英格兰多发长期疾病（多重发病）的进展：一项针对4960万成年人的基于人群的描述性研究
2026/04/28
摘要
背景：多发长期疾病（MLTCs）或多重发病（multimorbidity）的发病率定义并不一致，且很少在全人群水平上进行报告。本研究旨在利用覆盖英国英格兰成年人群的常规收集的医疗保健数据，测量MLTC的发病率和进展率，并检验种族与社会经济剥夺之间的相互作用。
方法：我们使用国家细分数据集（National Segmentation Dataset），测量了2022年4月1日至2023年3月31日期间英格兰20岁及以上成年人中28种长期疾病的发病率，这些疾病与研究中MLTC定义的德尔菲（Delphi）共识相一致。我们将MLTC进展率定义为通过患上一种或多种长期疾病而导致疾病负担加重的事件发生率。我们在更长的一个6年期间内对其进行了测量：确定了在2017年4月1日至2018年3月31日期间患上第一种或第二种长期疾病的20岁及以上成年人，并测量了截至2023年3月31日的MLTC进展率。使用Cox比例风险回归模型来检验社会人口学特征的关联性。
结果：在2022年4月1日至2023年3月31日期间的4960万名成年人中，作为首发疾病出现且发病率最高的疾病为：抑郁症（每10万人年1088例 [95% CI 1085-1092]）、高血压（885 [882-888]）、癌症（525 [522-528]）、糖尿病（464 [462-466]）、哮喘（440 [438-443]）、骨关节炎（394 [392-396]）、冠心病（252 [250-254]）和脑血管病（196 [194-197]）。这些疾病占所有首发疾病的78.5%。在2017年4月1日至2018年3月31日期间，有1,092,728人患上第一种疾病，535,661人患上第二种疾病，其中位随访时间分别为5.16年（IQR 2.58-5.50）和4.41年（IQR 1.33-5.41）。从一种疾病进展为两种或多种疾病的进展率为每100人年8.56（95% CI 8.53-8.58）；从两种疾病进展为三种或多种疾病的进展率为每100人年13.60（13.55-13.65）。在基线年龄为40-49岁的人群中，从两种疾病进展为三种或多种疾病的进展率（9.48 [9.36-9.60]）比从一种疾病进展为两种或多种疾病的进展率（6.48 [6.42-6.53]）高出46%。比例风险模型显示，从一种疾病进展为两种或多种疾病的风险在最被剥夺的五分位数人群中最高（风险比 [HR] 1.37 [1.36-1.39]；与最未被剥夺的人群相比，p<0.0001），在黑人种族群体中也最高（HR 1.19 [1.11-1.29]；与白人种族群体相比，p<0.0001），而在女性中较低（HR 0.95 [0.94-0.95]；与男性相比，p<0.0001）。黑人种族与最被剥夺的五分位数（多重剥夺指数第1个五分位）之间的负交互作用系数表明，在黑人种族群体内部，疾病进展与剥夺程度之间的关联性有所减弱（HR 0.78 [0.72-0.85]；p<0.0001）。
结论：在这项针对英格兰成年人的全人群研究中，八种长期疾病（即抑郁症、高血压、癌症、糖尿病、哮喘、骨关节炎、冠心病和脑血管病）构成了人们所患首发疾病的绝大多数。现有疾病的存在与更高的MLTC进展率相关。社会经济剥夺与疾病的进展密切相关，但黑人种族群体除外——在该群体中，跨越所有种族和剥夺程度交叉子群体的疾病进展率都普遍偏高。这突显了在公共卫生政策和研究中采用交叉方法（intersectional approaches）的重要性。
Progression of multiple long-term conditions (multimorbidity) in England: a population-based descriptive study of 49·6 million adults
Slade E, Turner EB, Pratt A, Dunbar-Rees R, Hafezparast N, Barron E, Bakhai C, Wainman G, Robery N, Paul A, Barczak K, Gregg E, Khunti K, Valabhji J
Abstract
BACKGROUND:Incidence of multiple long-term conditions (MLTCs), or multimorbidity, is inconsistently defined and infrequently reported at whole-population level. We aimed to measure the MLTC incidence and progression rates, examining the interaction between ethnicity and socioeconomic deprivation, using routinely collected health-care data covering the adult population of England, UK.
METHODS:Using the National Segmentation Dataset, we measured incidence of 28 long-term conditions, that align with the Delphi consensus for the definition of MLTCs in research, among adults aged 20 years and older in England between April 1, 2022, and March 31, 2023. We defined MLTC progression rate as the incidence of events in which disease burden progresses through the acquisition of one or more long-term conditions. We measured this over a longer 6-year period, identifying adults aged 20 years and older acquiring their first or second long-term condition between April 1, 2017, and March 31, 2018, and measuring the MLTC progression rate to March 31, 2023. Cox proportional hazard regression was used to examine sociodemographic associations.
RESULTS:Among 49·6 million adults between April 1, 2022, and March 31, 2023, conditions occurring as a first condition with the highest incidence were depression (1088 [95% CI 1085-1092] cases per 100 000 person-years), hypertension (885 [882-888]), cancer (525 [522-528]), diabetes (464 [462-466]), asthma (440 [438-443]), osteoarthritis (394 [392-396]), coronary heart disease (252 [250-254]), and cerebrovascular disease (196 [194-197]). These accounted for 78·5% of all first conditions. Of 1 092 728 people acquiring their first and 535 661 their second conditions between April 1, 2017, and March 31, 2018, median follow-up time was 5·16 years (IQR 2·58-5·50) and 4·41 years (IQR 1·33-5·41), respectively. Progression rate per 100 person-years was 8·56 (95% CI 8·53-8·58) from one condition to two or more conditions and 13·60 (13·55-13·65) from two conditions to three or more conditions. Among those aged 40-49 years at baseline, the progression rate from two to three or more conditions (9·48 [9·36-9·60]) was 46% higher than one to two or more conditions (6·48 [6·42-6·53]). Proportional hazards models showed progression from one to two or more conditions was highest in the most deprived quintile (hazard ratio [HR] 1·37 [1·36-1·39]; p<0·0001 compared with least deprived) and the Black ethnic group (HR 1·19 [1·11-1·29]; p<0·0001 compared with the White ethnic group), and lower in females (HR 0·95 [0·94-0·95]; p<0·0001 compared with males). Negative interaction coefficients between Black ethnicity and most deprived quintile (index of multiple deprivation quintile 1) showed a reduced association between progression and deprivation within the Black ethnic group (HR 0·78 [0·72-0·85]; p<0·0001).
CONCLUSION:In this whole-population study of adults in England, eight long-term conditions (ie, depression, hypertension, cancer, diabetes, asthma, osteoarthritis, coronary heart disease, and cerebrovascular disease) account for the majority of the first conditions people acquire. The presence of existing conditions is associated with higher MLTC progression rate. Socioeconomic deprivation is strongly associated with progression, apart from in the Black ethnic group in which progression is high across all intersectional ethnicity and deprivation subgroups, highlighting the importance of intersectional approaches in public health policy and research.
背景：多发长期疾病（MLTCs）或多重发病（multimorbidity）的发病率定义并不一致，且很少在全人群水平上进行报告。本研究旨在利用覆盖英国英格兰成年人群的常规收集的医疗保健数据，测量MLTC的发病率和进展率，并检验种族与社会经济剥夺之间的相互作用。
方法：我们使用国家细分数据集（National Segmentation Dataset），测量了2022年4月1日至2023年3月31日期间英格兰20岁及以上成年人中28种长期疾病的发病率，这些疾病与研究中MLTC定义的德尔菲（Delphi）共识相一致。我们将MLTC进展率定义为通过患上一种或多种长期疾病而导致疾病负担加重的事件发生率。我们在更长的一个6年期间内对其进行了测量：确定了在2017年4月1日至2018年3月31日期间患上第一种或第二种长期疾病的20岁及以上成年人，并测量了截至2023年3月31日的MLTC进展率。使用Cox比例风险回归模型来检验社会人口学特征的关联性。
结果：在2022年4月1日至2023年3月31日期间的4960万名成年人中，作为首发疾病出现且发病率最高的疾病为：抑郁症（每10万人年1088例 [95% CI 1085-1092]）、高血压（885 [882-888]）、癌症（525 [522-528]）、糖尿病（464 [462-466]）、哮喘（440 [438-443]）、骨关节炎（394 [392-396]）、冠心病（252 [250-254]）和脑血管病（196 [194-197]）。这些疾病占所有首发疾病的78.5%。在2017年4月1日至2018年3月31日期间，有1,092,728人患上第一种疾病，535,661人患上第二种疾病，其中位随访时间分别为5.16年（IQR 2.58-5.50）和4.41年（IQR 1.33-5.41）。从一种疾病进展为两种或多种疾病的进展率为每100人年8.56（95% CI 8.53-8.58）；从两种疾病进展为三种或多种疾病的进展率为每100人年13.60（13.55-13.65）。在基线年龄为40-49岁的人群中，从两种疾病进展为三种或多种疾病的进展率（9.48 [9.36-9.60]）比从一种疾病进展为两种或多种疾病的进展率（6.48 [6.42-6.53]）高出46%。比例风险模型显示，从一种疾病进展为两种或多种疾病的风险在最被剥夺的五分位数人群中最高（风险比 [HR] 1.37 [1.36-1.39]；与最未被剥夺的人群相比，p<0.0001），在黑人种族群体中也最高（HR 1.19 [1.11-1.29]；与白人种族群体相比，p<0.0001），而在女性中较低（HR 0.95 [0.94-0.95]；与男性相比，p<0.0001）。黑人种族与最被剥夺的五分位数（多重剥夺指数第1个五分位）之间的负交互作用系数表明，在黑人种族群体内部，疾病进展与剥夺程度之间的关联性有所减弱（HR 0.78 [0.72-0.85]；p<0.0001）。
结论：在这项针对英格兰成年人的全人群研究中，八种长期疾病（即抑郁症、高血压、癌症、糖尿病、哮喘、骨关节炎、冠心病和脑血管病）构成了人们所患首发疾病的绝大多数。现有疾病的存在与更高的MLTC进展率相关。社会经济剥夺与疾病的进展密切相关，但黑人种族群体除外——在该群体中，跨越所有种族和剥夺程度交叉子群体的疾病进展率都普遍偏高。这突显了在公共卫生政策和研究中采用交叉方法（intersectional approaches）的重要性。
（中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校）
（Lancet Public Health. 2026 May; DOI: 10.1016/S2468-2667(26)00052-6 ）
（Lancet Public Health. 2026 May; DOI: 10.1016/S2468-2667(26)00052-6 ）
Progression of multiple long-term conditions (multimorbidity) in England: a population-based descriptive study of 49·6 million adults
Slade E, Turner EB, Pratt A, Dunbar-Rees R, Hafezparast N, Barron E, Bakhai C, Wainman G, Robery N, Paul A, Barczak K, Gregg E, Khunti K, Valabhji J
Abstract
BACKGROUND:Incidence of multiple long-term conditions (MLTCs), or multimorbidity, is inconsistently defined and infrequently reported at whole-population level. We aimed to measure the MLTC incidence and progression rates, examining the interaction between ethnicity and socioeconomic deprivation, using routinely collected health-care data covering the adult population of England, UK.
METHODS:Using the National Segmentation Dataset, we measured incidence of 28 long-term conditions, that align with the Delphi consensus for the definition of MLTCs in research, among adults aged 20 years and older in England between April 1, 2022, and March 31, 2023. We defined MLTC progression rate as the incidence of events in which disease burden progresses through the acquisition of one or more long-term conditions. We measured this over a longer 6-year period, identifying adults aged 20 years and older acquiring their first or second long-term condition between April 1, 2017, and March 31, 2018, and measuring the MLTC progression rate to March 31, 2023. Cox proportional hazard regression was used to examine sociodemographic associations.
RESULTS:Among 49·6 million adults between April 1, 2022, and March 31, 2023, conditions occurring as a first condition with the highest incidence were depression (1088 [95% CI 1085-1092] cases per 100 000 person-years), hypertension (885 [882-888]), cancer (525 [522-528]), diabetes (464 [462-466]), asthma (440 [438-443]), osteoarthritis (394 [392-396]), coronary heart disease (252 [250-254]), and cerebrovascular disease (196 [194-197]). These accounted for 78·5% of all first conditions. Of 1 092 728 people acquiring their first and 535 661 their second conditions between April 1, 2017, and March 31, 2018, median follow-up time was 5·16 years (IQR 2·58-5·50) and 4·41 years (IQR 1·33-5·41), respectively. Progression rate per 100 person-years was 8·56 (95% CI 8·53-8·58) from one condition to two or more conditions and 13·60 (13·55-13·65) from two conditions to three or more conditions. Among those aged 40-49 years at baseline, the progression rate from two to three or more conditions (9·48 [9·36-9·60]) was 46% higher than one to two or more conditions (6·48 [6·42-6·53]). Proportional hazards models showed progression from one to two or more conditions was highest in the most deprived quintile (hazard ratio [HR] 1·37 [1·36-1·39]; p<0·0001 compared with least deprived) and the Black ethnic group (HR 1·19 [1·11-1·29]; p<0·0001 compared with the White ethnic group), and lower in females (HR 0·95 [0·94-0·95]; p<0·0001 compared with males). Negative interaction coefficients between Black ethnicity and most deprived quintile (index of multiple deprivation quintile 1) showed a reduced association between progression and deprivation within the Black ethnic group (HR 0·78 [0·72-0·85]; p<0·0001).
CONCLUSION:In this whole-population study of adults in England, eight long-term conditions (ie, depression, hypertension, cancer, diabetes, asthma, osteoarthritis, coronary heart disease, and cerebrovascular disease) account for the majority of the first conditions people acquire. The presence of existing conditions is associated with higher MLTC progression rate. Socioeconomic deprivation is strongly associated with progression, apart from in the Black ethnic group in which progression is high across all intersectional ethnicity and deprivation subgroups, highlighting the importance of intersectional approaches in public health policy and research.
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