关节炎加重了其它慢性疾病的影响


  【24drs.com】研究者在发表于6月5日发病率与死亡率周报的一篇文章中报告指出,关节炎对于有多种慢性健康问题者的特殊影响一直被低估,研究者、健康照护提供者与政策制定者应将此议题纳入讨论。
  
  格鲁吉亚州亚特兰大疾病控制与预防中心人口卫生与防疫情报服务组的Jin Qin等人分析了2013年全国健康访查(National Health Interview Survey)的资料,发现有一种以上慢性疾病的受访者,在社会参与限制、严重心理困扰和工作限制的盛行率显著逐渐增加。
  
  此外,慢性疾病之一为关节炎者,在这三种生活领域之不良结果的盛行率更高于那些没有关节炎者。
  
  作者们写道,单就关节炎而言,对社会参与限制和工作失能的影响大于其它慢性疾病,如果是有多种慢性病且其中之一为关节炎时,则前述三种生活领域的不良影响盛行率更高。这些后果具有深远的公共卫生意义,因为社会活动参与、心理健康、以及工作能力对于生活质量相当重要。
  
  全国健康访查资料来自非住院平民的代表性样本(n = 34,506人),询问他们是否有医师诊断的关节炎(定义是关节炎、类风湿性关节炎、痛风、红斑性狼疮或纤维肌痛),以及高血压、心脏病(冠心病、心绞痛、心脏病发作、其它心脏疾病)、中风、糖尿病、气喘、癌症、肾脏虚弱或失能、肝炎、慢性阻塞性肺部疾病,作者们将受访对象分成5类:
  * 没有慢性疾病(51.0%的受访者);
  * 只有关节炎(6.1%);
  * 一种疾病、但不是关节炎(16.8%);
  * 两种以上慢性疾病、其中一种是关节炎(16.6%);以及
  * 两种以上慢性疾病、都不是关节炎(9.5%)。
  
  共变项分析包括年龄、性别、种族、教育程度、身体质量指数以及抽菸情况。
  
  生活领域结果包括:对社会参与的限制,例如购物、参加体育活动、参加派对、访友等的能力;严重的心理压力;以及工作限制。
  
  关节炎患者将近四分之三有其它慢性病,特别是65岁以上者、妇女、白人或黑人、过重成年人、现在或曾经抽菸者。
  
  这三个生活领域结果都会因为慢性疾病而逐渐恶化,从没有慢性疾病、到一种慢性病(有或没有关节炎)、然后是两种或以上的非关节炎疾病,最后,最严重的,同时有关节炎与一种以上其它慢性病。
  
  有一种慢性病的成年人中,关节炎者有15.6%工作失能、3.7%出现社会参与限制,不是关节炎者则是8.6%失能、2.1%出现社会参与限制。有两种以上慢性病者中,有关节炎者有30.7%工作失能、没有关节炎者则是22.5%。有关节炎和另外一种以上慢性病者,有10.4%的社会参与限制受到影响,没有关节炎者则是6.3%。严重心理压力方面,有关节炎者有9.9%受影响,有两种以上慢性病但没有关节炎者则是6.8%。
  
  作者们也强调自我管理介入对于减少疼痛、害怕疼痛和其它与关节炎有关之运动障碍的重要性。 现有的计画包括「慢性疾病自我管理计画(Chronic Disease Self-Management Program)」以及「行走自如(Walk with Eas)」,两个计画都是由美国健康与人类服务部所发表。
  
  资料来源:http://www.24drs.com/
  
  Native link:Arthritis Magnifies Effect of Other Chronic Conditions

Arthritis Magnifies Effect of Other Chronic Conditions

By Janis C. Kelly
Medscape Medical News

The special effect of arthritis on people who have multiple chronic health problems has been underappreciated and should be included in discussions among researchers, healthcare providers, and policy makers, researchers report in an article published in the June 5 issue of the Morbidity and Mortality Weekly Report.

Jin Qin, ScD, and colleagues from the Division of Population Health and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, analyzed data from the 2013 National Health Interview Survey and found that subjects with one or more chronic conditions also had "significant and progressively higher prevalences of social participation restriction, serious psychological distress, and work limitations."

Moreover, those who reported arthritis as one of their chronic conditions had higher prevalences of adverse outcomes on all three life domains than those whose health burdens did not include arthritis.

The authors write, "Arthritis alone had a greater impact on social participation restriction and work disability than having one of the other chronic conditions, and arthritis as one of multiple chronic conditions was associated with higher prevalences of adverse impact on all three life domains. These consequences have profound public health implications because social activity participation, mental health, and the ability to work can be important contributors to quality of life."

Stepwise Increase in Disability

The National Health Interview Survey data were from a representative sample of the noninstitutionalized civilian population (n = 34,506) who were asked about physician-diagnosed arthritis (defined as arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia), as well as hypertension, heart disease (coronary heart disease, angina pectoris, heart attack, or any other heart condition), stroke, diabetes, asthma, cancer, weak or failing kidneys, hepatitis, and chronic obstructive pulmonary disease. The authors divided subjects into 5 categories:

  • no chronic conditions (51.0% of subjects);

  • arthritis only (6.1%);

  • one nonarthritis condition (16.8%);

  • two or more chronic conditions, one of which is arthritis (16.6%); and

  • two or more chronic conditions, none of which is arthritis (9.5%).

Covariate analysis included age, sex, race/ethnicity, educational level, body mass index, and smoking status.

Life domain outcomes included restrictions on social participation such as ability to go shopping, to go to movies, to go to sporting events, to go to parties, or to visit friends; serious psychological distress; and work limitations.

Nearly three quarters of subjects with arthritis had additional chronic conditions, and this combination was more common in people older than 65 years, women, whites or blacks, adults who were overweight, and current or former smokers.

All three of the life domain outcomes were worsened by the presence of chronic conditions in a stepwise progression from no chronic conditions through one chronic condition (with or without arthritis), and then two or more nonarthritis conditions, and finally, most severely, for arthritis plus one or more other chronic conditions.

Among adults with one chronic condition, work disability affected 15.6% of those with arthritis only vs 8.6% of those without arthritis. Social participation restrictions affected 3.7% of those with arthritis only vs 2.1% of those without. In subjects with two or more chronic conditions, work disability affected 30.7% with arthritis vs 22.5% without arthritis. Social participation restrictions affected 10.4% of those with arthritis and one or more other conditions vs 6.3% without arthritis. Serious psychological distress affected 9.9% of those with arthritis vs.6.8% of those who also had two or more conditions but did not have arthritis.

The authors also emphasize the importance of self-management interventions to reduce pain, fear of pain, and other arthritis-specific barriers to physical activity. Available programs include the "Chronic Disease Self-Management Program" and "Walk with Ease," both programs developed by the US Department of Health and Human Services.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:578-582.

    
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