描述多发病对就诊急诊科的患者以不良患者为中心的结果的影响。基于人群的队列研究。苏格兰 NHS 洛锡安急诊科，2012 年 1 月 1 日至 2019 年 12 月 31 日。就诊急诊科的成人（≥ 18 岁）。链接来自急诊科、医院出院和癌症登记处的数据以及国家死亡率数据。多重发病被定义为 Elixhauser 合并症指数中的至少两种情况。使用多变量逻辑回归或线性回归来评估多重发病率与 30 天死亡率（主要结果）、入院、7 天内再次到急诊室就诊以及在急诊室花费的时间（次要结果）的关联。主要分析按年龄分层（<65 v ≥65 岁）。在研究期间，451 291 人中有 1 273 937 人到急诊科就诊。 43 504 (9.6%) 患有多种疾病，患有多种疾病的人年龄较大（中位 73 岁 vs 43 岁），更有可能乘坐紧急救护车到达（57.8% vs 23.7%），并且更有可能被分类为非常紧急（23.5%） v 9.2%）比没有多重疾病的人高。调整其他预后协变量后，与无多重疾病相比，多重疾病与较高的 30 天死亡率相关（8.2% vs 1.2%，调整后优势比 1.81（95% 置信区间 (CI) 1.72 至 1.91））、较高的住院率入院率（60.1% vs 20.5%，1.81（1.76 至 1.86）），7 天内再次到急诊科就诊的比例更高（7.8% vs 3.5%，1.41（1.32 至 1.50）），以及在急诊科停留的时间更长（调整后的系数0.27 小时（95% CI 0.26 至 0.27））。年轻患者的多种发病率与所有结局之间的关联性更大：例如，65 岁以下患者的 30 天死亡率调整后比值比为 3.03（95% CI 2.68 至 3.42），而 65 岁以下患者为 1.61（95% CI 1.53 至 3.42）。 1.71）在 65 岁或以上的人群中。根据 Elixhauser 指数条件，几乎十分之一到急诊室就诊的患者患有多种疾病。多重发病与不良后果密切相关，并且这些关联在年轻人中更为明显。人口中多种疾病的日益流行可能会加剧急诊科的压力，除非实践和政策不断发展以满足不断增长的需求。版权所有©作者（或其雇主）2024。CC BY 允许重复使用。英国医学杂志出版。

To describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department.Population based cohort study.Emergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019.Adults (≥18 years) attending emergency departments.Linked data from emergency departments, hospital discharges, and cancer registries, and national mortality data.Multimorbidity was defined as at least two conditions from the Elixhauser comorbidity index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30 day mortality (primary outcome), hospital admission, reattendance at the emergency department within seven days, and time spent in emergency department (secondary outcomes). Primary analysis was stratified by age (<65 v ≥65 years).451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 v 43 years), more likely to arrive by emergency ambulance (57.8% v 23.7%), and more likely to be triaged as very urgent (23.5% v 9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2% v 1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1% v 20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8% v 3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older.Almost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.