Chronic disease classification

Currently there is no unified standard for classifying chronic diseases globally, and the classification logic in different application scenarios varies greatly. The mainstream classification dimensions mainly include three categories: "involved body systems", "core disease triggers" and "disease hazard levels". Practitioners in different institutions and different positions will adjust the classification methods according to actual needs, and there is no absolute right or wrong. 】

I don’t say this casually. At the last chronic disease prevention and control seminar in the district, doctors from the three fields of clinical, public health, and nutrition argued about this for half an hour. The clinical doctor believes that the classification should be based on the affected system, otherwise it will take an extra ten minutes to go through the medical history in the outpatient department. The public health doctor said that the patients should be classified according to the priority of prevention and control, otherwise the community will manage thousands of chronic patients and will not be able to schedule follow-up plans. The teacher of the nutrition department is more direct, saying that the common people can understand best when classifying according to triggers, and there is no need to spend half a day explaining professional terms during science popularization.

In fact, to be honest, each classification logic has its own applicable scenarios. For example, we usually hear that hypertension and coronary heart disease are classified into the circulatory system, COPD and asthma are classified into the respiratory system, and diabetes and gout are classified into the endocrine and metabolic categories. This is the most commonly used classification in clinical practice. It is purely for the convenience of diagnosis and treatment. When the doctor opens the medical record and looks at the classification, he can basically predict what tests to order and which direction to check for complications. The probability of error is extremely low. This is also the mainstream classification logic used in ICD-11 (International Classification of Diseases, Eleventh Revision).

It would be completely different if the scene were changed. If you go to a community health service center and ask the doctor who does health education, he will most likely not tell you any systematic classification. Instead, he will tell you: high blood pressure and hyperlipidemia caused by smoking and drinking are "diseases caused by lifestyle", cirrhosis caused by hepatitis B and cervical cancer caused by long-term HPV infection are "diseases caused by infection", and hemophilia and hereditary arrhythmias caused by birth are "diseases given by parents". This classification may not seem rigorous, but it is very useful when doing science popularization for uncles and aunts. After listening to it, you will know where to make adjustments. It is more effective than talking about ten professional terms.

When it comes to the community nurse in charge of follow-up visits, the classification logic is more down-to-earth. They don't care what kind of systemic disease you have, and they just pile them up according to risk level: high-risk people are those whose blood pressure fluctuates and have a history of myocardial infarction and stroke, and they have to come to check their indicators once a week and remind them to take medicine; medium-risk people are in stable condition, and just call them every half month to ask about the situation; low-risk people are those who have just been found to have high blood sugar and are not yet ready to take medicine, and a reminder to go for a run every two months is enough to reduce their belly. When I first entered the industry, I was obsessed with the classification list in the textbook. Once I met a 72-year-old Uncle Zhang, who had high blood pressure for 30 years, diabetes for 20 years, and chronic obstructive pulmonary disease. I struggled with the list for ten minutes and didn’t know which category to classify. Uncle Zhang himself I laughed first and said, "There are no classifications. I am suffering from old age. All you have to do is remember to take my blood pressure." Only then did I realize that classification is meant to serve people and cannot be used to frame people.

Of course, there are now many voices in the academic community that oppose solid classification. Last year, I read a paper from the Peking University Public Health Institute. The author said that the current classification is too fragmented. 80% of chronic diseases are related to metabolic abnormalities. Hypertension, hyperlipidemia, diabetes, and obesity are actually different stages of metabolic syndrome. If they are separated into different systems, it is easy for doctors to only focus on their own problems and ignore the overall health of the patient. However, many clinicians do not agree with this statement. Director Li from the cardiology department I know said that when the outpatient clinic is really busy, classification by system is the most efficient. If every patient has to go through the chronic disease relationships in the entire system, he will not be able to see ten more patients in the morning, but it will waste other people's time.

To put it bluntly, classifying chronic diseases is like storing clothes at home. For daily wear, classify them by spring, summer, autumn, and winter. For seasonal storage, classify them by thickness. When donating clothes, classify them by new or old. There is no absolute standard answer. If you are doing clinical diagnosis and treatment, you can classify them by system, if you are doing public health prevention and control, you can classify them by risk, and if you are doing science popularization, they can be classified by triggers. As long as it can help prevent, treat, and manage diseases more conveniently, it is a useful classification. There is really no need to hold on to a certain standard to say who is right and who is wrong. After all, tools always serve people.