Objective To explore the correlation between multimorbidity and hip fractures in middle-aged and elderly populations. Methods The population without hip fractures in 2011 was selected in the China Health and Retirement Longitudinal Study database. According to whether the research subjects experienced hip fractures between 2015 and 2020, they were divided into the hip fracture group and the non-hip fracture group. Multiple logistic regression analysis was used to explore the correlation between multimorbidity and hip fracture occurrence. Results A total of 9644 subjects were included. Among them, there were 4406 males and 5238 females. There were 419 cases in the hip fracture group and 9225 cases in the non-hip fracture group. Multivariate logistic regression analysis showed that diabetes, heart disease, arthritis and hearing impairment were independent risk factors for hip fracture. Compared to those without chronic diseases, individuals with ≥3 types of comorbidities among the 4 chronic diseases had a higher risk of hip fracture. Conclusions In the middle-aged and elderly population, diabetes, heart disease, arthritis and hearing impairment are chronic diseases associated with hip fracture. The higher the number of comorbidities of chronic diseases, the higher the risk of new hip fractures.
Multimorbidity is becoming a major issue in global health due to the increased prevalence of chronic diseases and the accelerated aging of the population. Clinical practice guidelines, as key tools for guiding clinical practice, play an important role in the field of multimorbidity, but also face many challenges. In this paper, we will review the necessity of developing multimorbidity guidelines, the current situation, challenges and opportunities, and on this basis, we will put forward our thoughts and suggestions to promote the development of guidelines in the field of multimorbidity in China.
ObjectiveTo explore the multimorbidity of age-related macular degeneration (AMD) and diabetic retinopathy (DR) in diabetic patients, and observe the association between AMD and the two-year progression of DR. MethodsA prospective cohort study. The data were obtained from the Phase I baseline and Phase II follow-up of the Beichen Eye Study, which was conducted from June 2020 to August 2023, and the data from participants with diabetes were extracted for analysis. The baseline study included demographic data, anthropometric indices, ocular biometry, visual acuity, fundus imaging, Lens Opacities Classification System Ⅲ grade, questionnaires and laboratory information, etc., and follow-up was performed after two years. DR diagnosis and grading was performed based on the DR International Classification Criteria, and the eye with the heavier DR classification was taken as the affected eye. According to whether there was new-onset DR or DR progression at the follow-up visit, patients were divided into DR non-progressing group and progressing group. The Wisconsin AMD grading standard was used for AMD diagnosis and grading. Quantitative data were compared using the Mann-Whitney U test, and categorical variables were compared using the χ2 test or Fisher's exact test. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval. Sub-group analysis would be executed if the primary analysis had no significant results. Sensitivity analysis was conducted after the application of multiple imputation for missing data. ResultsA total of 1 190 eligible diabetic patients were included at baseline. The observed prevalence rates were 22.69% (270/1 190) for DR, 25.97% (309/1 190) for AMD, and 6.64% (79/1 190) for DR-AMD co-morbidity. Among the 741 patients who completed the 2-year follow-up, 95 cases (12.82%) were in the DR Progression group and 646 cases (87.18%) were in the non-progression group. Compared with those without AMD, the prevalence of DR In patients with early (24.44%, 66/270), middle (4.07%, 11/270), late atrophic AMD (0.37%, 1/270), and exudative AMD (0.37%, 1/270) showed an increasing trend. However, the differences were not statistically significant (P＞0.05). The results of logistic regression analysis showed that having AMD at baseline was an independent risk factor for DR (OR=1.532, P=0.026). During the follow-up period, subgroup analysis revealed that in AMD patients with an axial length of 22.9-23.5 mm (OR=4.507, P=0.028) OR a platelet-lymphocyte ratio of 99.5-122.0 (OR=4.107, P=0.015), the risk of DR Progression was significantly increased. The results of the sensitivity analysis after multiple imputation of the missing data remained stable. ConclusionAMD in DM patients over 50 years of age is an independent risk factor for DR prevalence and progression.