多病簇对成人健康结局的预后影响：一项系统回顾和荟萃分析。

IF 12.4 1区医学 Q1 CELL BIOLOGY

Ageing Research Reviews Pub Date : 2025-09-09 DOI:10.1016/j.arr.2025.102897

Jing Xi , Miao Miao , Polly W.C. Li , Doris S.F. Yu

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引用次数: 0

摘要

背景：多发病是一个重要的全球健康问题。我们评估了多病聚集性对成人健康结局的预后影响。方法：本研究在PROSPERO注册（CRD42024528148），未收到任何资助。8个数据库（PubMed， EMBASE, Cochrane Library, Web of Science, PsycINFO， CINAHL，万方和中国知网）被检索到报告多病集群预后影响的纵向研究。采用纽卡斯尔-渥太华量表评估方法学质量。数据分析包括叙事综合、随机效应meta分析、亚组分析、meta回归、敏感性分析和Egger检验。结果：共纳入40篇文献，确定了12个多发病群。心血管代谢多病（校正风险比[HR]: 1.97, 95%可信区间[CI]: 1.76-2.21；校正优势比[OR]: 1.44, 95% CI: 1.16-1.80）对全因死亡率有很强的预后影响，其次是心肺（校正风险比：1.70,95% CI: 1.38-2.09）和消化系统多病（校正风险比：1.46,95% CI: 1.11-1.93）。它还预测了循环（调整后的HR: 3.41, 95% CI: 2.27-5.12）和癌症死亡率（调整后的HR: 1.32, 95% CI: 1.04-1.67）、日常生活残疾活动（调整后的OR: 1.76, 95% CI: 1.57-1.99）和抑郁症（调整后的OR: 1.53, 95% CI: 1.27-1.85）。多系统多发病预测全因死亡率（校正OR: 1.41, 95% CI: 1.12-1.77）和日常生活残疾活动（校正OR: 2.04, 95% CI: 1.36-3.05）。当使用预先确定的方法确定时，心脏代谢多病预示着更高的全因死亡风险。结论：多病群强烈影响日常生活活动、抑郁和死亡率，心脏代谢多病值得特别关注。然而，由于方法学的局限性、异质性、亚洲人主导的样本和语言偏见，这些结果应该谨慎解释。

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Prognostic effects of multimorbidity clusters on health outcomes in adults: A systematic review and meta-analysis

Background

Multimorbidity is an important global health concern. We evaluated the prognostic impacts of multimorbidity clusters on health outcomes in adults.

Methods

This study was registered in PROSPERO (CRD42024528148), and no funding was received. Eight databases (PubMed, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, Wan Fang, and CNKI) were searched for longitudinal studies reporting the prognostic impacts of multimorbidity clusters. Methodological quality was assessed using Newcastle–Ottawa Scale. Data analysis incorporated narrative synthesis, random-effects meta-analysis, subgroup analysis, meta-regression, sensitivity analysis, and Egger’s test.

Results

Forty articles identifying 12 multimorbidity clusters were included. Cardiometabolic multimorbidity (adjusted hazard ratio [HR]: 1.97, 95 % confidence interval [CI]: 1.76–2.21; adjusted odds ratio [OR]: 1.44, 95 % CI: 1.16–1.80) had strong prognostic impact on all-cause mortality, followed by cardiopulmonary (adjusted HR: 1.70, 95 % CI: 1.38–2.09), and digestive multimorbidity (adjusted HR: 1.46, 95 % CI: 1.11–1.93). It also predicted circulatory (adjusted HR: 3.41, 95 % CI: 2.27–5.12) and cancer mortality (adjusted HR: 1.32, 95 % CI: 1.04–1.67), activities of daily living disability (adjusted OR: 1.76, 95 % CI: 1.57–1.99), and depression (adjusted OR: 1.53, 95 % CI: 1.27–1.85). Multi-system multimorbidity predicted all-cause mortality (adjusted OR: 1.41, 95 % CI: 1.12–1.77) and activities of daily living disability (adjusted OR: 2.04, 95 % CI: 1.36–3.05). Cardiometabolic multimorbidity predicted a higher risk of all-cause mortality when identified using a pre-determined method.

Conclusion

Multimorbidity clusters strongly impact activities of daily living, depression, and mortality, with cardiometabolic multimorbidity warranting particular attention. However, due to methodological limitations, heterogeneity, Asian-dominant samples, and language bias, these results should be interpreted with caution.

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来源期刊

Ageing Research Reviews 医学-老年医学

CiteScore

19.80

自引率

2.30%

发文量

216

审稿时长

55 days

期刊介绍： With the rise in average human life expectancy, the impact of ageing and age-related diseases on our society has become increasingly significant. Ageing research is now a focal point for numerous laboratories, encompassing leaders in genetics, molecular and cellular biology, biochemistry, and behavior. Ageing Research Reviews (ARR) serves as a cornerstone in this field, addressing emerging trends. ARR aims to fill a substantial gap by providing critical reviews and viewpoints on evolving discoveries concerning the mechanisms of ageing and age-related diseases. The rapid progress in understanding the mechanisms controlling cellular proliferation, differentiation, and survival is unveiling new insights into the regulation of ageing. From telomerase to stem cells, and from energy to oxyradical metabolism, we are witnessing an exciting era in the multidisciplinary field of ageing research. The journal explores the cellular and molecular foundations of interventions that extend lifespan, such as caloric restriction. It identifies the underpinnings of manipulations that extend lifespan, shedding light on novel approaches for preventing age-related diseases. ARR publishes articles on focused topics selected from the expansive field of ageing research, with a particular emphasis on the cellular and molecular mechanisms of the aging process. This includes age-related diseases like cancer, cardiovascular disease, diabetes, and neurodegenerative disorders. The journal also covers applications of basic ageing research to lifespan extension and disease prevention, offering a comprehensive platform for advancing our understanding of this critical field.