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Simard M, Rahme E, Dubé M, Boiteau V, Talbot D, Sirois C. Multimorbidity prevalence and health outcome prediction: assessing the impact of lookback periods, disease count, and definition criteria in health administrative data at the population-based level. BMC Med Res Methodol 2024; 24:113. [PMID: 38755529 PMCID: PMC11097445 DOI: 10.1186/s12874-024-02243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Health administrative databases play a crucial role in population-level multimorbidity surveillance. Determining the appropriate retrospective or lookback period (LP) for observing prevalent and newly diagnosed diseases in administrative data presents challenge in estimating multimorbidity prevalence and predicting health outcome. The aim of this population-based study was to assess the impact of LP on multimorbidity prevalence and health outcomes prediction across three multimorbidity definitions, three lists of diseases used for multimorbidity assessment, and six health outcomes. METHODS We conducted a population-based study including all individuals ages > 65 years on April 1st, 2019, in Québec, Canada. We considered three lists of diseases labeled according to the number of chronic conditions it considered: (1) L60 included 60 chronic conditions from the International Classification of Diseases (ICD); (2) L20 included a core of 20 chronic conditions; and (3) L31 included 31 chronic conditions from the Charlson and Elixhauser indices. For each list, we: (1) measured multimorbidity prevalence for three multimorbidity definitions (at least two [MM2+], three [MM3+] or four (MM4+) chronic conditions); and (2) evaluated capacity (c-statistic) to predict 1-year outcomes (mortality, hospitalisation, polypharmacy, and general practitioner, specialist, or emergency department visits) using LPs ranging from 1 to 20 years. RESULTS Increase in multimorbidity prevalence decelerated after 5-10 years (e.g., MM2+, L31: LP = 1y: 14%, LP = 10y: 58%, LP = 20y: 69%). Within the 5-10 years LP range, predictive performance was better for L20 than L60 (e.g., LP = 7y, mortality, MM3+: L20 [0.798;95%CI:0.797-0.800] vs. L60 [0.779; 95%CI:0.777-0.781]) and typically better for MM3 + and MM4 + definitions (e.g., LP = 7y, mortality, L60: MM4+ [0.788;95%CI:0.786-0.790] vs. MM2+ [0.768;95%CI:0.766-0.770]). CONCLUSIONS In our databases, ten years of data was required for stable estimation of multimorbidity prevalence. Within that range, the L20 and multimorbidity definitions MM3 + or MM4 + reached maximal predictive performance.
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Affiliation(s)
- Marc Simard
- Institut national de santé publique du Québec, 945, Wolfe, 5e étage Québec, Québec, QC, G1V 5B3, Canada.
- Department of social and preventive medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
- Centre de recherche du CHU de Québec, Québec, QC, Canada.
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada.
| | - Elham Rahme
- The Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marjolaine Dubé
- Institut national de santé publique du Québec, 945, Wolfe, 5e étage Québec, Québec, QC, G1V 5B3, Canada
| | - Véronique Boiteau
- Institut national de santé publique du Québec, 945, Wolfe, 5e étage Québec, Québec, QC, G1V 5B3, Canada
| | - Denis Talbot
- Department of social and preventive medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Caroline Sirois
- Institut national de santé publique du Québec, 945, Wolfe, 5e étage Québec, Québec, QC, G1V 5B3, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
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Marzban M, Jamshidi A, Khorrami Z, Hall M, Batty JA, Farhadi A, Mahmudpour M, Gholizade M, Nabipour I, Larijani B, Afrashteh S. Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program. BMC Geriatr 2024; 24:247. [PMID: 38468227 DOI: 10.1186/s12877-024-04848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Multimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran. RESEARCH DESIGN AND METHODS In a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy. RESULTS In 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52-2.54) and class 3 (OR 4.52, 95% CI 3.22-6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65-4.68) and class 3 (OR 1.84, 95% CI 1.28-2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01-2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28-0.62) and to class 2 (OR 0.61; 95% CI: 0.38-0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95). DISCUSSION AND IMPLICATIONS A large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development.
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Affiliation(s)
- Maryam Marzban
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, QLD, Brisbane, Australia
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Jamshidi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Zahra Khorrami
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Jonathan A Batty
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Akram Farhadi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Mehdi Mahmudpour
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohamad Gholizade
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Afrashteh
- Department of Biostatistics and Epidemiology, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran.
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Nishida Y, Anzai T, Takahashi K, Kozuma T, Kanda E, Yamauchi K, Katsukawa F. Multimorbidity patterns in the working age population with the top 10% medical cost from exhaustive insurance claims data of Japan Health Insurance Association. PLoS One 2023; 18:e0291554. [PMID: 37768909 PMCID: PMC10538783 DOI: 10.1371/journal.pone.0291554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
Although the economic burden of multimorbidity is a growing global challenge, the contribution of multimorbidity in patients with high medical expenses remains unclear. We aimed to clarify multimorbidity patterns that have a large impact on medical costs in the Japanese population. We conducted a cross-sectional study using health insurance claims data provided by the Japan Health Insurance Association. Latent class analysis (LCA) was used to identify multimorbidity patterns in 1,698,902 patients who had the top 10% of total medical costs in 2015. The present parameters of the LCA model included 68 disease labels that were frequent among this population. Moreover, subgroup analysis was performed using a generalized linear model (GLM) to assess the factors influencing annual medical cost and 5-year mortality. As a result of obtaining 30 latent classes, the kidney disease class required the most expensive cost per capita, while the highest portion (28.6%) of the total medical cost was spent on metabolic syndrome (MetS) classes, which were characterized by hypertension, dyslipidemia, and type 2 diabetes. GLM applied to patients with MetS classes showed that cardiovascular diseases or complex conditions, including malignancies, were powerful determinants of medical cost and mortality. MetS was classified into 7 classes based on real-world data and accounts for a large portion of the total medical costs. MetS classes with cardiovascular diseases or complex conditions, including malignancies, have a significant impact on medical costs and mortality.
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Affiliation(s)
- Yuki Nishida
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
- Graduate School of Health Management, Keio University, Yokohama, Kanagawa, Japan
- Sports Medicine Research Center, Keio University, Yokohama, Kanagawa, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahide Kozuma
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University, Yokohama, Kanagawa, Japan
| | - Fuminori Katsukawa
- Sports Medicine Research Center, Keio University, Yokohama, Kanagawa, Japan
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Simard M, Rahme E, Calfat AC, Sirois C. Multimorbidity measures from health administrative data using ICD system codes: A systematic review. Pharmacoepidemiol Drug Saf 2021; 31:1-12. [PMID: 34623723 DOI: 10.1002/pds.5368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to identify and characterize adult population-based multimorbidity measures using health administrative data and the International Classification of Diseases (ICD) codes for disease identification. METHODS We performed a narrative systematic review of studies using or describing development or validation of multimorbidity measures. We compared the number of diseases included in the measures, the process of data extraction (case definition) and the validation process. We assessed the methodological robustness using eight criteria, five based on general criteria for indicators (AIRE instrument) and three multimorbidity-specific criteria. RESULTS Twenty-two multimorbidity measures were identified. The number of diseases they included ranged from 5 to 84 (median = 20), with 19 measures including both physical and mental conditions. Diseases were identified using ICD codes extracted from inpatient and outpatient data (18/22) and sometimes including drug claims (10/22). The validation process relied mainly on the capacity of the measures to predict health outcome (5/22), or on the validation of each individual disease against a gold standard (8/22). Six multimorbidity measures met at least six of the eight robustness criteria assessed. CONCLUSION There is significant heterogeneity among the measures used to assess multimorbidity in administrative databases, and about a third are of low to moderate quality. A more consensual approach to the number of diseases or groups of diseases included in multimorbidity measures may improve comparison between regions, and potentially provide better control for multimorbidity-related confounding in studies.
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Affiliation(s)
- Marc Simard
- Quebec National Institute of Public Health, Quebec City, Québec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Québec, Canada
| | - Alexandre Campeau Calfat
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Caroline Sirois
- Quebec National Institute of Public Health, Quebec City, Québec, Canada.,Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada.,Centre of Excellence on Aging of Quebec, VITAM Research Centre on Sustainable Health, Quebec City, Québec, Canada
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Walls AB, Bengaard AK, Iversen E, Nguyen CN, Kallemose T, Juul-Larsen HG, Jawad BN, Hornum M, Andersen O, Eugen-Olsen J, Houlind MB. Utility of suPAR and NGAL for AKI Risk Stratification and Early Optimization of Renal Risk Medications among Older Patients in the Emergency Department. Pharmaceuticals (Basel) 2021; 14:843. [PMID: 34577543 PMCID: PMC8471084 DOI: 10.3390/ph14090843] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/29/2022] Open
Abstract
Diagnosis of acute kidney injury (AKI) based on plasma creatinine often lags behind actual changes in renal function. Here, we investigated early detection of AKI using the plasma soluble urokinase plasminogen activator receptor (suPAR) and neutrophil gelatinase-sssociated lipocalin (NGAL) and observed the impact of early detection on prescribing recommendations for renally-eliminated medications. This study is a secondary analysis of data from the DISABLMENT cohort on acutely admitted older (≥65 years) medical patients (n = 339). Presence of AKI according to kidney disease: improving global outcomes (KDIGO) criteria was identified from inclusion to 48 h after inclusion. Discriminatory power of suPAR and NGAL was determined by receiver-operating characteristic (ROC). Selected medications that are contraindicated in AKI were identified in Renbase®. A total of 33 (9.7%) patients developed AKI. Discriminatory power for suPAR and NGAL was 0.69 and 0.78, respectively, at a cutoff of 4.26 ng/mL and 139.5 ng/mL, respectively. The interaction of suPAR and NGAL yielded a discriminatory power of 0.80, which was significantly higher than for suPAR alone (p = 0.0059). Among patients with AKI, 22 (60.6%) used at least one medication that should be avoided in AKI. Overall, suPAR and NGAL levels were independently associated with incident AKI and their combination yielded excellent discriminatory power for risk determination of AKI.
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Affiliation(s)
- Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
| | - Anne Kathrine Bengaard
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Camilla Ngoc Nguyen
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Emergency Department, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Nephrology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Emergency Department, Copenhagen University Hospital—Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
| | - Morten Baltzer Houlind
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (A.B.W.); (A.K.B.); (C.N.N.)
- The Capital Region Pharmacy, 2730 Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital—Amager and Hvidovre, 2650 Copenhagen, Denmark; (E.I.); (T.K.); (H.G.J.-L.); (B.N.J.); (O.A.); (J.E.-O.)
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Juul-Larsen HG, Christensen LD, Bandholm T, Andersen O, Kallemose T, Jørgensen LM, Petersen J. Patterns of Multimorbidity and Differences in Healthcare Utilization and Complexity Among Acutely Hospitalized Medical Patients (≥65 Years) - A Latent Class Approach. Clin Epidemiol 2020; 12:245-259. [PMID: 32184671 PMCID: PMC7053819 DOI: 10.2147/clep.s226586] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/12/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The majority of acutely admitted older medical patients are multimorbid, receive multiple drugs, and experience a complex treatment regime. To be able to optimize treatment and care, we need more knowledge of the association between different patterns of multimorbidity and healthcare utilization and the complexity thereof. The purpose was therefore to investigate patterns of multimorbidity in a Danish national cohort of acutely hospitalized medical patients aged 65 and older and to determine the association between these multimorbid patterns with the healthcare utilization and complexity. PATIENTS AND METHODS Longitudinal cohort study of 129,900 (53% women) patients. Latent class analysis (LCA) was used to develop patterns of multimorbidity based on 22 chronic conditions ascertained from Danish national registers. A latent class regression was used to test for differences in healthcare utilization and healthcare complexity among the patterns measured in the year leading up to the index admission. RESULTS LCA identified eight distinct multimorbid patterns. Patients belonging to multimorbid patterns including the major chronic conditions; diabetes and chronic obstructive pulmonary disease was associated with higher odds of healthcare utilization and complexity than the reference pattern ("Minimal chronic conditions"). The pattern with the highest number of chronic conditions did not show the highest healthcare utilization nor complexity. CONCLUSION Our study showed that chronic conditions cluster together and that these patterns differ in healthcare utilization and complexity. Patterns of multimorbidity have the potential to be used in epidemiological studies of healthcare planning but should be confirmed in other population-based studies.
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Affiliation(s)
- Helle Gybel Juul-Larsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Line Due Christensen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Research Unit for General Practice, Aarhus, Denmark
| | - Thomas Bandholm
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Lillian Mørch Jørgensen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Juul-Larsen HG, Andersen O, Bandholm T, Bodilsen AC, Kallemose T, Jørgensen LM, Klausen HH, Gilkes H, Petersen J. Differences in function and recovery profiles between patterns of multimorbidity among older medical patients the first year after an acute admission-An exploratory latent class analysis. Arch Gerontol Geriatr 2019; 86:103956. [PMID: 31586786 DOI: 10.1016/j.archger.2019.103956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Multimorbidity is common among older people and may contribute to adverse health effects, such as functional limitations. It may help stratify rehabilitation of older medical patients, if we can identify differences in function under and after an acute medical admission, among patient with different patterns of multimorbidity. AIM To investigate differences in function and recovery profiles among older medical patients with different patterns of multimorbidity the first year after an acute admission. METHODS Longitudinal prospective cohort study of 369 medical patients (77.9 years, 62% women) acutely admitted to the Emergency Department. During the first 24 h after admission, one month and one year after discharge we assessed mobility level using the de Morton Mobility Index. At baseline and one-year we assessed handgrip strength, gait speed, Barthel20, and the New Mobility Score. Information about chronic conditions was collected by national registers. We used Latent Class Analysis to determine differences among patterns of multimorbidity based on 22 chronic conditions. RESULTS Four distinct patterns of multimorbidity were identified (Minimal chronic disease; Degenerative, lifestyle, and mental disorders; Neurological, functional and sensory disorders; and Metabolic, pulmonary and cardiovascular disorders). The "Neurological, functional and sensory disorders"-pattern showed significant lower function than the "Minimal chronic disease"-pattern in all outcome measures. There were no differences in recovery profile between patients in the four patterns. CONCLUSION The results support that patients with different patterns of multimorbidity among acutely hospitalized older medical patients differ in function, which suggests a differentiated approach towards treatment and rehabilitation warrants further studies.
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Affiliation(s)
- Helle Gybel Juul-Larsen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Ove Andersen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Emergency Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ann Christine Bodilsen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Exercise and Health, Roskilde Municipality, Roskilde, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lillian Mørch Jørgensen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Emergency Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hedegaard Klausen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Gilkes
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
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