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Wang Y, Shen Z, Xing X, Ge L, Pan F, Cai G. Association of physical activity trajectories over 8 years and risk of knee replacement: data from the osteoarthritis initiative. BMC Musculoskelet Disord 2024; 25:586. [PMID: 39061027 DOI: 10.1186/s12891-024-07710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND To identify physical activity (PA) trajectories in adults with or at risk of knee osteoarthritis and to evaluate the association of PA trajectories with incident knee replacement (KR). METHODS This study used data from the Osteoarthritis Initiative. The Physical Activity Scale for the Elderly and the KR were assessed annually from baseline to 9 years. Individuals were included if they did not undergo KR surgery at baseline and had data on PA at ≥ 1 visit before KR. Latent class growth mixture Modeling was used to identify the optimal trajectories of PA before KR. Log-binomial regression models were used to assess the association between PA trajectories and the risk of KR. Data analyses were conducted in all individuals and those with radiographic osteoarthritis (ROA) and significant knee pain (Western Ontario and McMaster Osteoarthritis Index pain score of ≥ 5 on a 0-20 scale) at baseline, respectively. RESULTS Of 4731 participants (mean age 61.1 years, 58.5% female), four distinct and slightly declined PA trajectories were identified. Compared to individuals with a "Low" PA trajectory, those with "Medium-low", "Medium-high", or "High" PA trajectories were not significantly associated with the risk of KR (risk ratios: 0.97-1.19, all p > 0.05). Similar PA trajectories and associations with the risk of KR were observed in the subgroups of individuals with radiographic osteoarthritis and those with significant knee pain at baseline, respectively. CONCLUSION In participants with or at risk of knee osteoarthritis, PA slightly declines over time and may play no role in the risk of KR.
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Affiliation(s)
- Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Xing Xing
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Liru Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China
- The Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
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Chalitsios CV, Santoso C, Nartey Y, Khan N, Simpson G, Islam N, Stuart B, Farmer A, Dambha-Miller H. Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing. BMJ Open 2024; 14:e074902. [PMID: 38991683 PMCID: PMC11243147 DOI: 10.1136/bmjopen-2023-074902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES To classify older adults into clusters based on accumulating long-term conditions (LTC) as trajectories, characterise clusters and quantify their associations with all-cause mortality. DESIGN We conducted a longitudinal study using the English Longitudinal Study of Ageing over 9 years (n=15 091 aged 50 years and older). Group-based trajectory modelling was used to classify people into clusters based on accumulating LTC over time. Derived clusters were used to quantify the associations between trajectory memberships, sociodemographic characteristics and all-cause mortality by conducting regression models. RESULTS Five distinct clusters of accumulating LTC trajectories were identified and characterised as: 'no LTC' (18.57%), 'single LTC' (31.21%), 'evolving multimorbidity' (25.82%), 'moderate multimorbidity' (17.12%) and 'high multimorbidity' (7.27%). Increasing age was consistently associated with a larger number of LTCs. Ethnic minorities (adjusted OR=2.04; 95% CI 1.40 to 3.00) were associated with the 'high multimorbidity' cluster. Higher education and paid employment were associated with a lower likelihood of progression over time towards an increased number of LTCs. All the clusters had higher all-cause mortality than the 'no LTC' cluster. CONCLUSIONS The development of multimorbidity in the number of conditions over time follows distinct trajectories. These are determined by non-modifiable (age, ethnicity) and modifiable factors (education and employment). Stratifying risk through clustering will enable practitioners to identify older adults with a higher likelihood of worsening LTC over time to tailor effective interventions to prevent mortality.
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Affiliation(s)
| | - Cornelia Santoso
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Yvonne Nartey
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nusrat Khan
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Dell'Isola A, Recenti F, Englund M, Kiadaliri A. Twenty-year trajectories of morbidity in individuals with and without osteoarthritis. RMD Open 2024; 10:e004164. [PMID: 38955511 PMCID: PMC11256023 DOI: 10.1136/rmdopen-2024-004164] [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: 01/30/2024] [Accepted: 05/21/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references. METHODS Cohort study using prospectively collected healthcare data from the Skåne region, Sweden (~1.4 million residents). We extracted diagnoses for OA and 67 common chronic conditions. We included individuals aged 40+ years on 31 December 2007, with incident OA between 2008 and 2009. We selected references without OA, matched on birth year, sex, and year of death or moving outside the region. We employed group-based trajectory modelling to capture morbidity count trajectories from 1998 to 2019. Individuals without any comorbidity were included as a reference group but were not included in the model. RESULTS We identified 9846 OA cases (mean age: 65.9 (SD 11.7), female: 58%) and 9846 matched references. Among both cases and references, 1296 individuals did not develop chronic conditions (no-chronic-condition class). We identified four classes. At the study outset, all classes exhibited a low average number of chronic conditions (≤1). Class 1 had the slowest progression towards multimorbidity, which increased progressively in each class. Class 1 had the lowest count of chronic conditions at the end of the follow-up (mean: 2.9 (SD 1.7)), while class 4 had the highest (9.6 (2.6)). The presence of OA was associated with a 1.29 (1.12, 1.48) adjusted relative risk of belonging to class 1 up to 2.45 (2.12, 2.83) for class 4. CONCLUSIONS Our findings suggest that individuals with OA face an almost threefold higher risk of developing severe multimorbidity.
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Affiliation(s)
- Andrea Dell'Isola
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Filippo Recenti
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Savona, Italy
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ali Kiadaliri
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Shen Z, Zhang X, Wang Y, Zhu R, Ge L, Cai G. Factors associated with trajectories of bone marrow lesions over 4 years: data from the Osteoarthritis Initiative. Skeletal Radiol 2024; 53:1333-1341. [PMID: 38244061 PMCID: PMC11093866 DOI: 10.1007/s00256-024-04579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To identify bone marrow lesion (BML) trajectories over 4 years and their demographic and structural predictors in middle-aged and older adults with or at increased risk of knee osteoarthritis (OA). METHODS A total of 614 participants (mean age 61 years, 62% female) from the Osteoarthritis Initiative cohort (OAI) were included. BMLs in 15 anatomical locations of the knee were measured annually from baseline to 4 years using the Magnetic Resonance Imaging Osteoarthritis Knee Score (MOAKS) method. BML trajectories were determined using latent class mixed models (LCMMs). Multinomial logistic regression was used to examine baseline characteristics that predicted BML trajectories. RESULTS Three distinct BML trajectories were identified: "Mild-stable BMLs" (25.9%), "Moderate-stable BMLs" (66.4%), and "Rapid-rise BMLs" (7.7%). Compared to the "Mild-stable BMLs" trajectory, current smokers were more likely to be in the "Moderate-stable BMLs" (odds ratio [OR] 2.089, P < 0.001) and "Rapid-rise" (OR 2.462, P < 0.001) trajectories. Moreover, female sex and meniscal tears were associated with an increased risk of being in the "Rapid-rise BMLs" trajectory (OR 2.023 to 2.504, P < 0.05). Participants who had higher education levels and drank more alcohol were more likely to be in the "Rapid-rise BMLs" trajectory (OR 1.624 to 3.178, P < 0.05) and less likely to be in the "Moderate-stable BMLs" trajectory (OR 0.668 to 0.674, P < 0.05). CONCLUSIONS During the 4-year follow-up, most participants had relatively stable BMLs, few had enlarged BMLs, and no trajectory of decreased BMLs was identified. Sociodemographic factors, lifestyle, and knee structural pathology play roles in predicting distinct BML trajectories.
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Affiliation(s)
- Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xiaoyue Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Rui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Liru Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
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Simard M, Rahme E, Dubé M, Boiteau V, Talbot D, Mésidor M, Chiu YM, Sirois C. 10-Year Multimorbidity Trajectories in Older People Have Limited Benefit in Predicting Short-Term Health Outcomes in Comparison to Standard Multimorbidity Thresholds: A Population-Based Study. Clin Epidemiol 2024; 16:345-355. [PMID: 38798914 PMCID: PMC11128253 DOI: 10.2147/clep.s456004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose To identify multimorbidity trajectories among older adults and to compare their health outcome predictive performance with that of cross-sectional multimorbidity thresholds (eg, ≥2 chronic conditions (CCs)). Patients and Methods We performed a population-based longitudinal study with a random sample of 99,411 individuals aged >65 years on April 1, 2019. Using health administrative data, we calculated for each individual the yearly CCs number from 2010 to 2019 and constructed the trajectories with latent class growth analysis. We used logistic regression to determine the increase in predictive capacity (c-statistic) of multimorbidity trajectories and traditional cross-sectional indicators (≥2, ≥3, or ≥4 CCs, assessed in April 2019) over that of a baseline model (including age, sex, and deprivation). We predicted 1-year mortality, hospitalization, polypharmacy, and frequent general practitioner, specialist, or emergency department visits. Results We identified eight multimorbidity trajectories, each representing between 3% and 25% of the population. These trajectories exhibited trends of increasing, stable, or decreasing number of CCs. When predicting mortality, the 95% CI for the increase in the c-statistic for multimorbidity trajectories [0.032-0.044] overlapped with that of the ≥3 indicator [0.037-0.050]. Similar results were observed when predicting other health outcomes and with other cross-sectional indicators. Conclusion Multimorbidity trajectories displayed comparable health outcome predictive capacity to those of traditional cross-sectional multimorbidity indicators. Given its ease of calculation, continued use of traditional multimorbidity thresholds remains relevant for population-based multimorbidity surveillance and clinical practice.
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Affiliation(s)
- Marc Simard
- Institut national de santé publique du Québec, Québec, QC, 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
- Department of Medicine, Division of Clinical Epidemiology, McGill University, and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marjolaine Dubé
- Institut national de santé publique du Québec, Québec, QC, 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
| | - Miceline Mésidor
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Yohann Moanahere Chiu
- Institut national de santé publique du Québec, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Faculty of de Pharmacy, Université Laval, Québec, QC, Canada
| | - Caroline Sirois
- Institut national de santé publique du Québec, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Faculty of de Pharmacy, Université Laval, Québec, QC, Canada
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Liu H, Zhang M, Zhang X, Zhao X. Exposure to early-life adversity and long-term trajectories of multimorbidity among older adults in China: analysis of longitudinal data from the China Health and Retirement Longitudinal Study. BMJ Open 2024; 14:e075834. [PMID: 38485180 PMCID: PMC10941172 DOI: 10.1136/bmjopen-2023-075834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES This study aimed to identify long-term distinct trajectories of multimorbidity with ageing from 50 to 85 years among Chinese older adults and examine the relationship between exposure to early-life adversity (ELA; including specific types of adversity and accumulation of different adversities) and these long-term multimorbidity trajectories. DESIGN The group-based trajectory models identified long-term multimorbidity trajectories. Multinomial logistic regression models were used to examine the relationship between ELA and the identified multimorbidity trajectories. SETTING This study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) and the 2014 Life History Survey. PARTICIPANTS We used data from 9112 respondents (aged 60 and above) of the 2018 wave of CHARLS. OUTCOME MEASURES Each respondent's history of chronic conditions and experiences of ELA were collected from the 2011-2018 waves of CHARLS and the 2014 Life History Survey. RESULTS Four heterogeneous long-term trajectories of multimorbidity development were identified: 'maintaining-low' (19.1%), 'low onset-rapidly increasing' (23.3%), 'middle onset-moderately increasing' (41.5%) and 'chronically-high' (16.2%). Our findings indicated that the heterogeneity can be explained by ELA experiences. Across various types of different ELA experiences, exposure to food insufficiency (relative risk ratios from 1.372 (95% CI 1.190 to 1.582) to 1.780 (95% CI 1.472 to 2.152)) and parental quarrel/divorce (relative risk ratios from 1.181 (95% CI 1.000 to 1.394) to 1.262 (95% CI 1.038 to 1.536)) had the most prominent associations with health deterioration. The accumulation of more different ELA experiences was associated with a higher relative risk of developing more severe multimorbidity trajectories (relative risk ratio for five to seven ELAs and chronically high trajectory: 7.555, 95% CI 4.993 to 11.431). CONCLUSIONS There are heterogeneous long-term trajectories of multimorbidity in Chinese older adults, and the risk of multimorbidity associated with ELA accumulates over the lifespan. Our findings highlight the role of a supportive early-life family environment in promoting health development across the lifespan, advocating for the integration of life-course approaches to implementing health disparity interventions.
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Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, China
| | - Mi Zhang
- Department of Sociology, Central South University, Changsha, China
| | - Xinyan Zhang
- Department of Sociology, Central South University, Changsha, China
| | - Xinyi Zhao
- School of Health Humanities, Peking University, Beijing, China
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Dervić E, Sorger J, Yang L, Leutner M, Kautzky A, Thurner S, Kautzky-Willer A, Klimek P. Unraveling cradle-to-grave disease trajectories from multilayer comorbidity networks. NPJ Digit Med 2024; 7:56. [PMID: 38454004 PMCID: PMC10920888 DOI: 10.1038/s41746-024-01015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
We aim to comprehensively identify typical life-spanning trajectories and critical events that impact patients' hospital utilization and mortality. We use a unique dataset containing 44 million records of almost all inpatient stays from 2003 to 2014 in Austria to investigate disease trajectories. We develop a new, multilayer disease network approach to quantitatively analyze how cooccurrences of two or more diagnoses form and evolve over the life course of patients. Nodes represent diagnoses in age groups of ten years; each age group makes up a layer of the comorbidity multilayer network. Inter-layer links encode a significant correlation between diagnoses (p < 0.001, relative risk > 1.5), while intra-layers links encode correlations between diagnoses across different age groups. We use an unsupervised clustering algorithm for detecting typical disease trajectories as overlapping clusters in the multilayer comorbidity network. We identify critical events in a patient's career as points where initially overlapping trajectories start to diverge towards different states. We identified 1260 distinct disease trajectories (618 for females, 642 for males) that on average contain 9 (IQR 2-6) different diagnoses that cover over up to 70 years (mean 23 years). We found 70 pairs of diverging trajectories that share some diagnoses at younger ages but develop into markedly different groups of diagnoses at older ages. The disease trajectory framework can help us to identify critical events as specific combinations of risk factors that put patients at high risk for different diagnoses decades later. Our findings enable a data-driven integration of personalized life-course perspectives into clinical decision-making.
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Affiliation(s)
- Elma Dervić
- Complexity Science Hub Vienna, Vienna, Austria
- Supply Chain Intelligence Institute Austria (ASCII), Vienna, Austria
- Medical University of Vienna, Section for Science of Complex Systems, CeMSIIS, Vienna, Austria
| | | | | | - Michael Leutner
- Medical University of Vienna, Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Vienna, Austria
| | - Alexander Kautzky
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Vienna, Austria
| | - Stefan Thurner
- Complexity Science Hub Vienna, Vienna, Austria
- Medical University of Vienna, Section for Science of Complex Systems, CeMSIIS, Vienna, Austria
- Santa Fe Institute, Santa Fe, NM, USA
| | - Alexandra Kautzky-Willer
- Medical University of Vienna, Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Vienna, Austria
- Gender Institute, Gars am Kamp, Austria
| | - Peter Klimek
- Complexity Science Hub Vienna, Vienna, Austria.
- Supply Chain Intelligence Institute Austria (ASCII), Vienna, Austria.
- Medical University of Vienna, Section for Science of Complex Systems, CeMSIIS, Vienna, Austria.
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Bowling CB, Faldowski RA, Sloane R, Pieper C, Brown TH, Dooley EE, Burrows BT, Allen NB, Gabriel KP, Lewis CE. Multimorbidity trajectories in early adulthood and middle age: Findings from the CARDIA prospective cohort study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241242277. [PMID: 38586603 PMCID: PMC10998492 DOI: 10.1177/26335565241242277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
Background Multimorbidity research has focused on the prevalence and consequences of multimorbidity in older populations. Less is known about the accumulation of chronic conditions earlier in the life course. Methods We identified patterns of longitudinal multimorbidity accumulation using 30 years of data from in-person exams, annual follow-ups, and adjudicated end-points among 4,945 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Chronic conditions included arthritis, asthma, atrial fibrillation, cancer, end stage renal disease, chronic obstructive pulmonary disease, coronary heart disease, diabetes, heart failure, hyperlipidemia, hypertension, and stroke. Trajectory patterns were identified using latent class growth curve models. Results Mean age (SD) at baseline (1985-6) was 24.9 (3.6), 55% were female, and 51% were Black. The median follow-up was 30 years (interquartile range 25-30). We identified six trajectory classes characterized by when conditions began to accumulate and the rapidity of accumulation: (1) early-fifties, slow, (2) mid-forties, fast, (3) mid-thirties, fast, (4) late-twenties, slow, (5) mid-twenties, slow, and (6) mid-twenties, fast. Compared with participants in the early-fifties, slow trajectory class, participants in mid-twenties, fast were more likely to be female, Black, and currently smoking and had a higher baseline mean waist circumference (83.6 vs. 75.6 cm) and BMI (27.0 vs. 23.4 kg/m2) and lower baseline physical activity (414.1 vs. 442.4 exercise units). Conclusions A life course approach that recognizes the heterogeneity in patterns of accumulation of chronic conditions from early adulthood into middle age could be helpful for identifying high risk subgroups and developing approaches to delay multimorbidity progression.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Richard A Faldowski
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Richard Sloane
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Carl Pieper
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Tyson H Brown
- Department of Sociology, Duke University, Durham NC, USA
| | - Erin E Dooley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brett T Burrows
- Center for Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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9
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Jang SY, Oksuzyan A, Myrskylä M, van Lenthe FJ, Loi S. Healthy immigrants, unhealthy ageing? Analysis of health decline among older migrants and natives across European countries. SSM Popul Health 2023; 23:101478. [PMID: 37635989 PMCID: PMC10448331 DOI: 10.1016/j.ssmph.2023.101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
The probability of having multiple chronic conditions simultaneously, or multimorbidity, tends to increase with age. Immigrants face a particularly high risk of unhealthy ageing. This study investigates the immigrant-native disparities in the speed of age-related chronic disease accumulation, focusing on the number of chronic health conditions; and considers the heterogeneity of this trajectory within immigrant populations by origin and receiving country. We use data from the Survey of Health, Ageing and Retirement in Europe from 2004 to 2020 on adults aged 50 to 79 from 28 European countries and employ both cross-sectional and longitudinal analyses. For longitudinal panel analyses, we use fixed-effects regression models to account for the unobserved heterogeneity related to individual characteristics including migration background. Our results indicate that immigrants report a higher number of chronic conditions at all ages relative to their native-born peers, but also that the immigrant-native differential in the number of chronic conditions decreases from age 65 onwards. When considering differences by origin country, we find that the speed of chronic disease accumulation is slower among immigrants from the Americas and the Asia and Oceania country groups than it is among natives. When looking at differences by receiving country group, we observe that the speed of accumulating chronic diseases is slower among immigrants in Eastern Europe than among natives, particularly at older ages. Our findings suggest that age-related trajectories of health vary substantially among immigrant populations by origin and destination country, which underscore that individual migration histories play a persistent role in shaping the health of ageing immigrant populations throughout the life course.
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Affiliation(s)
- Su Yeon Jang
- Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- Centre for Social Data Science and Population Research Unit, University of Helsinki, Helsinki, Finland
- Max Planck – University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Silvia Loi
- Max Planck Institute for Demographic Research, Rostock, Germany
- Max Planck – University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland
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Rod NH, Broadbent A, Rod MH, Russo F, Arah OA, Stronks K. Complexity in Epidemiology and Public Health. Addressing Complex Health Problems Through a Mix of Epidemiologic Methods and Data. Epidemiology 2023; 34:505-514. [PMID: 37042967 DOI: 10.1097/ede.0000000000001612] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Public health and the underlying disease processes are complex, often involving the interaction of biologic, social, psychologic, economic, and other processes that may be nonlinear and adaptive and have other features of complex systems. There is therefore a need to push the boundaries of public health beyond single-factor data analysis and expand the capacity of research methodology to tackle real-world complexities. This article sets out a way to operationalize complex systems thinking in public health, with a particular focus on how epidemiologic methods and data can contribute towards this end. Our proposed framework comprises three core dimensions-patterns, mechanisms, and dynamics-along which complex systems may be conceptualized. These dimensions cover seven key features of complex systems-emergence, interactions, nonlinearity, interference, feedback loops, adaptation, and evolution. We relate this framework to examples of methods and data traditionally used in epidemiology. We conclude that systematic production of knowledge on complex health issues may benefit from: formulation of research questions and programs in terms of the core dimensions we identify, as a comprehensive way to capture crucial features of complex systems; integration of traditional epidemiologic methods with systems methodology such as computational simulation modeling; interdisciplinary work; and continued investment in a wide range of data types. We believe that the proposed framework can support the systematic production of knowledge on complex health problems, with the use of epidemiology and other disciplines. This will help us understand emergent health phenomena, identify vulnerable population groups, and detect leverage points for promoting public health.
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Affiliation(s)
- Naja Hulvej Rod
- From the Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
| | - Alex Broadbent
- Department of Philosophy, Durham University, UK
- Department of Philosophy, University of Johannesburg, South Africa
| | - Morten Hulvej Rod
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
- Health Promotion Research Unit, Steno Diabetes Center Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Federica Russo
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
- Department of Philosophy & ILLC, Amsterdam University, The Netherlands
- Department of Science and Technology Studies, University College London, UK
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, California, USA
- Department of Statistics, Division of Physical Sciences, UCLA, Los Angeles, California, USA
| | - Karien Stronks
- Institute of Advanced Studies, University of Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
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11
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Faraji Azad S, Biglarian A, Rostami M, Bidhendi-Yarandi R. Maternal weight latent trajectories and associations with adverse pregnancy outcomes using a smoothing mixture model. Sci Rep 2023; 13:9011. [PMID: 37268823 DOI: 10.1038/s41598-023-36312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Abstract
Class membership is a critical issue in health data sciences. Different types of statistical models have been widely applied to identify participants within a population with heterogeneous longitudinal trajectories. This study aims to identify latent longitudinal trajectories of maternal weight associated with adverse pregnancy outcomes using smoothing mixture model (SMM). Data were collected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy. We applied the data of 877 pregnant women living in Shooshtar city, whose weights during the nine months of pregnancy were available. In the first step, maternal weight was classified and participants were assigned to only one group for which the estimated trajectory is the most similar to the observed one using SMM; then, we examined the associations of identified trajectories with risk of adverse pregnancy endpoints by applying logistic regression. Three latent trajectories for maternal weight during pregnancy were identified and named as low, medium and high weight trajectories. Crude estimated odds ratio (OR) for icterus, preterm delivery, NICU admission and composite neonatal events shows significantly higher risks in trajectory 1 (low weight) compared to trajectory 2 (medium weight) by 69% (OR = 1.69, 95%CI 1.20, 2.39), 82% (OR = 1.82, 95%CI 1.14, 2.87), 77% (OR = 1.77, 95%CI 1.17, 2.43), and 85% (OR = 1.85, 95%CI 1.38, 2.76), respectively. Latent class trajectories of maternal weights can be accurately estimated using SMM. It is a powerful means for researchers to appropriately assign individuals to their class. The U-shaped curve of association between maternal weight gain and risk of maternal complications reveals that the optimum place for pregnant women could be in the middle of the growth curve to minimize the risks. Low maternal weight trajectory compared to high had even a significantly higher hazard for some neonatal adverse events. Therefore, appropriate weight gain is critical for pregnant women.Trial registration International Standard Randomized Controlled Trial Number (ISRCTN): 2014102519660N1; http://www.irct.ir/searchresult.php?keyword=&id=19660&number=1&prt=7805&total=10&m=1 (Archived by WebCite at http://www.webcitation.org/6p3lkqFdV ).
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Affiliation(s)
- Shirin Faraji Azad
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Rostami
- Department of Community Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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12
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O'Neill AS, Newsom JT, Trubits EF, Elman MR, Botoseneanu A, Allore HG, Nagel CL, Dorr DA, Quiñones AR. Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans. SSM Popul Health 2023; 22:101375. [PMID: 36941895 PMCID: PMC10024041 DOI: 10.1016/j.ssmph.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories. Methods Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count. Results Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth). Conclusion These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.
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Affiliation(s)
- AnnaMarie S. O'Neill
- VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
- Corresponding author. VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA. AnnaMarie.O'
| | - Jason T. Newsom
- Department of Psychology, Portland State University, OR, USA
| | - Em F. Trubits
- Department of Psychology, Portland State University, OR, USA
| | - Miriam R. Elman
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Dearborn, MI, USA
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USA
| | - Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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13
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Chalitsios CV, Santoso C, Nartey Y, Khan N, Simpson G, Islam N, Stuart B, Farmer A, Dambha-Miller H. Trajectories of multiple long-term conditions and mortality in older adults: A retrospective cohort study using English Longitudinal Study of Ageing (ELSA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.18.23290151. [PMID: 37292869 PMCID: PMC10246039 DOI: 10.1101/2023.05.18.23290151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectives To classify older adults with MLTC into clusters based on accumulating conditions as trajectories over time, characterise clusters and quantify associations between derived clusters and all-cause mortality. Design We conducted a retrospective cohort study using the English Longitudinal Study of Ageing (ELSA) over nine years (n=15,091 aged 50 years and older). Group-based trajectory modelling was used to classify people into MLTC clusters based on accumulating conditions over time. Derived clusters were used to quantify the associations between MLTC trajectory memberships, sociodemographic characteristics, and all-cause mortality. Results Five distinct clusters of MLTC trajectories were identified and characterised as: "no-LTC" (18.57%), "single-LTC" (31.21%), "evolving MLTC" (25.82%), "moderate MLTC" (17.12%), and "high MLTC" (7.27%). Increasing age was consistently associated with an increased number of MLTC. Female sex (aOR = 1.13; 95%CI 1.01 to 1.27) and ethnic minority (aOR = 2.04; 95%CI 1.40 to 3.00) were associated with the "moderate MLTC" and "high MLTC" clusters, respectively. Higher education and paid employment were associated with a lower likelihood of progression over time towards an increased number of MLTC. All the clusters had higher all-cause mortality than the "no-LTC" cluster. Conclusions The development of MLTC and the increase in the number of conditions over time follow distinct trajectories. These are determined by non-modifiable (age, sex, ethnicity) and modifiable factors (education and employment). Stratifying risk through clustering will enable practitioners to identify older adults with a higher likelihood of worsening MLTC over time to tailor effective interventions.
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Affiliation(s)
| | - Cornelia Santoso
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Yvonne Nartey
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nusrat Khan
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Nikoloudaki M, Nikolopoulos D, Koutsoviti S, Flouri I, Kapsala N, Repa A, Katsimbri P, Theotikos E, Pitsigavdaki S, Pateromichelaki K, Bertsias A, Elezoglou A, Sidiropoulos P, Fanouriakis A, Boumpas D, Bertsias G. Clinical response trajectories and drug persistence in systemic lupus erythematosus patients on belimumab treatment: A real-life, multicentre observational study. Front Immunol 2023; 13:1074044. [PMID: 36685524 PMCID: PMC9845912 DOI: 10.3389/fimmu.2022.1074044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Objective To obtain real-world data on outcomes of belimumab treatment and respective prognostic factors in patients with systemic lupus erythematosus (SLE). Methods Observational study of 188 active SLE patients (median disease duration 6.2 years, two previous immunosuppressive/biological agents) treated with belimumab, who were monitored for SLEDAI-2K, Physician Global Assessment (PGA), LLDAS (lupus low disease activity state), remission (DORIS/Padua definitions), SELENA-SLEDAI Flare Index, SLICC/ACR damage index and treatment discontinuations. Group-based disease activity trajectories were modelled followed by multinomial regression for predictive variables. Drug survival was analysed by Cox-regression. Results At 6, 12 and 24 months, LLDAS was attained by 36.2%, 36.7% and 33.5%, DORIS-remission by 12.3%, 11.6% and 17.8%, and Padua-remission by 21.3%, 17.9% and 29.0%, respectively (attrition-corrected). Trajectory analysis of activity indices classified patients into complete (25.5%), partial (42.0%) and non-responder (32.4%) groups, which were predicted by baseline PGA, inflammatory rash, leukopenia and prior use of mycophenolate. During median follow-up of 15 months, efficacy-related discontinuations occurred in 31.4% of the cohort, especially in patients with higher baseline PGA (hazard ratio [HR] 2.78 per 1-unit; 95% CI 1.32-5.85). Conversely, PGA improvement at 3 months predicted longer drug retention (HR 0.57; 95% CI 0.33-0.97). Use of hydroxychloroquine was associated with lower risk for safety-related drug discontinuation (HR 0.33; 95% CI 0.13-0.85). Although severe flares were reduced, flares were not uncommon (58.0%) and contributed to treatment stops (odds ratio [OR] 1.73 per major flare; 95% CI 1.09-2.75) and damage accrual (OR 1.83 per mild/moderate flare; 95% CI 1.15-2.93). Conclusions In a real-life setting with predominant long-standing SLE, belimumab was effective in the majority of patients, facilitating the achievement of therapeutic targets. Monitoring PGA helps to identify patients who will likely benefit and stay on the treatment. Vigilance is required for the prevention and management of flares while on belimumab.
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Affiliation(s)
- Myrto Nikoloudaki
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece
| | - Dionysis Nikolopoulos
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sofia Koutsoviti
- Department of Rheumatology, ‘Asklepieion’ General Hospital, Athens, Greece
| | - Irini Flouri
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece
| | - Noemin Kapsala
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Argyro Repa
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece
| | - Pelagia Katsimbri
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Sofia Pitsigavdaki
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece
| | - Katerina Pateromichelaki
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece
| | - Antonios Bertsias
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece
| | - Antonia Elezoglou
- Department of Rheumatology, ‘Asklepieion’ General Hospital, Athens, Greece
| | - Prodromos Sidiropoulos
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece,Division of Immunity, Institute of Molecular Biology and Biotechnology-Foundation for Research and Technology – Hellas (FORTH), Heraklion, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece,Department of Rheumatology, ‘Asklepieion’ General Hospital, Athens, Greece
| | - Dimitrios Boumpas
- Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece,Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - George Bertsias
- Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion, Greece,Division of Internal Medicine, University of Crete Medical School, Heraklion, Greece,Division of Immunity, Institute of Molecular Biology and Biotechnology-Foundation for Research and Technology – Hellas (FORTH), Heraklion, Greece,*Correspondence: George Bertsias,
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15
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Martinez-De la Torre A, Perez-Cruz F, Weiler S, Burden AM. Comorbidity clusters associated with newly treated type 2 diabetes mellitus: a Bayesian nonparametric analysis. Sci Rep 2022; 12:20653. [PMID: 36450743 PMCID: PMC9712684 DOI: 10.1038/s41598-022-24217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with the development of chronic comorbidities, which can lead to high drug utilization and adverse events. We aimed to identify common comorbidity clusters and explore the progression over time in newly treated T2DM patients. The IQVIA Medical Research Data incorporating data from THIN, a Cegedim database of anonymized electronic health records, was used to identify all patients with a first-ever prescription for a non-insulin antidiabetic drug (NIAD) between January 2006 and December 2019. We selected 58 chronic comorbidities of interest and used Bayesian nonparametric models to identify disease clusters and model their progression over time. Among the 175,383 eligible T2DM patients, we identified the 20 most frequent comorbidity clusters, which were comprised of 14 latent features (LFs). Each LF was associated with a primary disease (e.g., 98% of patients in cluster 2, characterized by LF2, had congestive heart failure [CHF]). The presence of certain LFs increased the probability of having another LF active. For example, LF2 (CHF) frequently appeared with LFs related to chronic kidney disease (CKD). Over time, the clusters associated with cardiovascular diseases, such as CHF, progressed rapidly. Moreover, the onset of certain diseases led to further complications. Our models identified established T2DM complications and previously unknown connections, thus, highlighting the potential for Bayesian nonparametric models to characterize complex comorbidity patterns.
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Affiliation(s)
- Adrian Martinez-De la Torre
- grid.5801.c0000 0001 2156 2780Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
| | - Fernando Perez-Cruz
- grid.5801.c0000 0001 2156 2780Swiss Data Science Center, ETH Zurich and EPFL, Zurich, Switzerland ,grid.5801.c0000 0001 2156 2780Institute of Machine Learning, Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Stefan Weiler
- grid.5801.c0000 0001 2156 2780Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
| | - Andrea M. Burden
- grid.5801.c0000 0001 2156 2780Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zurich, Switzerland
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16
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Chen H, Zhou Y, Huang L, Xu X, Yuan C. Multimorbidity burden and developmental trajectory in relation to later‐life dementia: A prospective study. Alzheimers Dement 2022; 19:2024-2033. [PMID: 36427050 DOI: 10.1002/alz.12840] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study assessed the associations of multimorbidity burden and its developmental trajectory with later-life dementia. METHODS Among 5923 Health and Retirement Study participants, major chronic conditions including hypertension, diabetes mellitus, cancer, lung diseases, heart disease, stroke, psychological disorders, and arthritis were self- or proxy-reported in 1994-2008. Dementia diagnosis was self- or proxy-reported in 2008-2018. We used Cox regression to assess the associations of multimorbidity with incident dementia. RESULTS During follow-up (median = 8 years), 701 participants developed dementia. Each additional chronic condition in 2008 was related to 15% (confidence interval: 9% to 22%) higher hazard of dementia. Multimorbidity trajectories in 1994-2008 were classified as "rapid growth", "steady growth", "slow growth", and "no new condition" by the group-based trajectory modelling methods. Compared to "no new condition", the "rapid growth" trajectory was related to 32% (3% to 69%) higher dementia risk. CONCLUSIONS Both multimorbidity burden and its developmental trajectory were prospectively associated with risk of dementia.
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Affiliation(s)
- Hui Chen
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Yaguan Zhou
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Liyan Huang
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Xiaolin Xu
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
- School of Public Health Faculty of Medicine The University of Queensland Brisbane Australia
| | - Changzheng Yuan
- School of Public Health and the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang China
- Department of Nutrition Harvard T.H. Chan School of Public Health Boston Massachusetts USA
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17
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Roso-Llorach A, Vetrano DL, Trevisan C, Fernández S, Guisado-Clavero M, Carrasco-Ribelles LA, Fratiglioni L, Violán C, Calderón-Larrañaga A. 12-year evolution of multimorbidity patterns among older adults based on Hidden Markov Models. Aging (Albany NY) 2022; 14:9805-9817. [PMID: 36435509 PMCID: PMC9831736 DOI: 10.18632/aging.204395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The evolution of multimorbidity patterns during aging is still an under-researched area. We lack evidence concerning the time spent by older adults within one same multimorbidity pattern, and their transitional probability across different patterns when further chronic diseases arise. The aim of this study is to fill this gap by exploring multimorbidity patterns across decades of age in older adults, and longitudinal dynamics among these patterns. METHODS Longitudinal study based on the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) on adults ≥60 years (N=3,363). Hidden Markov Models were applied to model the temporal evolution of both multimorbidity patterns and individuals' transitions over a 12-year follow-up. FINDINGS Within the study population (mean age 76.1 years, 66.6% female), 87.2% had ≥2 chronic conditions at baseline. Four longitudinal multimorbidity patterns were identified for each decade. Individuals in all decades showed the shortest permanence time in an Unspecific pattern lacking any overrepresented diseases (range: 4.6-10.9 years), but the pattern with the longest permanence time varied by age. Sexagenarians remained longest in the Psychiatric-endocrine and sensorial pattern (15.4 years); septuagenarians in the Neuro-vascular and skin-sensorial pattern (11.0 years); and octogenarians and beyond in the Neuro-sensorial pattern (8.9 years). Transition probabilities varied across decades, sexagenarians showing the highest levels of stability. INTERPRETATION Our findings highlight the dynamism and heterogeneity underlying multimorbidity by quantifying the varying permanence times and transition probabilities across patterns in different decades. With increasing age, older adults experience decreasing stability and progressively shorter permanence time within one same multimorbidity pattern.
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Affiliation(s)
- Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola de Vallès), Spain,Programa de Doctorat en Metodologia de la Recerca Biomèdica i Salut Pública, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Davide L. Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Caterina Trevisan
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Sergio Fernández
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola de Vallès), Spain
| | - Marina Guisado-Clavero
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Norte, Gerencia Asistencial Atención Primaria, Madrid Health Service, Madrid, Spain
| | - Lucía A. Carrasco-Ribelles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Signal Theory and Communications Department, Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Concepción Violán
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola de Vallès), Spain,Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitaria per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Barcelona, Spain
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
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18
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Construction of Life-Cycle Simulation Framework of Chronic Diseases and Their Comorbidities Based on Population Cohort. ALGORITHMS 2022. [DOI: 10.3390/a15050167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Life-cycle population follow-up data collection is time-consuming and often takes decades. General cohort data studies collect short-to-medium-term data from populations of different age groups. The purpose of constructing a life-cycle simulation method is to find an efficient and reliable way to achieve the way to characterize life-cycle disease metastasis from these short-to-medium-term data. In this paper, we have presented our effort at construction of a full lifetime population cohort simulation framework. The design aim is to generate a comprehensive understanding of the disease transition for full lifetime when we only have short-or-medium term population cohort data. We have conducted several groups of experiments to show the effectiveness of our method.
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Yao SS, Xu HW, Han L, Wang K, Cao GY, Li N, Luo Y, Chen YM, Su HX, Chen ZS, Huang ZT, Hu YH, Xu B. Multimorbidity measures differentially predicted mortality among older Chinese adults. J Clin Epidemiol 2022; 146:97-105. [DOI: 10.1016/j.jclinepi.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/26/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
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20
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Botoseneanu A, Markwardt S, Nagel CL, Allore HG, Newsom JT, Dorr DA, Quiñones AR. Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index. J Gerontol A Biol Sci Med Sci 2022; 77:e89-e97. [PMID: 33880490 PMCID: PMC8824553 DOI: 10.1093/gerona/glab116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups. METHOD We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (≥2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases. RESULTS Overweight and obesity were more prevalent in non-Hispanic Black (82.3%) and Hispanic (78.9%) than non-Hispanic White (70.9 %) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants. CONCLUSIONS Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, USA
- Address correspondence to: Anda Botoseneanu, MD, PhD, University of Michigan, 19000 Hubbard Drive, Dearborn, MI 48126. E-mail:
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut,USA
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, USA
| | - Ana R Quiñones
- School of Public Health, Oregon Health & Science University, Portland, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, USA
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21
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Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:8-35. [PMID: 34991091 DOI: 10.1159/000521288] [Citation(s) in RCA: 385] [Impact Index Per Article: 192.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient's unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.
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Affiliation(s)
- Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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22
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Wickwire EM, Albrecht JS, Capaldi VF, Jain SO, Gardner RC, Werner JK, Mukherjee P, McKeon AB, Smith MT, Giacino JT, Nelson LD, Williams SG, Collen J, Sun X, Schnyer DM, Markowitz AJ, Manley GT, Krystal AD. Trajectories of Insomnia in Adults After Traumatic Brain Injury. JAMA Netw Open 2022; 5:e2145310. [PMID: 35080600 PMCID: PMC8792888 DOI: 10.1001/jamanetworkopen.2021.45310] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE Insomnia is common after traumatic brain injury (TBI) and contributes to morbidity and long-term sequelae. OBJECTIVE To identify unique trajectories of insomnia in the 12 months after TBI. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study, latent class mixed models (LCMMs) were used to model insomnia trajectories over time and to classify participants into distinct profile groups. Data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a longitudinal, multisite, observational study, were uploaded to the Federal Interagency Traumatic Brain Injury Repository (FITBIR) database. Participants were enrolled at 1 of 18 participating level I trauma centers and enrolled within 24 hours of TBI injury. Additional data were obtained directly from the TRACK-TBI investigators that will be uploaded to FITBIR in the future. Data were collected from February 26, 2014, to August 8, 2018, and analyzed from July 1, 2020, to November 15, 2021. EXPOSURES Traumatic brain injury. MAIN OUTCOMES AND MEASURES Insomnia Severity Index assessed serially at 2 weeks and 3, 6, and 12 months thereafter. RESULTS The final sample included 2022 participants (1377 [68.1%] men; mean [SD] age, 40.1 [17.2] years) from the FITBIR database and the TRACK-TBI study. The data were best fit by a 5-class LCMM. Of these participants, 1245 (61.6%) reported persistent mild insomnia symptoms (class 1); 627 (31.0%) initially reported mild insomnia symptoms that resolved over time (class 2); 91 (4.5%) reported persistent severe insomnia symptoms (class 3); 44 (2.2%) initially reported severe insomnia symptoms that resolved by 12 months (class 4); and 15 (0.7%) initially reported no insomnia symptoms but had severe symptoms by 12 months (class 5). In a multinomial logistic regression model, several factors significantly associated with insomnia trajectory class membership were identified, including female sex (odds ratio [OR], 1.65 [95% CI, 1.02-2.66]), Black race (OR, 2.36 [95% CI, 1.39-4.01]), history of psychiatric illness (OR, 2.21 [95% CI, 1.35-3.60]), and findings consistent with intracranial injury on computed tomography (OR, 0.36 [95% CI, 0.20-0.65]) when comparing class 3 with class 1. CONCLUSIONS AND RELEVANCE These results suggest important heterogeneity in the course of insomnia after TBI in adults. More work is needed to identify outcomes associated with these insomnia trajectory class subgroups and to identify optimal subgroup-specific treatment approaches.
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Affiliation(s)
- Emerson M. Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Vincent F. Capaldi
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sonia O. Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | | | - J. Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Neurology, The Johns Hopkins University, Baltimore, Maryland
| | - Pratik Mukherjee
- Department of Radiology, School of Medicine, University of California, San Francisco
| | - Ashlee B. McKeon
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Michael T. Smith
- Division of Behavioral Medicine, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | - Scott G. Williams
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | | | - Amy J. Markowitz
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center, University of California, San Francisco
- Department of Neurosurgery, University of California, San Francisco
| | - Andrew D. Krystal
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Weill Institute for Neurosciences, University of California, San Francisco
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Willadsen TG, Siersma V, Nicolaisdóttir DR, Køster-Rasmussen R, Reventlow S, Rozing M. The effect of disease onset chronology on mortality among patients with multimorbidity: A Danish nationwide register study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221122025. [PMID: 36032184 PMCID: PMC9400403 DOI: 10.1177/26335565221122025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 11/22/2022]
Abstract
Background Multimorbidity is associated with increased mortality. Certain combinations of diseases are known to be more lethal than others, but the limited knowledge of how the chronology in which diseases develop impacts mortality may impair the development of effective clinical interventions for patients with multimorbidity. Objective To explore if in multimorbidity the chronology of disease onset is associated with mortality. Design: A prospective nationwide cohort study, including 3,986,209 people aged ≥18 years on 1 January 2000, was performed. We included ten diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. We defined multimorbidity as the presence of at least two diagnoses from two diagnosis groups (out of ten). To determine mortality, logistic regression models were used to calculate odds ratios (OR) and ratio of ORs (RORs). Results For most combinations of multimorbidity, the chronology of disease onset does not change mortality. However, when multimorbidity included mental health diagnoses, mortality was in general higher if the mental health diagnosis appeared first. If multimorbidity included heart and sensory diagnoses, mortality was higher if these developed second. For the majority of multimorbidity combinations, there was excess mortality if multimorbidity was diagnosed simultaneously, rather than consecutively, for example, heart and kidney (3.58 ROR; CI 2.39–5.36), or mental health and musculoskeletal diagnoses (2.38 ROR; CI 1.70–3.32). Conclusions Overall, in multimorbidity, the chronology in which diseases develop is not associated with mortality, with few exceptions. For almost all combinations of multimorbidity, diagnoses act synergistically in relation to mortality if diagnosed simultaneously.
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Affiliation(s)
- Tora G Willadsen
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dagny R Nicolaisdóttir
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Rozing
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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24
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Liu H, Zhang X, Chen B, Fang B, Lou VWQ, Hu J. The Differential Impact of Multimorbidity Patterns and Subsequent Accumulation on Longitudinal Trajectories of Physical Function Decline in a Population-based Cohort of Older People. J Gerontol A Biol Sci Med Sci 2021; 77:1629-1636. [PMID: 34951651 DOI: 10.1093/gerona/glab384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although both the patterns and accumulation of multimorbidity are important for predicting physical function, studies have not simultaneously examined their impact on functional decline. This study aimed to associate multimorbidity patterns and subsequently developed conditions with longitudinal trajectories of functional decline, and it tested whether the effects of newly developed conditions on functional decline varied across distinct multimorbidity patterns. METHODS We included 6,634 participants aged at least 60 years from the China Health and Retirement Longitudinal Survey. Latent class analysis identified multimorbidity patterns from 14 chronic conditions. Mixed negative binomial models estimated the changes in physical function measured across four waves as a function of multimorbidity patterns, subsequently developed conditions and their interactions. RESULTS Five distinct patterns were identified three years before wave 1: stomach/arthritis (15.7%), cardiometabolic (6.7%), arthritis/hypertension (47.9%), hepatorenal/multi-system (18.3%), and lung/asthma (11.4%). The hepatorenal/multi-system and the lung/asthma pattern were associated with worse baseline physical function, and the hypertension/arthritis pattern was associated with greater decline of physical function. The effect of developing new conditions on decline of physical function over time was most evident for individuals from the cardiometabolic pattern. DISCUSSION Considering both the combinations and progressive nature of multimorbidity is important for identifying individuals at greater risk of disability. Future studies are warranted to differentiate the factors responsible for the progression of chronic conditions in distinct multimorbidity patterns and investigate the potential implications for improved prediction of functional decline.
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Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, Hunan province, China.,Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
| | - Xinyan Zhang
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Beizhuo Chen
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Boye Fang
- Sun Yat-Sen University, School of Sociology & Anthropology, Guangzhou, Guangdong province, CN
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Jian Hu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
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25
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Cezard G, McHale CT, Sullivan F, Bowles JKF, Keenan K. Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence. BMJ Open 2021; 11:e048485. [PMID: 34810182 PMCID: PMC8609933 DOI: 10.1136/bmjopen-2020-048485] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/20/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Multimorbidity-the co-occurrence of at least two chronic diseases in an individual-is an important public health challenge in ageing societies. The vast majority of multimorbidity research takes a cross-sectional approach, but longitudinal approaches to understanding multimorbidity are an emerging research area, being encouraged by multiple funders. To support development in this research area, the aim of this study is to scope the methodological approaches and substantive findings of studies that have investigated longitudinal multimorbidity trajectories. DESIGN We conducted a systematic search for relevant studies in four online databases (Medline, Scopus, Web of Science and Embase) in May 2020 using predefined search terms and inclusion and exclusion criteria. The search was complemented by searching reference lists of relevant papers. From the selected studies, we systematically extracted data on study methodology and findings and summarised them in a narrative synthesis. RESULTS We identified 35 studies investigating multimorbidity longitudinally, all published in the last decade, and predominantly in high-income countries from the Global North. Longitudinal approaches employed included constructing change variables, multilevel regression analysis (eg, growth curve modelling), longitudinal group-based methodologies (eg, latent class modelling), analysing disease transitions and visualisation techniques. Commonly identified risk factors for multimorbidity onset and progression were older age, higher socioeconomic and area-level deprivation, overweight and poorer health behaviours. CONCLUSION The nascent research area employs a diverse range of longitudinal approaches that characterise accumulation and disease combinations and to a lesser extent disease sequencing and progression. Gaps include understanding the long-term, life course determinants of different multimorbidity trajectories, and doing so across diverse populations, including those from low-income and middle-income countries. This can provide a detailed picture of morbidity development, with important implications from a clinical and intervention perspective.
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Affiliation(s)
- Genevieve Cezard
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | | | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
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Calderón-Larrañaga A, Hu X, Haaksma M, Rizzuto D, Fratiglioni L, Vetrano DL. Health trajectories after age 60: the role of individual behaviors and the social context. Aging (Albany NY) 2021; 13:19186-19206. [PMID: 34383709 PMCID: PMC8386565 DOI: 10.18632/aging.203407] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Background: This study aimed to detect health trajectories after age 60, and to explore to what extent individual and social factors may contribute to healthier aging. Methods: Twelve-year health trajectories were identified in subjects from the Swedish National Study on Aging and Care in Kungsholmen (N=3108), integrating five indicators of disease, physical and cognitive function, and disability through nominal response models. Growth mixture models were applied to explore health trajectories in terms of rate and pattern of change. Baseline information about health-related behaviors and the social context was collected through standardized questionnaires. The strength of the associations was estimated using logistic regression, and their impact through population attributable fractions (PAF). Results: Three trajectories were identified grouping 78%, 18%, and 4% of people with respectively increasing rates of health decline. Compared to the best trajectory, subjects in the middle and worst trajectories became functionally dependent 12.0 (95% CI: 11.4-12.6) and 12.1 (95% CI: 11.5-12.7) years earlier, respectively. Insufficient physical activity (OR: 3.38, 95% CI: 2.58-4.42), financial strain (OR: 2.76, 95% CI: 1.77-4.30), <12 years education (OR: 1.53, 95% CI: 1.14-2.04), low social connections (OR: 1.45, 95% CI: 1.09-1.94), low social participation (OR: 1.39, 95% CI: 1.06-1.83) and a body mass index ≥25 (OR: 1.34, 95% CI: 1.03-1.75) were associated with belonging to the middle/worst trajectories. The highest PAFs were observed for insufficient physical activity (27.1%), low education (19.3%) and low social participation (15.9%); a total PAF of 66.1% was obtained. Conclusions: Addressing the social determinants of health in its broadest sense, complementarily considering life-long factors belonging to the socioeconomic, psychosocial, and behavioral dimensions, should be central to any strategy aimed at fostering health in older age.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Xiaonan Hu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Miriam Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,Centro di Medicina dell'Invecchiamento, IRCCS Fondazione Policlinico "A. Gemelli", and Catholic University of Rome, Rome, Italy
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Lee SA, Joo S, Chai HW, Jun HJ. Patterns of multimorbidity trajectories and their correlates among Korean older adults. Age Ageing 2021; 50:1336-1341. [PMID: 33570586 DOI: 10.1093/ageing/afab002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/07/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aims to identify distinct patterns of 10-year multimorbidity trajectory among Korean older adults and examine factors associated with the patterns. METHODS Data were drawn from the six waves of the Korean Longitudinal Study of Ageing (KLoSA, 2006-2016). We examined trajectories of multimorbidity of 1,705 older adults aged 65 and older using Growth Mixture Modeling. Then, the identified patterns were used as dependent variables to examine the correlates of multimorbidity trajectories. Explanatory variables considered were sociodemographic, psychological, health behavioural and interpersonal factors at baseline. RESULTS Four distinct patterns of multimorbidity trajectories were identified: 'maintaining-low' (59.4%), 'chronically-high' (7.5%), 'moderately-increasing' (26.0%) and 'rapidly- increasing' (7.1%). Gender, depressive symptoms, life satisfaction and frequency of contacts with others were associated with trajectory membership. Specifically, women were more likely to be in the 'chronically-high' group than any other groups. Compared to the 'maintaining-low' group, those with higher levels of depressive symptoms and lower levels of life satisfaction were more likely to belong to the 'chronically-high' group and 'moderately-increasing' group, respectively. Respondents who had less frequent meetings with others in close relationships were more likely to be in the 'rapidly-increasing' group than the 'maintaining-low' group. DISCUSSION These findings are suggestive of distinct trajectories of multimorbidity across older adulthood, indicating that multimorbidity experiences might differ among older adults. Moreover, results suggest that there may be gender inequalities in multimorbidity trajectories, and that levels of psychological well-being and social engagement could be useful in identifying older adults who are at higher risk of worsening multimorbidity.
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Affiliation(s)
- Sun Ah Lee
- Department of Child and Family Studies, Yonsei University, Seoul, Korea
| | - Susanna Joo
- BK21 Symbiotic Society and Design, Yonsei University, Seoul, Korea
| | - Hye Won Chai
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Hey Jung Jun
- Department of Child and Family Studies, Yonsei University, Seoul, Korea
- Human Life Innovation Design, Yonsei University, Seoul, Korea
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Quiñones AR, Newsom JT, Elman MR, Markwardt S, Nagel CL, Dorr DA, Allore HG, Botoseneanu A. Racial and Ethnic Differences in Multimorbidity Changes Over Time. Med Care 2021; 59:402-409. [PMID: 33821829 PMCID: PMC8024615 DOI: 10.1097/mlr.0000000000001527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our understanding of how multimorbidity progresses and changes is nascent. OBJECTIVES Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297). MEASURES Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms. RESULTS Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014. CONCLUSIONS AND RELEVANCE Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.
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Affiliation(s)
- Ana R. Quiñones
- Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, OR
| | - Miriam R. Elman
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Sheila Markwardt
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI
- Institute of Gerontology, University of Michigan, Ann Arbor, MI
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Pérez LM, Hooshmand B, Mangialasche F, Mecocci P, Smith AD, Refsum H, Inzitari M, Fratiglioni L, Rizzuto D, Calderón-Larrañaga A. Glutathione Serum Levels and Rate of Multimorbidity Development in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:1089-1094. [PMID: 31086967 PMCID: PMC7243585 DOI: 10.1093/gerona/glz101] [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: 12/01/2018] [Indexed: 12/12/2022] Open
Abstract
We aimed to investigate the association between baseline levels of total serum glutathione (tGSH) and rate of chronic disease accumulation over time. The study population (n = 2,596) was derived from a population-based longitudinal study on ≥60-year-olds living in Stockholm. Participants were clinically assessed at baseline, 3- and 6-year follow-ups. Multimorbidity was measured as the number of chronic conditions from a previously built list of 60 diseases. Linear mixed models were applied to analyze the association between baseline tGSH levels and the rate of multimorbidity development over 6 years. We found that at baseline, participants with ≥4 diseases had lower tGSH levels than participants with no chronic conditions (3.3 vs 3.6 µmol/L; p < .001). At follow-up, baseline levels of tGSH were inversely associated with the rate of multimorbidity development (β * time: -0.044, p < .001) after adjusting for age, sex, education, levels of serum creatinine, C-reactive protein, albumin, body mass index, smoking, and time of dropout or death. In conclusion, serum levels of tGSH are inversely associated with multimorbidity development; the association exists above and beyond the link between tGSH and specific chronic conditions. Our findings support the hypothesis that tGSH is a biomarker of multisystem dysregulation that eventually leads to multimorbidity.
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Affiliation(s)
- Laura M Pérez
- Aging Research Center, NVS Department, Karolinska Institutet, Stockholm University, Sweden.,Hospital Parc Sanitari Pere Virgili, Barcelona, Spain.,RE-FiT Barcelona Research Group, Vall d'Hebrón Institute of Research, Spain
| | - Babak Hooshmand
- Aging Research Center, NVS Department, Karolinska Institutet, Stockholm University, Sweden.,Department of Neurology, Ulm University Hospital, Germany
| | - Francesca Mangialasche
- Aging Research Center, NVS Department, Karolinska Institutet, Stockholm University, Sweden.,Division of Clinical geriatrics, NVS Department, Karolinska Institutet, Stockholm, Sweden
| | - Patrizia Mecocci
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Italy
| | - A David Smith
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Helga Refsum
- Department of Pharmacology, University of Oxford, Oxford, UK.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Marco Inzitari
- Hospital Parc Sanitari Pere Virgili, Barcelona, Spain.,RE-FiT Barcelona Research Group, Vall d'Hebrón Institute of Research, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Laura Fratiglioni
- Aging Research Center, NVS Department, Karolinska Institutet, Stockholm University, Sweden.,Stockholm Gerontology Research Center, Sweden
| | - Debora Rizzuto
- Aging Research Center, NVS Department, Karolinska Institutet, Stockholm University, Sweden
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30
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Kudesia P, Salimarouny B, Stanley M, Fortin M, Stewart M, Terry A, Ryan BL. The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211032880. [PMID: 34350127 PMCID: PMC8287424 DOI: 10.1177/26335565211032880] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
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Affiliation(s)
- Prtha Kudesia
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Banafsheh Salimarouny
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Meagan Stanley
- Allyn & Betty Taylor Library, University of Western
Ontario, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Amanda Terry
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
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31
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Hassaine A, Canoy D, Solares JRA, Zhu Y, Rao S, Li Y, Zottoli M, Rahimi K, Salimi-Khorshidi G. Learning multimorbidity patterns from electronic health records using Non-negative Matrix Factorisation. J Biomed Inform 2020; 112:103606. [PMID: 33127447 DOI: 10.1016/j.jbi.2020.103606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 08/01/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
Multimorbidity, or the presence of several medical conditions in the same individual, has been increasing in the population - both in absolute and relative terms. Nevertheless, multimorbidity remains poorly understood, and the evidence from existing research to describe its burden, determinants and consequences has been limited. Previous studies attempting to understand multimorbidity patterns are often cross-sectional and do not explicitly account for multimorbidity patterns' evolution over time; some of them are based on small datasets and/or use arbitrary and narrow age ranges; and those that employed advanced models, usually lack appropriate benchmarking and validations. In this study, we (1) introduce a novel approach for using Non-negative Matrix Factorisation (NMF) for temporal phenotyping (i.e., simultaneously mining disease clusters and their trajectories); (2) provide quantitative metrics for the evaluation of these clusters and trajectories; and (3) demonstrate how the temporal characteristics of the disease clusters that result from our model can help mine multimorbidity networks and generate new hypotheses for the emergence of various multimorbidity patterns over time. We trained and evaluated our models on one of the world's largest electronic health records (EHR) datasets, containing more than 7 million patients, from which over 2 million where relevant to, and hence included in this study.
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Affiliation(s)
- Abdelaali Hassaine
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Dexter Canoy
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jose Roberto Ayala Solares
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Yajie Zhu
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Shishir Rao
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Yikuan Li
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Mariagrazia Zottoli
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kazem Rahimi
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
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Latent Class Growth Analysis of Gout Flare Trajectories: A Three‐Year Prospective Cohort Study in Primary Care. Arthritis Rheumatol 2020; 72:1928-1935. [DOI: 10.1002/art.41476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/30/2020] [Indexed: 01/22/2023]
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33
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Hassaine A, Salimi-Khorshidi G, Canoy D, Rahimi K. Untangling the complexity of multimorbidity with machine learning. Mech Ageing Dev 2020; 190:111325. [PMID: 32768443 PMCID: PMC7493712 DOI: 10.1016/j.mad.2020.111325] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
The prevalence of multimorbidity has been increasing in recent years, posing a major burden for health care delivery and service. Understanding its determinants and impact is proving to be a challenge yet it offers new opportunities for research to go beyond the study of diseases in isolation. In this paper, we review how the field of machine learning provides many tools for addressing research challenges in multimorbidity. We highlight recent advances in promising methods such as matrix factorisation, deep learning, and topological data analysis and how these can take multimorbidity research beyond cross-sectional, expert-driven or confirmatory approaches to gain a better understanding of evolving patterns of multimorbidity. We discuss the challenges and opportunities of machine learning to identify likely causal links between previously poorly understood disease associations while giving an estimate of the uncertainty on such associations. We finally summarise some of the challenges for wider clinical adoption of machine learning research tools and propose some solutions.
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Affiliation(s)
- Abdelaali Hassaine
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Gholamreza Salimi-Khorshidi
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Dexter Canoy
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Kazem Rahimi
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.
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34
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Ermogenous C, Green C, Jackson T, Ferguson M, Lord JM. Treating age-related multimorbidity: the drug discovery challenge. Drug Discov Today 2020; 25:1403-1415. [DOI: 10.1016/j.drudis.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
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35
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Syed S, Baghal A, Prior F, Zozus M, Al-Shukri S, Syeda HB, Garza M, Begum S, Gates K, Syed M, Sexton KW. Toolkit to Compute Time-Based Elixhauser Comorbidity Indices and Extension to Common Data Models. Healthc Inform Res 2020; 26:193-200. [PMID: 32819037 PMCID: PMC7438698 DOI: 10.4258/hir.2020.26.3.193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/17/2020] [Indexed: 01/02/2023] Open
Abstract
Objectives The time-dependent study of comorbidities provides insight into disease progression and trajectory. We hypothesize that understanding longitudinal disease characteristics can lead to more timely intervention and improve clinical outcomes. As a first step, we developed an efficient and easy-to-install toolkit, the Time-based Elixhauser Comorbidity Index (TECI), which pre-calculates time-based Elixhauser comorbidities and can be extended to common data models (CDMs). Methods A Structured Query Language (SQL)-based toolkit, TECI, was built to pre-calculate time-specific Elixhauser comorbidity indices using data from a clinical data repository (CDR). Then it was extended to the Informatics for Integrating Biology and the Bedside (I2B2) and Observational Medical Outcomes Partnership (OMOP) CDMs. Results At the University of Arkansas for Medical Sciences (UAMS), the TECI toolkit was successfully installed to compute the indices from CDR data, and the scores were integrated into the I2B2 and OMOP CDMs. Comorbidity scores calculated by TECI were validated against: scores available in the 2015 quarter 1–3 Nationwide Readmissions Database (NRD) and scores calculated using the comorbidities using a previously validated algorithm on the 2015 quarter 4 NRD. Furthermore, TECI identified 18,846 UAMS patients that had changes in comorbidity scores over time (year 2013 to 2019). Comorbidities for a random sample of patients were independently reviewed, and in all cases, the results were found to be 100% accurate. Conclusions TECI facilitates the study of comorbidities within a time-dependent context, allowing better understanding of disease associations and trajectories, which has the potential to improve clinical outcomes.
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Affiliation(s)
- Shorabuddin Syed
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmad Baghal
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Meredith Zozus
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Shaymaa Al-Shukri
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hafsa Bareen Syeda
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Maryam Garza
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Salma Begum
- Department of Information Technology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kim Gates
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mahanazuddin Syed
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin W Sexton
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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36
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Tadeu ACR, E Silva Caetano IRC, de Figueiredo IJ, Santiago LM. Multimorbidity and consultation time: a systematic review. BMC FAMILY PRACTICE 2020; 21:152. [PMID: 32723303 PMCID: PMC7390198 DOI: 10.1186/s12875-020-01219-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/12/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multimorbidity (MM) is one of the major challenges health systems currently face. Management of time length of a medical consultation with a patient with MM is a matter of concern for doctors. METHODS A systematic review was performed to describe the impact of MM on the average time of a medical consultation considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa = 0.84 and Kappa = 0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined - the length of medical appointments with patients with MM. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The length of time of medical appointment for patients without MM was the comparator criteria. Experimental and observational studies were included. RESULTS Of 85 articles identified, only 1 observational study was included, showing a clear trend for patients with MM to have longer consultations than patients without MM criteria (p < 0.001). CONCLUSIONS More studies are required to better assess allocation length-time for patients with MM and to measure other characteristics like doctors' workload.
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Affiliation(s)
| | | | - Inês Jorge de Figueiredo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ACeS Dão Lafões, Coimbra, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Luiz Miguel Santiago
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,General Practice/Family Practice clinic of the Faculty of Medicine of University of Coimbra, Coimbra, Portugal.,Center for Health and Investigation studies of the University of Coimbra (CEISUC), Coimbra, Portugal
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37
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Iovino P, De Maria M, Matarese M, Vellone E, Ausili D, Riegel B. Depression and self-care in older adults with multiple chronic conditions: A multivariate analysis. J Adv Nurs 2020; 76:1668-1678. [PMID: 32281683 DOI: 10.1111/jan.14385] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
AIMS To investigate the relationship between depression and self-care behaviours in older individuals with multimorbidity. DESIGN Cross-sectional study. Data were collected between April 2017 - June 2019. METHODS Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 was used to measure depression and Self-Care of Chronic Illness Inventory was used to measure self-care maintenance, monitoring, and management. The relationship between depression and self-care was evaluated by performing two sets of univariate analyses, followed by multivariate and step-down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function. RESULTS The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self-care maintenance and monitoring and a significant negative association between depression and multivariate self-care. Step-down analysis showed that self-care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function. CONCLUSION In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity. IMPACT The results of this study may help guide clinical practice. In patients with depressive symptoms, self-care maintenance behaviours should be assessed first, as a potential first indicator of poor self-care.
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Affiliation(s)
- Paolo Iovino
- University of Rome Tor Vergata, Rome, Italy.,Australian Catholic University, Melbourne, Australia
| | | | | | | | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
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38
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Chan MS, van den Hout A, Pujades-Rodriguez M, Jones MM, Matthews FE, Jagger C, Raine R, Bajekal M. Socio-economic inequalities in life expectancy of older adults with and without multimorbidity: a record linkage study of 1.1 million people in England. Int J Epidemiol 2020; 48:1340-1351. [PMID: 30945728 PMCID: PMC6693817 DOI: 10.1093/ije/dyz052] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 12/05/2022] Open
Abstract
Background Age of onset of multimorbidity and its prevalence are well documented. However, its contribution to inequalities in life expectancy has yet to be quantified. Methods A cohort of 1.1 million English people aged 45 and older were followed up from 2001 to 2010. Multimorbidity was defined as having 2 or more of 30 major chronic diseases. Multi-state models were used to estimate years spent healthy and with multimorbidity, stratified by sex, smoking status and quintiles of small-area deprivation. Results Unequal rates of multimorbidity onset and subsequent survival contributed to higher life expectancy at age 65 for the least (Q1) compared with most (Q5) deprived: there was a 2-year gap in healthy life expectancy for men [Q1: 7.7 years (95% confidence interval: 6.4–8.5) vs Q5: 5.4 (4.4–6.0)] and a 3-year gap for women [Q1: 8.6 (7.5–9.4) vs Q5: 5.9 (4.8–6.4)]; a 1-year gap in life expectancy with multimorbidity for men [Q1: 10.4 (9.9–11.2) vs Q5: 9.1 (8.7–9.6)] but none for women [Q1: 11.6 (11.1–12.4) vs Q5: 11.5 (11.1–12.2)]. Inequalities were attenuated but not fully attributable to socio-economic differences in smoking prevalence: multimorbidity onset was latest for never smokers and subsequent survival was longer for never and ex smokers. Conclusions The association between social disadvantage and multimorbidity is complex. By quantifying socio-demographic and smoking-related contributions to multimorbidity onset and subsequent survival, we provide evidence for more equitable allocation of prevention and health-care resources to meet local needs.
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Affiliation(s)
- Mei Sum Chan
- Department of Applied Health Research, University College London, London, UK.,Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ardo van den Hout
- Department of Statistical Science, University College London, London, UK
| | - Mar Pujades-Rodriguez
- Health Science Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,Clinical Epidemiology, Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK
| | - Melvyn Mark Jones
- Research Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - Fiona E Matthews
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Jagger
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Madhavi Bajekal
- Department of Applied Health Research, University College London, London, UK
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Herle M, Micali N, Abdulkadir M, Loos R, Bryant-Waugh R, Hübel C, Bulik CM, De Stavola BL. Identifying typical trajectories in longitudinal data: modelling strategies and interpretations. Eur J Epidemiol 2020; 35:205-222. [PMID: 32140937 PMCID: PMC7154024 DOI: 10.1007/s10654-020-00615-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/17/2020] [Indexed: 11/06/2022]
Abstract
Individual-level longitudinal data on biological, behavioural, and social dimensions are becoming increasingly available. Typically, these data are analysed using mixed effects models, with the result summarised in terms of an average trajectory plus measures of the individual variations around this average. However, public health investigations would benefit from finer modelling of these individual variations which identify not just one average trajectory, but several typical trajectories. If evidence of heterogeneity in the development of these variables is found, the role played by temporally preceding (explanatory) variables as well as the potential impact of differential trajectories may have on later outcomes is often of interest. A wide choice of methods for uncovering typical trajectories and relating them to precursors and later outcomes exists. However, despite their increasing use, no practical overview of these methods targeted at epidemiological applications exists. Hence we provide: (a) a review of the three most commonly used methods for the identification of latent trajectories (growth mixture models, latent class growth analysis, and longitudinal latent class analysis); and (b) recommendations for the identification and interpretation of these trajectories and of their relationship with other variables. For illustration, we use longitudinal data on childhood body mass index and parental reports of fussy eating, collected in the Avon Longitudinal Study of Parents and Children.
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Affiliation(s)
- Moritz Herle
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Nadia Micali
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Child and Adolescent Psychiatry Division, Department of Child and Adolescent Health, Geneva University Hospital, Geneva, Switzerland
| | - Mohamed Abdulkadir
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ruth Loos
- The Charles Bronfman Institute for Personalized Medicine, The Mindich Child Health and Development Institute, Icahn Mount Sinai School of Medicine, New York, NY, USA
| | - Rachel Bryant-Waugh
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Christopher Hübel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bianca L De Stavola
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
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Calderón-Larrañaga A, Vetrano DL, Welmer AK, Grande G, Fratiglioni L, Dekhtyar S. Psychological correlates of multimorbidity and disability accumulation in older adults. Age Ageing 2019; 48:789-796. [PMID: 31579908 PMCID: PMC6814086 DOI: 10.1093/ageing/afz117] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/08/2019] [Accepted: 08/15/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/OBJECTIVES attitudes toward life and health are emerging as important psychological contributors to health heterogeneity in ageing. We aimed to explore whether different psychological factors were associated with the rate of chronic disease and disability accumulation over time. DESIGN population-based cohort study between 2001 and 2010. SETTING Swedish National study on aging and care in Kungsholmen. SUBJECTS adults aged 60 and older (N = 2293). METHODS linear mixed models were employed to study the association of life satisfaction, health outlook, resistance to illness, sickness orientation, and health worry with the rate of accumulation of chronic diseases and impaired basic and instrumental activities of daily living. Models were adjusted for demographic, clinical, social, personality and lifestyle factors. Analyses were repeated after excluding individuals with multimorbidity or disability at baseline. RESULTS high life satisfaction and positive health outlook were consistently associated with a lower rate of accumulation and progression of multimorbidity (β -0.064 95% confidence interval [CI] -0.116, -0.011; β -0.065 95% CI -0.121, -0.008, respectively) and disability (β -0.063 95% CI -0.098, -0.028; β -0.042 95% CI -0.079, -0.004, respectively) over time. This was true even for people without multimorbidity or disability at baseline and after adjusting for all covariates. CONCLUSIONS positive attitudes toward life in general and health in particular may be especially important in old age, when the cumulative effects of biological and environmental deficits lead to accelerated health decline. These findings should encourage researchers to use measures of psychological well-being to better understand the multifactorial and diverse process of ageing.
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Affiliation(s)
- Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro di Medicina dell’Invecchiamento, IRCCS Fondazione Policlinico “A. Gemelli”, Rome, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
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Dekhtyar S, Vetrano DL, Marengoni A, Wang HX, Pan KY, Fratiglioni L, Calderón-Larrañaga A. Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences: A Cohort Study. Am J Epidemiol 2019; 188:1627-1636. [PMID: 31274148 DOI: 10.1093/aje/kwz101] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 11/14/2022] Open
Abstract
Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life-childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network-and the speed of chronic disease accumulation. We followed 2,589 individuals aged ≥60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001-2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, β × time = -0.065, 95% CI: -0.126, -0.004; for university, β × time = -0.118, 95% CI: -0.185, -0.050); for active occupations compared with high-strain jobs (β × time = -0.078, 95% CI: -0.138, -0.017); and for richer social networks (for moderate tertile, β × time = -0.102, 95% CI: -0.149, -0.055; for highest tertile, β × time = -0.135, 95% CI: -0.182, -0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging.
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Affiliation(s)
- Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro di Medicina dell’Invecchiamento, Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico “A. Gemelli”, Rome, Italy
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Hui-Xin Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Kuan-Yu Pan
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Prevalence, characteristics, and patterns of patients with multimorbidity in primary care: a retrospective cohort analysis in Canada. Br J Gen Pract 2019; 69:e647-e656. [PMID: 31308002 PMCID: PMC6715467 DOI: 10.3399/bjgp19x704657] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/21/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Multimorbidity is a complex issue in modern medicine and a more nuanced understanding of how this phenomenon occurs over time is needed. AIM To determine the prevalence, characteristics, and patterns of patients living with multimorbidity, specifically the unique combinations (unordered patterns) and unique permutations (ordered patterns) of multimorbidity in primary care. DESIGN AND SETTING A retrospective cohort analysis of the prospectively collected data from 1990 to 2013 from the Canadian Primary Care Sentinel Surveillance Network electronic medical record database. METHOD Adult primary care patients who were aged ≥18 years at their first recorded encounter were followed over time. A list of 20 chronic condition categories was used to detect multimorbidity. Computational analyses were conducted using the Multimorbidity Cluster Analysis Tool to identify all combinations and permutations. RESULTS Multimorbidity, defined as two or more and three or more chronic conditions, was prevalent among adult primary care patients and most of these patients were aged <65 years. Among female patients with two or more chronic conditions, 6075 combinations and 14 891 permutations were detected. Among male patients with three or more chronic conditions, 4296 combinations and 9716 permutations were detected. While specific patterns were identified, combinations and permutations became increasingly rare as the total number of chronic conditions and patient age increased. CONCLUSION This research confirms that multimorbidity is common in primary care and provides empirical evidence that clinical management requires a tailored, patient-centred approach. While the prevalence of multimorbidity was found to increase with increasing patient age, the largest proportion of patients with multimorbidity in this study were aged <65 years.
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Gardner RC, Cheng J, Ferguson AR, Boylan R, Boscardin J, Zafonte RD, Manley GT. Divergent Six Month Functional Recovery Trajectories and Predictors after Traumatic Brain Injury: Novel Insights from the Citicoline Brain Injury Treatment Trial Study. J Neurotrauma 2019; 36:2521-2532. [PMID: 30909795 DOI: 10.1089/neu.2018.6167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cross-sectional approaches to outcome assessment may not adequately capture heterogeneity in recovery after traumatic brain injury (TBI). Using latent class mixed models (LCMM), a data-driven analytic that identifies groups of patients with similar trajectories, we identified distinct 6 month functional recovery trajectories in a large cohort (n = 1046) of adults 18-70 years of age with complicated mild to severe TBI who participated in the Citicoline Brain Injury Treatment Trial (COBRIT). We used multinomial logistic fixed effect models and backward elimination, forward selection, and forward stepwise selection with several stopping rules to explore baseline predictors of functional recovery trajectory. Based on statistical and clinical considerations, the seven-class model was deemed superior. Visualization of these seven functional recovery trajectories revealed that each trajectory class started at one of three recovery levels at 1 month, which, for ease of reference we labeled groups A-C: Group A, good recovery (two classes; A1 and A2); Group B, moderate disability (two classes; B1 and B2); and Group C, severe disability (three classes; C1, C2, and C3). By 6 months, these three groups experienced dramatically divergent trajectories. Group A experienced stable good recovery (A1, n = 115) or dramatic decline (A2, n = 4); Group B experienced rapid complete recovery (B1, n = 71) or gradual recovery (B2, n = 742); Group C experienced dramatic rapid recovery (C1, n = 12), no recovery (C2, n = 91), or death (C3, n = 11). Trajectory class membership was not predicted by citicoline treatment (p = 0.57). The models identified demographic, pre-injury, and injury-related predictors of functional recovery trajectory, including: age, race, education, pre-injury employment, pre-injury diabetes, pre-injury psychiatric disorder, site, Glasgow Coma Scale (GCS) score, post-traumatic amnesia, TBI mechanism, major extracranial injury, hemoglobin, and acute computed tomographic (CT) findings. GCS was the most consistently selected predictor across all models. All models also selected at least one demographic or pre-injury medical predictor. LCMM successfully identified dramatically divergent, clinically meaningful 6 month recovery trajectories with utility to inform clinical trial design.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, Memory and Aging Center, and Weill Institute for Neurosciences, University of California, San Franscisco, San Francisco, California.,Department of Neurology and Center for Population Brain Health, San Francisco Veterans Affairs Mecical Center, San Francisco, California
| | - Jing Cheng
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Adam R Ferguson
- Department of Neurological Surgery and Weil Institute for Neurosciences, University of California San Francisco, San Francisco, California.,Brain and Spinal Injury Center, Zuckerberg san Francisco General Hospital, San Francisco, California.,Department of Research and Development, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Ross Boylan
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - John Boscardin
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California.,Department of Research and Development, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Medicine, University of California, san Francisco, California
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Geoffrey T Manley
- Department of Neurological Surgery and Weil Institute for Neurosciences, University of California San Francisco, San Francisco, California.,Brain and Spinal Injury Center, Zuckerberg san Francisco General Hospital, San Francisco, California
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Unfolding of hidden white blood cell count phenotypes for gene discovery using latent class mixed modeling. Genes Immun 2018; 20:555-565. [PMID: 30459343 DOI: 10.1038/s41435-018-0051-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 09/24/2018] [Accepted: 10/24/2018] [Indexed: 12/26/2022]
Abstract
Resting-state white blood cell (WBC) count is a marker of inflammation and immune system health. There is evidence that WBC count is not fixed over time and there is heterogeneity in WBC trajectory that is associated with morbidity and mortality. Latent class mixed modeling (LCMM) is a method that can identify unobserved heterogeneity in longitudinal data and attempts to classify individuals into groups based on a linear model of repeated measurements. We applied LCMM to repeated WBC count measures derived from electronic medical records of participants of the National Human Genetics Research Institute (NHRGI) electronic MEdical Record and GEnomics (eMERGE) network study, revealing two WBC count trajectory phenotypes. Advancing these phenotypes to GWAS, we found genetic associations between trajectory class membership and regions on chromosome 1p34.3 and chromosome 11q13.4. The chromosome 1 region contains CSF3R, which encodes the granulocyte colony-stimulating factor receptor. This protein is a major factor in neutrophil stimulation and proliferation. The association on chromosome 11 contain genes RNF169 and XRRA1; both involved in the regulation of double-strand break DNA repair.
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45
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Zhu Z, Heng BH, Teow KL. Lifetime trajectory simulation of chronic disease progression and comorbidity development. J Biomed Inform 2018; 88:29-36. [PMID: 30414473 DOI: 10.1016/j.jbi.2018.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 07/25/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Comorbidity is common in elderly patients and it imposes heavy burden on both individual and the whole healthcare system. This study aims to gain insights of comorbidity development by simulating the lifetime trajectory of disease progression from single chronic disease to comorbidity. METHODS Eight health states spanning from no chronic condition to comorbidity are considered in this study. Disease progression network is constructed based on the seven-year retrospective data of around 700,000 residents living in Singapore central region. Microsimulation is applied to simulate the process of aging and disease progression of a synthetic new-born cohort for the entire lifetime. RESULTS Among the 40 unique trajectories observed from the simulation, the top 10 trajectories covers 60% of the cohort. Timespan of most trajectories from birth to death is 80 years. Most people progress to at risk at late 30 s, develop the first chronic condition at 50 s or 60 s, and then progress to complications at 70 s. It is also observed that the earlier one person develops chronic conditions, the more life-year-lost is incurred. DISCUSSION The lifetime disease progression trajectory constructed for each person in the cohort describes how a person starts healthy, becomes at risk, then progresses to one or more chronic conditions, and finally deteriorates to various complications over the years. This study may help us have a better understanding of chronic disease progression and comorbidity development, hence add values to chronic disease prevention and management.
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Affiliation(s)
- Zhecheng Zhu
- Health Services & Outcomes Research, National Healthcare Group, Singapore.
| | - Bee Hoon Heng
- Health Services & Outcomes Research, National Healthcare Group, Singapore
| | - Kiok Liang Teow
- Health Services & Outcomes Research, National Healthcare Group, Singapore
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Multi-trajectory modeling of home blood pressure telemonitoring utilization among hypertensive patients in China: A latent class growth analysis. Int J Med Inform 2018; 119:70-74. [PMID: 30342688 DOI: 10.1016/j.ijmedinf.2018.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/23/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Home blood pressure telemonitoring (HBPT) has great potential in improving blood pressure (BP) control among patients with hypertension. However, the longitudinal use trajectories of HBPT have not been identified yet. In addition, there has been a lack of understanding of the relationship between developmental trajectories of HBPT and BP control over time. The primary goal of this study was to identify the longitudinal trajectories of using HBPT among hypertensive patients and to explore the relationship between longitudinal trajectories of HBPT use patterns and BP control. METHODS A total of 122 hypertensive patients were enrolled consecutively in Xiling, Huayan, Baisha and Xueyuan communities in Yichang City, Hubei Province, China. Each patient was provided with a portable monitoring device which has unlimited data service at the time of enrollment. Socio-demographics (e.g. name, age, sex, marital status) were collected at baseline. Real-time data including systolic and diastolic blood pressure were automatically uploaded to cloud platform through devices. Latent class growth analysis was conducted to determine the latent trajectory of HBPT use. Joint trajectory method was used to correlate the longitudinal trajectories of HBPT utilization and BP control status. RESULTS Five trajectories were identified which are persistently low (47.1%), moderate with decreasing (23.9%), sharply decreasing (11.2%), high with decreasing (11.3%) and persistently high with increasing (6.6%). There was no statistically significant difference among 5 trajectories in the baseline survey in terms of age, marital status, BP (both SBP and DBP) and BP control status. However, there was a strong positive correlation between the HBPT utilization pattern and BP control status over time. CONCLUSIONS The latent trajectories of HBPT utilization were identified in our study. However, no predictors of trajectory membership were identified. Nevertheless, we have demonstrated that HBPT was to some extent positively correlated with improved BP control, and this correlation still needs to be further proved.
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47
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Calderón-Larrañaga A, Santoni G, Wang HX, Welmer AK, Rizzuto D, Vetrano DL, Marengoni A, Fratiglioni L. Rapidly developing multimorbidity and disability in older adults: does social background matter? J Intern Med 2018; 283:489-499. [PMID: 29415323 DOI: 10.1111/joim.12739] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multimorbidity is among the most disabling geriatric conditions. In this study, we explored whether a rapid development of multimorbidity potentiates its impact on the functional independence of older adults, and whether different sociodemographic factors play a role beyond the rate of chronic disease accumulation. METHODS A random sample of persons aged ≥60 years (n = 2387) from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) was followed over 6 years. The speed of multimorbidity development was estimated as the rate of chronic disease accumulation (linear mixed models) and further dichotomized into the upper versus the three lower rate quartiles. Binomial negative mixed models were used to analyse the association between speed of multimorbidity development and disability (impaired basic and instrumental activities of daily living), expressed as the incidence rate ratio (IRR). The effect of sociodemographic factors, including sex, education, occupation and social network, was investigated. RESULTS The risk of new activity impairment was higher among participants who developed multimorbidity faster (IRR 2.4, 95% CI 1.9-3.1) compared with those who accumulated diseases more slowly overtime, even after considering the baseline number of chronic conditions. Only female sex (IRR for women vs. men 1.6, 95% CI 1.2-2.0) and social network (IRR for poor vs. rich social network 1.7, 95% CI 1.3-2.2) showed an effect on disability beyond the rate of chronic disease accumulation. CONCLUSIONS Rapidly developing multimorbidity is a negative prognostic factor for disability. However, sociodemographic factors such as sex and social network may determine older adults' reserves of functional ability, helping them to live independently despite the rapid accumulation of chronic conditions.
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Affiliation(s)
- A Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - G Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - H X Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - A K Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - D Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - D L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Catholic University of Rome, Italy
| | - A Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - L Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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Fortin M, Almirall J, Nicholson K. Development of a research tool to document self-reported chronic conditions in primary care. JOURNAL OF COMORBIDITY 2017; 7:117-123. [PMID: 29354597 PMCID: PMC5772378 DOI: 10.15256/joc.2017.7.122] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Researchers interested in multimorbidity often find themselves in the dilemma of identifying or creating an operational definition in order to generate data. Our team was invited to propose a tool for documenting the presence of chronic conditions in participants recruited for different research studies. OBJECTIVE To describe the development of such a tool. DESIGN A scoping review in which we identified relevant studies, selected studies, charted the data, and collated and summarized the results. The criteria considered for selecting chronic conditions were: (1) their relevance to primary care services; (2) the impact on affected patients; (3) their prevalence among the primary care users; and (4) how often the conditions were present among the lists retrieved from the scoping review. RESULTS Taking into account the predefined criteria, we developed a list of 20 chronic conditions/categories of conditions that could be self-reported. A questionnaire was built using simple instructions and a table including the list of chronic conditions/categories of conditions. CONCLUSIONS We developed a questionnaire to document 20 self-reported chronic conditions/categories of conditions intended to be used for research purposes in primary care. Guided by previous literature, the purpose of this questionnaire is to evaluate the self-reported burden of multimorbidity by participants and to encourage comparability among research studies using the same measurement.
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Affiliation(s)
- Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, and Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - José Almirall
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, and Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, Ontario, Canada
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Ubalde-Lopez M, Arends I, Almansa J, Delclos GL, Gimeno D, Bültmann U. Beyond Return to Work: The Effect of Multimorbidity on Work Functioning Trajectories After Sick Leave due to Common Mental Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:210-217. [PMID: 27250634 PMCID: PMC5405093 DOI: 10.1007/s10926-016-9647-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Objectives Patients with common mental disorders (CMDs) often suffer from comorbidities, which may limit their functioning at work. We assessed the longitudinal impact of multimorbidity, defined as two or more co-occurring chronic health conditions, on work functioning over time among workers who had returned to work after sick leave due to CMDs. Methods Prospective cohort study of 156 workers followed for 1 year after return to work from sick leave due to CMDs. A multimorbidity score was computed by counting severity-weighted chronic health conditions measured at baseline. Work functioning was measured at baseline and at 3, 6 and 12 months follow-up with the Work Role Functioning Questionnaire. Work functioning trajectories, i.e. the course of work functioning after return to work over time, were identified through latent class growth analysis. Results A total of 44 % of workers had multimorbidity. Four work functioning trajectories were identified: one (12 % of the workers) showed increasing work functioning scores during follow-up, whereas the other trajectories showed low, medium and high scores (23, 41 and 25 %, respectively) that remained stable across time points. Although multimorbidity did not predict membership in any trajectory, within the increasing score trajectory levels of work functioning were lower among those with high baseline multimorbidity score (p < 0.001). Conclusions Over time, multimorbidity negatively impacts work functioning after return to work from sick leave due to CMDs.
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Affiliation(s)
- Monica Ubalde-Lopez
- CISAL-Center for Research in Occupational Health, Barcelona Biomedical Research Park (PRBB), Pompeu Fabra University, C/Dr. Aiguader, 80, 08003, Barcelona, Spain.
- CIBERESP, CIBER in Epidemiology and Public Health, Madrid, Spain.
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - I Arends
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - J Almansa
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G L Delclos
- CISAL-Center for Research in Occupational Health, Barcelona Biomedical Research Park (PRBB), Pompeu Fabra University, C/Dr. Aiguader, 80, 08003, Barcelona, Spain
- CIBERESP, CIBER in Epidemiology and Public Health, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Southwest Center for Occupational and Environmental Health, Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - D Gimeno
- CISAL-Center for Research in Occupational Health, Barcelona Biomedical Research Park (PRBB), Pompeu Fabra University, C/Dr. Aiguader, 80, 08003, Barcelona, Spain
- CIBERESP, CIBER in Epidemiology and Public Health, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Southwest Center for Occupational and Environmental Health, Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, San Antonio Campus, San Antonio, TX, USA
| | - U Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Larsen FB, Pedersen MH, Friis K, Glümer C, Lasgaard M. A Latent Class Analysis of Multimorbidity and the Relationship to Socio-Demographic Factors and Health-Related Quality of Life. A National Population-Based Study of 162,283 Danish Adults. PLoS One 2017; 12:e0169426. [PMID: 28056050 PMCID: PMC5215832 DOI: 10.1371/journal.pone.0169426] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/16/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives To identify patterns of multimorbidity in the general population and examine how these patterns are related to socio-demographic factors and health-related quality of life. Study design and setting We used latent class analysis to identify subgroups with statistically distinct and clinically meaningful disease patterns in a nationally representative sample of Danish adults (N = 162,283) aged 16+ years. The analysis was based on 15 chronic diseases. Results Seven classes with different disease patterns were identified: a class with no or only a single chronic condition (59% of the population) labeled “1) Relatively Healthy” and six classes with a very high prevalence of multimorbidity labeled; “2) Hypertension” (14%); “3) Musculoskeletal Disorders” (10%); “4) Headache-Mental Disorders” (7%); “5) Asthma-Allergy” (6%); “6) Complex Cardiometabolic Disorders” (3%); and “7) Complex Respiratory Disorders” (2%). Female gender was associated with an increased likelihood of belonging to any of the six multimorbidity classes except for class 2 (Hypertension). Low educational attainment predicted membership of all of the multimorbidity classes except for class 5 (Asthma-Allergy). Marked differences in health-related quality of life between the seven latent classes were found. Poor health-related quality of life was highly associated with membership of class 6 (Complex Cardiometabolic Disorders) and class 7 (Complex Respiratory Disorders). Despite different disease patterns, these two classes had nearly identical profiles in relation to health-related quality of life. Conclusion The results clearly support that diseases tend to compound and interact, which suggests that a differentiated public health and treatment approach towards multimorbidity is needed.
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Affiliation(s)
- Finn Breinholt Larsen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
- * E-mail:
| | - Marie Hauge Pedersen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Karina Friis
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Glostrup, Denmark
| | - Mathias Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
- Department of Psychology, Southern University of Denmark, Odense, Denmark
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