Цель. Установить возрастные и гендерные особенности, нозологическую структуру коморбидности среди лиц в возрасте 20–99 лет с гипертонической болезнью (ГБ). Материалы и методы. Исследование основано на данных 21 514 электронных медицинских карт населения (20–99 лет) с ГБ, средний возраст – 63,0 года, 68,2% – женщины. Анализировались заболевания, ассоциированные с ГБ с частотой выше 10%. Результаты. В выборке лиц с ГБ сопутствующие заболевания выявлены в 82,7% случаев, 1 заболевание сопутствует 21,0% выборки с ГБ, 2 заболевания – 17,9%, 3 заболевания – 14,0%, 4+ заболевания – 29,8%. Частота ассоциации ГБ с ≥1 сопутствующим заболеванием в возрасте 20–29 лет составляет 60,8% случаев, в 30–39 лет – 65,1%, в 40–49 лет – 73,9%, в 50–59 лет – 81,1%, в 60–69 лет – 85,8%, 70–79 лет – 87,3%, в 80+ лет – 86,2% случаев. Среди женщин с ГБ среднее количество сопутствующих заболеваний выше, чем среди мужчин (3,47 случая vs 2,4 случая; р<0,001). Среди лиц молодого и среднего возраста ГБ в большинстве случаев ассоциирована с остеохондрозом позвоночника, остеоартрозом, хроническим панкреатитом, гастритом и дуоденитом, болезнями сетчатки, болезнями щитовидной железы; женской когорте с ГБ часто сопутствуют доброкачественные заболевания молочной железы и нарушения менопаузы. ГБ в пожилом возрасте наиболее часто ассоциирована с цереброваскулярными болезнями, ишемической болезнью сердца, сахарным диабетом, старческой катарактой, но остеохондроз позвоночника и остеоартроз также не теряют свою значимость. Заключение. Существующая система организации медицинской помощи не может удовлетворить потребности пациентов с коморбидностью, что свидетельствует о необходимости переориентации медицинской помощи к пациентоориентированной.
Aim. To establish age and gender characteristics, nosological structure of comorbidity among persons 20–99 years with hypertension. Materials and methods. The study is based on data from 21 514 electronic health records of the population (20–99 years old) with hypertension, mean age 63.0 years, 68.2% women. Diseases associated with hypertension with a frequency above 10% were analyzed. Results. In the sample of people with hypertension, concomitant diseases were detected in 82.7% of cases, 1 disease accompanies 21.0% of the sample with hypertension, 2 diseases 17.9%, 3 diseases 14.0%, 4+ diseases 29.8%. The frequency of association of hypertension with ≥1 concomitant disease at the 20–29 years is 60.8% of cases, at 30–39 years – 65.1%, at 40–49 years – 73.9%, at 50–59 years – 81.1%, 60–69 years – 85.8%, 70–79 years – 87.3%, 80+ years – 86.2% of cases. Among women with hypertension, the average number of concomitant diseases is higher compared to men (3.47 vs 2.4 cases; p<0.001). Among young and middle-aged people, hypertension in most cases is associated with osteochondrosis, osteoarthritis, chronic pancreatitis, gastritis and duodenitis, retinal diseases, thyroid diseases, the female with hypertension accompanied by benign breast disease and menopausal disorders. Hypertension in the elderly is most often associated with cerebrovascular disease, coronary heart disease, diabetes mellitus, senile cataract, but osteochondrosis and osteoarthritis also do not lose their relevance. Conclusion. The existing system of organization of medical care cannot meet the needs of patients with comorbidity, which indicates the need to reorient medical care towards patient-centered care.
Keywords: hypertension, comorbidity, electronic medical records, comorbidities, gender characteristics, age characteristics
1. Richard P, Walker R, Alexandre P. The burden of out of pocket costs and medical debt faced by households with chronic health conditions in the United States. PLoS One. 2018;13(6):e0199598. DOI:10.1371/journal.pone.0199598
2. Meraya AM, Raval AD, Sambamoorthi U. Chronic condition combinations and health care expenditures and out-of-pocket spending burden among adults, Medical Expenditure Panel Survey, 2009 and 2011. Prev Chronic Dis. 2015;12:E12. DOI:10.5888/pcd12.140388
3. Picco L, Achilla E, Abdin E, et al. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016;16:173. DOI:10.1186/s12913-016-1421-7
4. Park C, Fang J, Hawkins NA, et al. Comorbidity Status and Annual Total Medical Expenditures in U.S. Hypertensive Adults. Am J Prev Med. 2017;53(6S2):S172-81. DOI:10.1016/j.amepre.2017.07.014
5. Андреенко Е.Ю., Лукьянов М.М., Якушин С.С., и др. Ранняя кардиоваскулярная мультиморбидность в амбулаторной и госпитальной практике: возрастные характеристики и медикаментозное лечение пациентов (данные регистров РЕКВАЗА и РЕКВАЗА-КЛИНИКА). Кардиоваскулярная терапия и профилактика. 2020;19(5):2672 [Andreenko EYu, Lukyanov MM, Yakushin SS, et al. Early cardiovascular multimorbidity in out- and in-patient care: age characteristics and medication therapy (data from the REKVAZA and REKVAZA-CLINIC registries). Kardiovaskulyarnaya terapiya i profilaktika. 2020;19(5):2672 (in Russian)]. DOI:10.15829/1728-8800-2020-2672
6. Шальнова С.А., Деев А.Д., Баланова Ю.А., и др. Двадцатилетние тренды ожирения и артериальной гипертонии и их ассоциации в России. Кардиоваскулярная терапия и профилактика. 2017;16(4):4-10 [Shalnova SA, Deev AD, Balanova YuA, et al. Twenty years trends of obesity and arterial hypertension and their association in Russia. Kardiovaskulyarnaya terapiya i profilaktika. 2017;16(4):4-10 (in Russian)]. DOI:10.15829/1728-8800-2017-4-4-10
7. Жернакова Ю.В., Чазова И.Е., Ощепкова Е.В., и др. Распространенность сахарного диабета в популяции больных артериальной гипертонией. По данным исследования ЭССЕ-РФ. Системные гипертензии. 2018;15(1):56-62 [Zhernakova YV, Chazova IE, Oshchepkova EV, et al. The prevalence of diabetes mellitus in population of hypertensive patients according to ESSE RF study results. Sistemnye gipertenzii. 2018;15(1):56-62 (in Russian)]. DOI:10.26442/2075-082X_15.1.56-62
8. Чазова И.Е., Невзорова В.А., Амбатьелло Л.Г., и др. Клинические рекомендации по диагностике и лечению пациентов с артериальной гипертонией и хронической обструктивной болезнью легких. Системные гипертензии. 2020;17(3):7-34 [Chazova IE, Nevzorova VA, Ambatiello LG, et al. Clinical practice guidelines on the diagnosis and treatment of patients with arterial hypertension and chronic obstructive pulmonary disease. Sistemnye gipertenzii. 2020;17(3):7-34 (in Russian)]. DOI:10.26442/2075082X.2020.3.200294
9. Гринштейн Ю.И., Шабалин В.В., Руф Р.Р., и др. Распространенность сочетания артериальной гипертонии и дислипидемии среди взрослого населения крупного Восточносибирского региона. Кардиоваскулярная терапия и профилактика. 2021;20(4):2865 [Grinshtein YuI, Shabalin VV, Ruf RR, et al. Prevalence of a combination of hypertension and dyslipidemia among the adult population of a large East Siberian region. Kardiovaskulyarnaya terapiya i profilaktika. 2021;20(4):2865 (in Russian)].
DOI:10.15829/1728-8800-2021-2865
10. Liu J, Ma J, Wang J, et al. Comorbidity Analysis According to Sex and Age in Hypertension Patients in China. Int J Med Sci. 2016;13(2):99-107. DOI:10.7150/ijms.13456
11. Бойцов С.А., Лукьянов М.М., Якушин С.С., и др. Регистр кардиоваскулярных заболеваний (РЕКВАЗА): диагностика, сочетанная сердечно-сосудистая патология, сопутствующие заболевания и лечение в условиях реальной амбулаторно-поликлинической практики. Кардиоваскулярная терапия и профилактика. 2014;13(6):44-50 [Boytsov SA, Luk’yanov MM, Yakushin SS, et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Kardiovaskulyarnaya terapiya i profilaktika. 2014;13(6):44-50 (in Russian)]. DOI:10.15829/1728-8800-2014-6-44-50
12. Li YT, Wang HHX, Liu KQL, et al. Medication Adherence and Blood Pressure Control Among Hypertensive Patients With Coexisting Long-Term Conditions in Primary Care Settings: A Cross-Sectional Analysis. Medicine (Baltimore). 2016;95(20):e3572. DOI:10.1097/MD.0000000000003572
13. Rocca WA, Boyd CM, Grossardt BR, et al. Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014;89(10):1336-49. DOI:10.1016/j.mayocp.2014.07.010
14. Низов А.А., Сучкова Е.И., Дашкевич О.В., и др. Кардиоваскулярная коморбидность в реальной клинической практике амбулаторного врача. Сравнительное регистровое исследование в Рязанской области. Кардиоваскулярная терапия и профилактика. 2019;18(2):70-5 [Nizov AA, Suchkova EI, Dashkevich OV, et al. Cardiovascular comorbidity in the real clinical practice of an ambulatory physician. Comparative register research in the Ryazan region. Kardiovaskulyarnaya terapiya i profilaktika. 2019;18(2):70-5 (in Russian)]. DOI:10.15829/1728-8800-2019-2-70-75
15. Prathapan S, Fernando GVMC, Matthias AT, et al. The rising complexity and burden of multimorbidity in a middle-income country. PLoS One. 2020;15(12):e0243614. DOI:10.1371/journal.pone.0243614
16. Carmel S. Health and Well-Being in Late Life: Gender Differences Worldwide. Front Med (Lausanne). 2019;6:218. DOI:10.3389/fmed.2019.00218
17. Crimmins EM, Shim H, Zhang YS, et al. Differences between Men and Women in Mortality and the Health Dimensions of the Morbidity Process. Clin Chem. 2019;65(1):135-45. DOI:10.1373/clinchem.2018.288332
18. Liu Y, Liu G, Wu H, et al. Sex differences in non-communicable disease prevalence in China: a cross-sectional analysis of the China Health and Retirement Longitudinal Study in 2011. BMJ Open. 2017;7(12):e017450. DOI:10.1136/bmjopen-2017-017450
19. van den Bussche H, Koller D, Kolonko T, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011;11:101. DOI:10.1186/1471-2458-11-101
20. Mahadir Naidu B, Mohd Yusoff MF, Abdullah S, et al. Factors associated with the severity of hypertension among Malaysian adults. PLoS One. 2019;14(1):e0207472. DOI:10.1371/journal.pone.0207472
21. Singh K, Patel SA, Biswas S, et al. Multimorbidity in South Asian adults: prevalence, risk factors and mortality. J Public Health (Oxf). 2019;41(1):80-9. DOI:10.1093/pubmed/fdy017
22. Feng L, Jehan I, de Silva HA, et al. Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia – Bangladesh, Pakistan and Sri Lanka. BMJ Open. 2019;9(9):e030584. DOI:10.1136/bmjopen-2019-030584
23. Kim HS, Shin JS, Lee J, et al. Association between Knee Osteoarthritis, Cardiovascular Risk Factors, and the Framingham Risk Score in South Koreans: A Cross-Sectional Study. PLoS One. 2016;11(10):e0165325. DOI:10.1371/journal.pone.0165325
________________________________________________
1. Richard P, Walker R, Alexandre P. The burden of out of pocket costs and medical debt faced by households with chronic health conditions in the United States. PLoS One. 2018;13(6):e0199598. DOI:10.1371/journal.pone.0199598
2. Meraya AM, Raval AD, Sambamoorthi U. Chronic condition combinations and health care expenditures and out-of-pocket spending burden among adults, Medical Expenditure Panel Survey, 2009 and 2011. Prev Chronic Dis. 2015;12:E12. DOI:10.5888/pcd12.140388
3. Picco L, Achilla E, Abdin E, et al. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016;16:173. DOI:10.1186/s12913-016-1421-7
4. Park C, Fang J, Hawkins NA, et al. Comorbidity Status and Annual Total Medical Expenditures in U.S. Hypertensive Adults. Am J Prev Med. 2017;53(6S2):S172-81. DOI:10.1016/j.amepre.2017.07.014
5. Andreenko EYu, Lukyanov MM, Yakushin SS, et al. Early cardiovascular multimorbidity in out- and in-patient care: age characteristics and medication therapy (data from the REKVAZA and REKVAZA-CLINIC registries). Kardiovaskulyarnaya terapiya i profilaktika. 2020;19(5):2672 (in Russian). DOI:10.15829/1728-8800-2020-2672
6. Shalnova SA, Deev AD, Balanova YuA, et al. Twenty years trends of obesity and arterial hypertension and their association in Russia. Kardiovaskulyarnaya terapiya i profilaktika. 2017;16(4):4-10 (in Russian). DOI:10.15829/1728-8800-2017-4-4-10
7. Zhernakova YV, Chazova IE, Oshchepkova EV, et al. The prevalence of diabetes mellitus in population of hypertensive patients according to ESSE RF study results. Sistemnye gipertenzii. 2018;15(1):56-62 (in Russian). DOI:10.26442/2075-082X_15.1.56-62
8. Chazova IE, Nevzorova VA, Ambatiello LG, et al. Clinical practice guidelines on the diagnosis and treatment of patients with arterial hypertension and chronic obstructive pulmonary disease. Sistemnye gipertenzii. 2020;17(3):7-34 (in Russian). DOI:10.26442/2075082X.2020.3.200294
9. Grinshtein YuI, Shabalin VV, Ruf RR, et al. Prevalence of a combination of hypertension and dyslipidemia among the adult population of a large East Siberian region. Kardiovaskulyarnaya terapiya i profilaktika. 2021;20(4):2865 (in Russian). DOI:10.15829/1728-8800-2021-2865
10. Liu J, Ma J, Wang J, et al. Comorbidity Analysis According to Sex and Age in Hypertension Patients in China. Int J Med Sci. 2016;13(2):99-107. DOI:10.7150/ijms.13456
11. Boytsov SA, Luk’yanov MM, Yakushin SS, et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Kardiovaskulyarnaya terapiya i profilaktika. 2014;13(6):44-50 (in Russian). DOI:10.15829/1728-8800-2014-6-44-50
12. Li YT, Wang HHX, Liu KQL, et al. Medication Adherence and Blood Pressure Control Among Hypertensive Patients With Coexisting Long-Term Conditions in Primary Care Settings: A Cross-Sectional Analysis. Medicine (Baltimore). 2016;95(20):e3572. DOI:10.1097/MD.0000000000003572
13. Rocca WA, Boyd CM, Grossardt BR, et al. Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014;89(10):1336-49. DOI:10.1016/j.mayocp.2014.07.010
14. Nizov AA, Suchkova EI, Dashkevich OV, et al. Cardiovascular comorbidity in the real clinical practice of an ambulatory physician. Comparative register research in the Ryazan region. Kardiovaskulyarnaya terapiya i profilaktika. 2019;18(2):70-5 (in Russian). DOI:10.15829/1728-8800-2019-2-70-75
15. Prathapan S, Fernando GVMC, Matthias AT, et al. The rising complexity and burden of multimorbidity in a middle-income country. PLoS One. 2020;15(12):e0243614. DOI:10.1371/journal.pone.0243614
16. Carmel S. Health and Well-Being in Late Life: Gender Differences Worldwide. Front Med (Lausanne). 2019;6:218. DOI:10.3389/fmed.2019.00218
17. Crimmins EM, Shim H, Zhang YS, et al. Differences between Men and Women in Mortality and the Health Dimensions of the Morbidity Process. Clin Chem. 2019;65(1):135-45. DOI:10.1373/clinchem.2018.288332
18. Liu Y, Liu G, Wu H, et al. Sex differences in non-communicable disease prevalence in China: a cross-sectional analysis of the China Health and Retirement Longitudinal Study in 2011. BMJ Open. 2017;7(12):e017450. DOI:10.1136/bmjopen-2017-017450
19. van den Bussche H, Koller D, Kolonko T, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011;11:101. DOI:10.1186/1471-2458-11-101
20. Mahadir Naidu B, Mohd Yusoff MF, Abdullah S, et al. Factors associated with the severity of hypertension among Malaysian adults. PLoS One. 2019;14(1):e0207472. DOI:10.1371/journal.pone.0207472
21. Singh K, Patel SA, Biswas S, et al. Multimorbidity in South Asian adults: prevalence, risk factors and mortality. J Public Health (Oxf). 2019;41(1):80-9. DOI:10.1093/pubmed/fdy017
22. Feng L, Jehan I, de Silva HA, et al. Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia – Bangladesh, Pakistan and Sri Lanka. BMJ Open. 2019;9(9):e030584. DOI:10.1136/bmjopen-2019-030584
23. Kim HS, Shin JS, Lee J, et al. Association between Knee Osteoarthritis, Cardiovascular Risk Factors, and the Framingham Risk Score in South Koreans: A Cross-Sectional Study. PLoS One. 2016;11(10):e0165325. DOI:10.1371/journal.pone.0165325
1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 ФКУЗ «Медико-санитарная часть Министерства внутренних дел России по Тамбовской области», Тамбов, Россия;
3 БУЗ ВО «Воронежская государственная клиническая поликлиника №1», Воронеж, Россия
*osmanov@bk.ru
________________________________________________
Esedulla M. Osmanov*1, Vladimir A. Reshetnikov1, Rustam R. Manyakov2, Amina S. Garaeva1, Lauriia Kh. Korkmazova1, Valeriya V. Demenkova3
1 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2 Medical Unit of the Ministry of Internal Affairs of Russia in the Tambov Region, Tambov, Russia;
3 Voronezh State Clinical Polyclinic №1, Voronezh, Russia
*osmanov@bk.ru