論文標題：The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan
期刊：BMC Geriatrics
作者：Takahiro Mori, Shota Hamada, Satoru Yoshie, Boyoung Jeon, Xueying Jin, Hideto Takahashi, Katsuya Iijima, Tatsuro Ishizaki and Nanako Tamiya
發表時間：2019/03/07
數字識別碼：10.1186/s12877-019-1057-7
原文連結：http://t.cn/AiN7AD8k
微信連結：https://mp.weixin.qq.com/s/uyxJPS-AcJx_UltO2QvhQw
隨著人口的老齡化，醫療保健的支出在不斷增加，這給國家保障體系帶來了很大的壓力。最新發表在BMC Geriatrics上的一篇文章探討了評估日本老年人慢性病經濟負擔的新方法，他們發現此前尚未被研究過的一種關聯能用於人口老齡化程度類似的許多國家。
全球範圍內疾病共患的現狀
疾病共患，是指一個人同時患有多種慢性疾病，且其發病率在老年人中隨著年齡的增長而增加。因此，老年人同時患有多種慢性疾病是很常見的，這樣的共患會影響對每種疾病的治療。疾病共患在世界範圍內（尤其是在人口老齡化的國家）受到了越來越多的關注。有研究報導，疾病共患與身體機能下降（即老年人在某些方面無法自理）、生活質量下降和可能更高的死亡率密切相關，而這些方面正是老年人和他們的護理者所擔憂的。除此之外，對相關患者的護理費用也是一個很大的社會負擔。
日本的醫療和長期護理保障制度及相關的支出
日本於1961年建立了強制性的全民醫療保障制度。報銷範圍包括專業醫護人員（如醫生、護士、各種治療師）的服務、診斷測試、處方、手術和麻醉。除了全民醫療保險制度，日本還於2000年推出了強制性的公共長期護理保障制度。65歲及以上的老年人以及40歲至64歲之間患有年齡相關特定疾病的人都有資格獲得服務。這些服務包括在長期護理機構裡長期住院或短期停留期間的機構護理，以及以社區和家庭為單位的護理如成人日託、門診康復、家庭幫助或上門護理。其他國家如德國、荷蘭和韓國也提供長期護理保障制度。
在人口老齡化國家，健康相關方面支出的穩步增長一直是一個大問題。例如，2016年日本每年的醫療支出約為3720億美元，長期護理支出約為880億美元，這些數字表明在過去五年醫療和長期護理的支出分別增加了9%和21%。隨著日本和世界各地迅速進入老齡化社會，這些支出還將進一步增加。
疾病共患與醫療開銷的關聯
在本次研究中，研究者使用了日本東京都郊區柏市的醫療和長期護理報銷數據，探討了患多種疾病與醫療和長期護理支出總額之間的關係。除了眾所周知的疾病共患與較高的醫療支出之間的關係，研究人員還發現疾病共患也與較高的長期護理支出相關，從而增加了兩種類型支出的總和。研究進一步表明，相對於僅考慮醫療支出，通過醫療和長期護理支出的總和可以更好地評估疾病共患對社會造成的經濟負擔，從而提供了更準確的評估。
作為世界上老齡化速度最快的國家之一，日本不僅有醫療保險，還有長期護理保險制度。據我們所知，這是全球範圍內首個研究了疾病共患與長期護理支出以及醫療和長期護理支出總和之間關係的研究。由於對於許多人口老齡化國家來說，健康相關支出的不斷增長非常不利於維持可持續的醫療體系，因此這一研究結果不僅對日本意義重大，而且在全球範圍內具有重要意義。減少疾病共患流行程度的有效策略不僅可以為個人和社會提供醫療和健康方面的利益，同時也具有經濟意義。
摘要：
Background
The occurrence of multimorbidity (i.e., the coexistence of multiple chronic diseases) increases with age in older adults and is a growing concern worldwide. Multimorbidity has been reported to be a driving factor in the increase of medical expenditures in OECD countries. However, to the best of our knowledge, there is no published research that has examined the associations between multimorbidity and either long-term care (LTC) expenditure or the sum of medical and LTC expenditures worldwide. We, therefore, aimed to examine the associations of multimorbidity with the sum of medical and LTC expenditures for older adults in Japan.
Methods
Medical insurance claims data for adults ≥75 years were merged with LTC insurance claims data from Kashiwa city, a suburb in the Tokyo metropolitan area, for the period between April 2012 and September 2013 to obtain an estimate of medical and LTC expenditures. We also calculated the 2011 updated and reweighted version of the Charlson Comorbidity Index (CCI) scores. Then, we performed multiple generalized linear regressions to examine the associations of CCI scores (0, 1, 2, 3, 4, or ≥ 5) with the sum of annual medical and LTC expenditures, adjusting for age, sex, and household income level.
Results
The mean sum of annual medical and LTC expenditures was ¥1,086,000 (US$12,340; n = 30,042). Medical and LTC expenditures accounted for 66 and 34% of the sum, respectively. Every increase in one unit of the CCI scores was associated with a ¥257,000 (US$2920); 95% Confidence Interval: ¥242,000, 271,000 (US$2750, 3080) increase in the sum of the expenditures (p < 0.001; n = 29,915).
Conclusions
Using a merged medical and LTC claims dataset, we found that greater CCI scores were associated with a higher sum of annual medical and LTC expenditures for older adults. To the best of our knowledge, this is the first study to examine the associations of multimorbidity with LTC expenditures or the sum of medical and LTC expenditures worldwide. Our study indicated that the economic burden on society caused by multimorbidity could be better evaluated by the sum of medical and LTC expenditures, rather than medical expenditures alone.
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期刊介紹:
BMC Geriatrics(https://bmcgeriatr.biomedcentral.com/,2.866 - 2-year Impact Factor,3.159 - 5-year Impact Factor) is an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. The journal also welcomes research focused on the aging process, including cellular, genetic, and physiological processes and cognitive modifications.
（來源：科學網）
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