關節炎加重了其他慢性疾病的影響


  【24drs.com】研究者在發表於6月5日發病率與死亡率週報的一篇文章中報告指出,關節炎對於有多種慢性健康問題者的特殊影響一直被低估,研究者、健康照護提供者與政策制定者應將此議題納入討論。
  
  喬治亞州亞特蘭大疾病控制與預防中心人口衛生與防疫情報服務組的Jin Qin等人分析了2013年全國健康訪查(National Health Interview Survey)的資料,發現有一種以上慢性疾病的受訪者,在社會參與限制、嚴重心理困擾和工作限制的盛行率顯著逐漸增加。
  
  此外,慢性疾病之一為關節炎者,在這三種生活領域之不良結果的盛行率更高於那些沒有關節炎者。
  
  作者們寫道,單就關節炎而言,對社會參與限制和工作失能的影響大於其他慢性疾病,如果是有多種慢性病且其中之一為關節炎時,則前述三種生活領域的不良影響盛行率更高。這些後果具有深遠的公共衛生意義,因為社會活動參與、心理健康、以及工作能力對於生活品質相當重要。
  
  全國健康訪查資料來自非住院平民的代表性樣本(n = 34,506人),詢問他們是否有醫師診斷的關節炎(定義是關節炎、類風濕性關節炎、痛風、紅斑性狼瘡或纖維肌痛),以及高血壓、心臟病(冠心病、心絞痛、心臟病發作、其他心臟疾病)、中風、糖尿病、氣喘、癌症、腎臟虛弱或失能、肝炎、慢性阻塞性肺部疾病,作者們將受訪對象分成5類:
  * 沒有慢性疾病(51.0%的受訪者);
  * 只有關節炎(6.1%);
  * 一種疾病、但不是關節炎(16.8%);
  * 兩種以上慢性疾病、其中一種是關節炎(16.6%);以及
  * 兩種以上慢性疾病、都不是關節炎(9.5%)。
  
  共變項分析包括年齡、性別、種族、教育程度、身體質量指數以及抽菸情況。
  
  生活領域結果包括:對社會參與的限制,例如購物、參加體育活動、參加派對、訪友等的能力;嚴重的心理壓力;以及工作限制。
  
  關節炎患者將近四分之三有其他慢性病,特別是65歲以上者、婦女、白人或黑人、過重成年人、現在或曾經抽菸者。
  
  這三個生活領域結果都會因為慢性疾病而逐漸惡化,從沒有慢性疾病、到一種慢性病(有或沒有關節炎)、然後是兩種或以上的非關節炎疾病,最後,最嚴重的,同時有關節炎與一種以上其他慢性病。
  
  有一種慢性病的成年人中,關節炎者有15.6%工作失能、3.7%出現社會參與限制,不是關節炎者則是8.6%失能、2.1%出現社會參與限制。有兩種以上慢性病者中,有關節炎者有30.7%工作失能、沒有關節炎者則是22.5%。有關節炎和另外一種以上慢性病者,有10.4%的社會參與限制受到影響,沒有關節炎者則是6.3%。嚴重心理壓力方面,有關節炎者有9.9%受影響,有兩種以上慢性病但沒有關節炎者則是6.8%。
  
  作者們也強調自我管理介入對於減少疼痛、害怕疼痛和其他與關節炎有關之運動障礙的重要性。 現有的計畫包括「慢性疾病自我管理計畫(Chronic Disease Self-Management Program)」以及「行走自如(Walk with Eas)」,兩個計畫都是由美國健康與人類服務部所發表。
  
  資料來源: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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