回族（OR=6.055，95%CI=1.107~33.126），职业为农民（OR=0.460，95%CI=0.252~0.839）是中年住院患者患≥2种慢性病的影响因素（P<0.05）。

三级医院全科医学科中年住院患者占比约1/3，并且绝大部分为慢性病共病状态，全科医学科在注重老年人慢性病的同时，更应注重中年人的慢性病管理，提升临床上对该人群的认识，完善全科医生健康管理服务内容，建立更全面的全科医疗服务模式。同时研究发现糖尿病患者更易出现慢性病共病现象，回族或汉族居民也更容易出现慢性病共病，在筛查管理时应重点关注。