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Dorr DA, Markwardt S, Bobo M, Allore HG, Botoseneanu A, Newsom JT, Nagel C, Quiñones AR. The extent and burden of high multimorbidity on older adults in the US: a descriptive analysis of Medicare beneficiaries. BMC Geriatr 2024; 24:777. [PMID: 39304796 DOI: 10.1186/s12877-024-05329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/23/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND The impact of multimorbidity (≥ 2 chronic diseases) on the well-being of older adults is substantial but variable. The burden of multimorbidity varies by the number and kinds of conditions, and timing of onset. The impact varies by age, race, ethnicity, socioeconomic status, and health indicators. Large scale longitudinal surveys linked to medical claims provide unique opportunities to characterize this variability. METHODS We analyzed Medicare-linked Health and Retirement Study data for respondents 65 and older with 3 or more years of fee-for-service coverage (n = 17,199; 2000-2016). We applied standardized claims algorithms for operationalizing 21 chronic diseases. We compared multimorbidity levels, demographics, and outcomes at baseline and over time and escalation to high multimorbidity levels (≥ 5 conditions). RESULTS At baseline, 51.2% had no multimorbidity, 36.5% had multimorbidity, and 12.4% had high multimorbidity. Loss of function, cognitive decline, and higher healthcare utilization were up to ten times more prevalent in the high multimorbidity group. Greater rates of high multimorbidity were seen among non-Hispanic Black and Hispanic groups, those with lower wealth, younger birth cohorts, and adults with obesity. Rates of transition to high multimorbidity varied greatly and was highest among Hispanic and respondents with lower education. CONCLUSIONS The development and progression of multimorbidity in old age is influenced by many factors. Higher levels of multimorbidity are associated with sociodemographic characteristics, suggesting possible mitigation strategies.
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Affiliation(s)
- David A Dorr
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: FM, Portland, OR, 97239, USA.
| | - Sheila Markwardt
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Michelle Bobo
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: FM, Portland, OR, 97239, USA
| | - Heather G Allore
- Departments of Medicine and Biostatistics, Yale University, New Haven, CT, USA
| | - Anda Botoseneanu
- College of Education, Health, and Human Services, University of Michigan-Dearborn, Dearborn, MI, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Corey Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ana R Quiñones
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Wister A, Li L, Ferris J, Kim B, Klasa K, Linkov I. Resilience among older adults with multimorbidity using the Connor-Davidson scale in the Canadian Longitudinal Study on Aging: health behaviour, socio-economic, and social support predictors. BMC Public Health 2024; 24:2567. [PMID: 39300381 DOI: 10.1186/s12889-024-19992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVE Multimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions. METHODS Using Baseline (2011-2015), Follow-up One (2015-2018), and Follow-up Two (2018-2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health. RESULTS Among all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster. DISCUSSION This research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance.
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Affiliation(s)
- Andrew Wister
- Gerontology Research Centre & Department of Gerontology, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - Lun Li
- School of Social Work, MacEwan University, 9-510A2, 10700 104 Ave NW, Edmonton, AB, T5J 4S2, Canada
| | - Jennifer Ferris
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, V6B 5K3, Canada
- BC Observatory for Population & Public Health, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
| | - Boah Kim
- Department of Gerontology, Simon Fraser University, Vancouver, BC, V6B 5K3, Canada
| | - Katarzyna Klasa
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Igor Linkov
- Engineering Research and Development Center, Army Corps of Engineers, Vicksburg, USA
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Namkung EH, Kang SH. The Trend of Chronic Diseases Among Older Koreans, 2004-2020: Age-Period-Cohort Analysis. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae128. [PMID: 39051674 DOI: 10.1093/geronb/gbae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES This study aimed to examine age, period, and cohort effects contributing to the prevalence of diabetes and hypertension among older Koreans. Additionally, it sought to investigate how sociodemographic characteristics interact with period and cohort effects to influence the disease prevalence. METHODS Using the 2004-2020 data from the National Survey of Older Koreans, a nationally representative sample of older adults aged 65 or older, hierarchical age-period-cohort cross-classified random effects models (HAPC-CCREMs) were employed to estimate separate age, period, and cohort components of the recent trends in diabetes and hypertension. Sociodemographic characteristics were tested for their interactions with period and cohort effects. RESULTS Significant period effects were observed, indicating a steady increase in the likelihood of being diagnosed with diabetes and hypertension over time. Age effects revealed a quadratic trend, with disease risks generally increasing with age, but the rate of increase diminishing at older ages. Cohort effects exhibited an inverted U-shaped pattern, with higher risks observed in the 1930s and early 1940s cohorts compared to earlier and later cohorts. Gender and educational attainment emerged as significant moderators. Women than men born in the early 1930s exhibited higher risks of diabetes and hypertension, whereas individuals with lower educational attainment showed a steadily increasing risk of hypertension over time. DISCUSSION The results underscore the complex interplay of age, period, and cohort effects in shaping disease prevalence among older Koreans. Our findings highlight the importance of considering historical context and sociodemographic factors in understanding disease trends and designing targeted interventions to mitigate health disparities.
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Affiliation(s)
- Eun Ha Namkung
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - Sung Hye Kang
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
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Ribe E, Cezard GI, Marshall A, Keenan K. Younger but sicker? Cohort trends in disease accumulation among middle-aged and older adults in Scotland using health-linked data from the Scottish Longitudinal Study. Eur J Public Health 2024; 34:696-703. [PMID: 38604658 PMCID: PMC11293808 DOI: 10.1093/eurpub/ckae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND In the United Kingdom, rising prevalence of multimorbidity-the co-occurrence of two or more chronic conditions- is coinciding with stagnation in life expectancy. We investigate patterns of disease accumulation and how they vary by birth cohort, social and environmental inequalities in Scotland, a country which has long suffered from excess mortality and poorer health outcomes relative to its neighbours. METHODS Using a dataset which links census data from 1991, 2001 and 2011 to disease registers and hospitalization data, we follow cohorts of adults aged 30-69 years for 18 years. We model physical and mental disease accumulation using linear mixed-effects models. RESULTS Recent cohorts experience higher levels of chronic disease accumulation compared to their predecessors at the same ages. Moreover, in more recently born cohorts we observe socioeconomic status disparities emerging earlier in the life course, which widen over time and with every successive cohort. Patterns of chronic conditions are also changing, and the most common diseases suffered by later born cohorts are cancer, hypertension, asthma, drug and alcohol problems and depression. CONCLUSION We recommend policies which target prevention of chronic disease in working age adults, considering how and why certain conditions are becoming more prevalent across time and space.
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Affiliation(s)
- Eloi Ribe
- School of Economic, Social and Political Sciences, University of Southampton, Southampton, UK
| | - Genevieve Isabelle Cezard
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Alan Marshall
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
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Nagel CL, Bishop NJ, Botoseneanu A, Allore HG, Newsom JT, Dorr DA, Quiñones AR. Recommendations on Methods for Assessing Multimorbidity Changes Over Time: Aligning the Method to the Purpose. J Gerontol A Biol Sci Med Sci 2024; 79:glae122. [PMID: 38742711 PMCID: PMC11163923 DOI: 10.1093/gerona/glae122] [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: 11/29/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The rapidly growing field of multimorbidity research demonstrates that changes in multimorbidity in mid- and late-life have far reaching effects on important person-centered outcomes, such as health-related quality of life. However, there are few organizing frameworks and comparatively little work weighing the merits and limitations of various quantitative methods applied to the longitudinal study of multimorbidity. METHODS We identify and discuss methods aligned to specific research objectives with the goals of (i) establishing a common language for assessing longitudinal changes in multimorbidity, (ii) illuminating gaps in our knowledge regarding multimorbidity progression and critical periods of change, and (iii) informing research to identify groups that experience different rates and divergent etiological pathways of disease progression linked to deterioration in important health-related outcomes. RESULTS We review practical issues in the measurement of multimorbidity, longitudinal analysis of health-related data, operationalizing change over time, and discuss methods that align with 4 general typologies for research objectives in the longitudinal study of multimorbidity: (i) examine individual change in multimorbidity, (ii) identify subgroups that follow similar trajectories of multimorbidity progression, (iii) understand when, how, and why individuals or groups shift to more advanced stages of multimorbidity, and (iv) examine the coprogression of multimorbidity with key health domains. CONCLUSIONS This work encourages a systematic approach to the quantitative study of change in multimorbidity and provides a valuable resource for researchers working to measure and minimize the deleterious effects of multimorbidity on aging populations.
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Affiliation(s)
- Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nicholas J Bishop
- Norton School of Family and Consumer Sciences, University of Arizona, Tucson, Arizona, USA
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, Michigan, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather G Allore
- Department of Biostatistics, Yale University, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
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Thompson AD, Petry SE, Hauser ER, Boyle SH, Pathak GA, Upchurch J, Press A, Johnson MG, Sims KJ, Williams CD, Gifford EJ. Longitudinal Patterns of Multimorbidity in Gulf War Era Veterans With and Without Gulf War Illness. J Aging Health 2024:8982643241245163. [PMID: 38591766 PMCID: PMC11461696 DOI: 10.1177/08982643241245163] [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] [Indexed: 04/10/2024]
Abstract
Objectives: To examine whether severe Gulf War illness (SGWI) case status was associated with longitudinal multimorbidity patterns. Methods: Participants were users of the Veteran Health Administration Health Care System drawn from the Gulf War Era Cohort and Biorepository (n = 840). Longitudinal measures of multimorbidity were constructed using (1) electronic health records (Charlson Comorbidity Index; Elixhauser; and Veterans Affairs Frailty Index) from 10/1/1999 to 6/30/2023 and (2) self-reported medical conditions (Deficit Accumulation Index) since the war until the survey date. Accelerated failure time models examined SGWI case status as a predictor of time until threshold level of multimorbidity was reached, adjusted for age and sociodemographic and military characteristics. Results: Models, adjusted for covariates, revealed that (1) relative to the SWGI- group, the SGWI+ group was associated with an accelerated time for reaching each threshold and (2) the relationship between SGWI and each threshold was not moderated by age. Discussion: Findings suggest that veterans with SGWI experienced accelerated aging.
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Affiliation(s)
- Andrew D. Thompson
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
| | - Sarah E. Petry
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
- Duke University Sanford School of Public Policy
- University of North Carolina Population Center, Chapel Hill, NC
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
- Duke Molecular Physiology Institute and Department of Biostatistics and Bioinformatics
| | - Stephen H. Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
| | - Gita A. Pathak
- Yale School of Medicine, Department of Psychiatry, Division of Human Genetics, New Haven, CT, USA
- Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
| | - Ashlyn Press
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
| | - Melissa G. Johnson
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
| | - Kellie J. Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
| | | | - Elizabeth J. Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center
- Duke University Sanford School of Public Policy
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SN, Agaltsov MV, Alekseeva LI, Almazova II, Andreenko EY, Antipushina DN, Balanova YA, Berns SA, Budnevsky AV, Gainitdinova VV, Garanin AA, Gorbunov VM, Gorshkov AY, Grigorenko EA, Jonova BY, Drozdova LY, Druk IV, Eliashevich SO, Eliseev MS, Zharylkasynova GZ, Zabrovskaya SA, Imaeva AE, Kamilova UK, Kaprin AD, Kobalava ZD, Korsunsky DV, Kulikova OV, Kurekhyan AS, Kutishenko NP, Lavrenova EA, Lopatina MV, Lukina YV, Lukyanov MM, Lyusina EO, Mamedov MN, Mardanov BU, Mareev YV, Martsevich SY, Mitkovskaya NP, Myasnikov RP, Nebieridze DV, Orlov SA, Pereverzeva KG, Popovkina OE, Potievskaya VI, Skripnikova IA, Smirnova MI, Sooronbaev TM, Toroptsova NV, Khailova ZV, Khoronenko VE, Chashchin MG, Chernik TA, Shalnova SA, Shapovalova MM, Shepel RN, Sheptulina AF, Shishkova VN, Yuldashova RU, Yavelov IS, Yakushin SS. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2024; 23:3696. [DOI: 10.15829/1728-8800-2024-3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024] Open
Abstract
Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.
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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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9
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Loyd C, Picken L, Sanders R, Zhang Y, Kennedy RE, Brown CJ. Changes in multimorbidity among hospitalized adults in the US. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241283436. [PMID: 39239101 PMCID: PMC11375669 DOI: 10.1177/26335565241283436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024]
Abstract
Objective This investigation examines burden of comorbidity measured by the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) among inpatients based on age, sex, and race. Methods Cross-sectional analysis of 2012-2018 US NIS datasets. Participants were inpatients 55y+. ICD-9/10 codes for admitting diagnoses were used to calculate disease burden using the CCI and ECI. Unweighted mean CCI and ECI scores were compared across demographic variables. Results An increase in mean CCI and ECI scores across age, sex, and races (p<.001) was identified. Compared to the youngest age group (55-59y), all age groups had higher mean CCI and ECI adjusting for time (p<.001). Increases were greatest in older age groups until age 80-84 for CCI and 85-89 for ECI. The female group had lower CCI adjusting for time (p<.001) compared to males. There was no difference between sex groups in mean ECI (p=.409). Compared with the White group, all other race groups had higher mean CCI adjusting for time (p<.001). Black inpatients had the highest CCI followed by Native American inpatients. Findings were similar for ECI, but with no difference between Hispanic and White groups (p=.434). Conclusions Growing multimorbidity burden among adult inpatients across age, sex, and race supports the continued need for programs for preventing and reducing multimorbidity, especially among communities that experience health inequity including older, Black, and Native American patients.
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Affiliation(s)
- Christine Loyd
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Picken
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richelle Sanders
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yue Zhang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard E Kennedy
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Johnstone AM, Lonnie M. Tackling diet inequalities in the UK food system: is food insecurity driving the obesity epidemic? (The FIO Food project). Proc Nutr Soc 2023:1-9. [PMID: 38058191 DOI: 10.1017/s0029665123004871] [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] [Indexed: 12/08/2023]
Abstract
By 2050 the number of adults living with obesity in the UK will rise with approximately one in four in the adult population. This rising trend is not equitable, with higher prevalence in socially disadvantaged groups. There is an apparent paradox of not being able to provide food for the family to eat, a feature of food insecurity and living with obesity. With the current cost-of-living crisis, there is a challenge to afford both food and fuel bills. Environmentally sustainable and healthy diets are proposed to improve public health and reduce the impact of the food system on the environment, while also improving diet quality. However, healthier foods tend to be nearly three times more expensive than unhealthy foods, and this provides a challenge for citizens on low incomes. In this review, we explore some of the evidence for solutions in the retail food environment to support the UK food system to be safe, nutritious, environmentally friendly and fair for all. We highlight the value of co-production in research, to give value and power to the lived experience to address these inequalities. Our multidisciplinary research approach within the FIO Food research grant will generate new insights into modifiable and potentially impactful changes to the UK food system, specifically for the retail food sector. We believe that the co-creation, design and delivery of research with those living with obesity and food insecurity will help to transform the UK food system for health and the environment in this vulnerable group.
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Affiliation(s)
- Alexandra M Johnstone
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Marta Lonnie
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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11
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Heikkinen J, Honkanen RJ, Quirk SE, Williams LJ, Koivumaa-Honkanen H. Long-term life satisfaction in ageing women with work disability due to mental and musculoskeletal disorders. Maturitas 2023; 178:107849. [PMID: 37774595 DOI: 10.1016/j.maturitas.2023.107849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Mental disorders (MDs) and musculoskeletal disorders (MSDs) are the major causes of global disability and increase in prevalence with age. AIMS To support healthy ageing, we studied how work disability due to MDs or MSDs is related to life satisfaction (LS) cross-sectionally and in 5- and 10-year follow-ups among ageing women. METHODS In the population-based OSTPRE cohort (women aged 58-67 in 1999), data on lifetime permanent work disability pensions (DPs) due to 'MDs only' (n = 337), 'MSDs only' (n = 942) and 'MDs + MSDs' (n = 212) and 'no DP' (n = 6322) until 1999 was obtained from the Finnish national register. The OSTPRE postal enquiry included a four-item life satisfaction (LS) scale (range 4-20: satisfied 4-6, intermediate 7-11, dissatisfied 12-20) at 5-year intervals, in 1999-2004 (n = 6548) and in 1999-2009 (n = 5562). RESULTS In 1999, the risks of belonging to the dissatisfied LS group (score 12-20) vs. the satisfied group (score 4-6) were higher in 'MDs only' (OR = 4.30; 95%CI 2.95-6.28), 'MSDs only' (OR = 2.69; 2.12-3.40) and 'MDs + MSDs' (OR = 2.72; 1.77-4.16) groups than in the 'no DP' group. In the follow-ups, these risks were OR5yr = 5.59 (3.54-8.84) and OR10yr = 4.94 (2.80-8.73) for 'MDs only', OR5yr = 3.36 (2.58-4.37) and OR10yr = 3.18 (2.40-4.21) for 'MSDs only', and OR5yr = 4.70 (2.75-8.05) and OR10yr = 6.84 (3.53-13.27) for 'MDs + MSDs' (all: p ≤ 0.001). Adjusting for baseline LS did not change the pattern (all p ≤ 0.001). CONCLUSION Work disability due to MDs and MSDs undermines healthy ageing among women via life dissatisfaction.
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Affiliation(s)
- J Heikkinen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Finland; Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Finland.
| | - R J Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Finland; Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Finland
| | - S E Quirk
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Finland; Deakin University, Institute for Physical and Mental Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - L J Williams
- Deakin University, Institute for Physical and Mental Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - H Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Finland; Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Finland
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12
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Stagg AL, Harber-Aschan L, Hatch SL, Fear NT, Dorrington S, Madan I, Stevelink SAM. Risk factors for the progression to multimorbidity among UK urban working-age adults. A community cohort study. PLoS One 2023; 18:e0291295. [PMID: 37682940 PMCID: PMC10490989 DOI: 10.1371/journal.pone.0291295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES The progression of long-term conditions (LTCs) from zero-to-one (initiation), and from one-to-many (progression)are common trajectories that impact a person's quality of life including their ability to work. This study aimed to explore the demographic, socioeconomic, psychosocial, and health-related determinants of LTC initiation and progression, with a focus on work participation. METHODS Data from 622 working-age adults who had completed two waves (baseline and follow-up) of the South-East London Community Health survey were analysed. Chi square tests and multinomial logistic regression were used to describe the associations between self-reported demographic, socioeconomic, psychosocial, and health-related variables, and the progression of LTCs. RESULTS Small social networks, an increased number of stressful life events, low self-rated health, functional impairment, and increased somatic symptom severity were all associated with both the progression from zero-to-one LTC and from one LTC to multimorbidity (two or more LTCs). Renting accommodation (RRR 1.73 [95% CI 1.03-2.90]), smoking (RRR 1.91 [95% CI 1.16-3.14]) and being overweight (RRR 1.88 [95% CL 1.12-3.16]) were unique risk factors of developing initial LTCs, whereas low income (RRR 2.53 [95% CI 1.11-5.80]), working part-time (RRR 2.82 ([95% CL 1.12-7.10]), being unemployed (RRR 4.83 [95% CI 1.69-13.84]), and making an early work exit (RRR 16.86 [95% CI 3.99-71.30]) all increased the risk of progressing from one LTC to multimorbidity compared to being employed full-time. At follow-up, depression was the most prevalent LTC in the unemployed group whereas musculoskeletal conditions were the most prevalent in those working. CONCLUSIONS The journey to multimorbidity is complex, with both common and unique risk factors. Non-full-time employment was associated with an increased risk of progression to multimorbidity. Future research should explore the risk and benefit pathways between employment and progression of LTCs. Interventions to prevent progression of LTCs should include mitigation of modifiable risk factors such as social isolation.
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Affiliation(s)
- Anne L. Stagg
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lisa Harber-Aschan
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ira Madan
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sharon A. M. Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
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13
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Hobbs M, McLeod GFH, Mackenbach JD, Marek L, Wiki J, Deng B, Eggleton P, Boden JM, Bhubaneswor D, Campbell M, Horwood LJ. Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study. Health Place 2023; 83:103078. [PMID: 37517383 DOI: 10.1016/j.healthplace.2023.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023]
Abstract
This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.
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Affiliation(s)
- Matthew Hobbs
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; The Cluster for Community and Urban Resilience (CURe), University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand.
| | - Geraldine F H McLeod
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije University, Amsterdam, the Netherlands; Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Amsterdam, the Netherlands
| | - Lukas Marek
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Jesse Wiki
- Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland - Waipapa Taumata Rau, Auckland, New Zealand
| | - Bingyu Deng
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Phoebe Eggleton
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Dhakal Bhubaneswor
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Malcolm Campbell
- Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; School of Earth and Environment, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - L John Horwood
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
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14
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Lee S, Koffer R, Drewelies J. Adults Older Than Age 55 Engage in Less Diverse Activities Than Those 18 Years Ago. J Gerontol B Psychol Sci Soc Sci 2023; 78:1511-1520. [PMID: 36932984 PMCID: PMC10461533 DOI: 10.1093/geronb/gbad047] [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: 08/19/2022] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES Life-span perspectives have long acknowledged that individual functioning is shaped by historical and sociocultural contexts. Secular increases favoring recent cohorts are widely documented. However, little is known about secular trends in day-to-day activities and whether historical changes have occurred in younger and older adults alike. METHODS We compared data from 2 independent cohort samples of the daily diary portion of the Midlife in the United States Study obtained 18 years apart (1995/1996 cohort: n = 1,499 vs 2013/2014 cohort: n = 782) and identified case-matched cohorts (n = 757 per cohort) based on age, gender, education, and race. An activity diversity score was calculated based on 7 common daily activities, using Shannon's entropy method. We additionally examined the roles of age and other sociodemographic and health characteristics in cohort differences in activity diversity. RESULTS Results revealed that the 2013/2014 cohort experienced lower daily activity diversity than the 1995/1996 cohort. Age was positively associated with activity diversity in the 1995/1996 cohort, whereas age was negatively associated with activity diversity in the 2013/2014 cohort. These associations were significant for those who were older than age 55. Cohorts also differed in the types of most dominant activities and average time spent on those activities. DISCUSSION Findings show changes in the lifestyles and daily activities of U.S. adults across 2 decades. Contrasting to the common belief that today's adults may be healthier and more active, they seem engaging in less diverse daily activities, which can be a risk for future health outcomes.
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Affiliation(s)
- Soomi Lee
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Rachel Koffer
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Johanna Drewelies
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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15
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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: 1] [Impact Index Per Article: 1.0] [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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16
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Newman MG, Porucznik CA, Date AP, Abdelrahman S, Schliep KC, VanDerslice JA, Smith KR, Hanson HA. Generating Older Adult Multimorbidity Trajectories Using Various Comorbidity Indices and Calculation Methods. Innov Aging 2023; 7:igad023. [PMID: 37179657 PMCID: PMC10168588 DOI: 10.1093/geroni/igad023] [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: 08/12/2022] [Indexed: 05/15/2023] Open
Abstract
Background and Objectives Older adult multimorbidity trajectories are helpful for understanding the current and future health patterns of aging populations. The construction of multimorbidity trajectories from comorbidity index scores will help inform public health and clinical interventions targeting those individuals that are on unhealthy trajectories. Investigators have used many different techniques when creating multimorbidity trajectories in prior literature, and no standard way has emerged. This study compares and contrasts multimorbidity trajectories constructed from various methods. Research Design and Methods We describe the difference between aging trajectories constructed with the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). We also explore the differences between acute (single-year) and chronic (cumulative) derivations of CCI and ECI scores. Social determinants of health can affect disease burden over time; thus, our models include income, race/ethnicity, and sex differences. Results We use group-based trajectory modeling (GBTM) to estimate multimorbidity trajectories for 86,909 individuals aged 66-75 in 1992 using Medicare claims data collected over the following 21 years. We identify low-chronic disease and high-chronic disease trajectories in all 8 generated trajectory models. Additionally, all 8 models satisfied prior established statistical diagnostic criteria for well-performing GBTM models. Discussion and Implications Clinicians may use these trajectories to identify patients on an unhealthy path and prompt a possible intervention that may shift the patient to a healthier trajectory.
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Affiliation(s)
- Michael G Newman
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Utah Population Database, University of Utah, Salt Lake City, Utah, USA
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ankita P Date
- Utah Population Database, University of Utah, Salt Lake City, Utah, USA
| | - Samir Abdelrahman
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Computer Science Department, Faculty of Computers and Artificial Intelligence, Cairo University, Giza, Egypt
| | - Karen C Schliep
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James A VanDerslice
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ken R Smith
- Utah Population Database, University of Utah, Salt Lake City, Utah, USA
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah, USA
| | - Heidi A Hanson
- Advanced Computing for Health Sciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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17
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Shirazi D, Haudenschild C, Lynch DH, Fanous M, Kahkoska AR, Jimenez D, Spangler H, Driesse T, Batsis JA. Obesity, multiple chronic conditions, and the relationship with physical function: Data from the national health and aging trends survey. Arch Gerontol Geriatr 2023; 107:104913. [PMID: 36565604 PMCID: PMC9975009 DOI: 10.1016/j.archger.2022.104913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The population of older adults living with multiple chronic conditions (MCC) continues to grow. MCC is independently associated with functional limitation and obesity. The aim of our study was to evaluate the association between obesity and MCC, and secondarily, the combined presence of obesity and functional limitations with MCC. METHODS We analyzed cross-sectional survey data from the National Health and Aging Trends Survey (NHATS) 2011 baseline data, a nationally representative Medicare beneficiary cohort of adults in the United States. We evaluated the coexistent prevalence of obesity and MCC overall, and by standard body mass index (BMI) categories. We then evaluated the prevalence of functional limitations (mobility, self-care, and household activities) and Fried-defined frailty status in persons with a BMI ≥ 30 kg/m2. Logistic regression was used to measure the association between MCC and BMI, and functional limitations and MCC among those with obesity. RESULTS In the 6,600 participants, the prevalence of concurrent obesity and MCC was 30.4%. Of those with obesity, the prevalence of MCC was 84.0%, and were more likely to have MCC (adjusted OR: 2.17, 95% CI 1.86, 2.54) compared to a normal BMI. Obesity and functional limitations or frailty were more likely have MCC than individuals with obesity alone. CONCLUSIONS We found that individuals with obesity is strongly associated with MCC and that functional limitations and frailty status have a greater association with having MCC than individuals with obesity without MCC. Future longitudinal analyses are needed to ascertain this relationship.
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Affiliation(s)
- Daniela Shirazi
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States; California University of Science and Medicine, CA, United States
| | | | - David H Lynch
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Marco Fanous
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Anna R Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Daniel Jimenez
- University of Miami Miller School of Medicine, MI, United States
| | - Hillary Spangler
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Tiffany Driesse
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - John A Batsis
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States.
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18
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Chandrasekar R, Lacey RE, Chaturvedi N, Hughes AD, Patalay P, Khanolkar AR. Adverse childhood experiences and the development of multimorbidity across adulthood-a national 70-year cohort study. Age Ageing 2023; 52:afad062. [PMID: 37104379 PMCID: PMC10137110 DOI: 10.1093/ageing/afad062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/16/2023] [Indexed: 04/28/2023] Open
Abstract
AIM To examine impact of adverse childhood experiences (ACE) on rates and development of multimorbidity across three decades in adulthood. METHODS Sample: Participants from the 1946 National Survey of Health and Development, who attended the age 36 assessment in 1982 and follow-up assessments (ages 43, 53, 63, 69; N = 3,264, 51% males). Prospectively collected data on nine ACEs was grouped into (i) psychosocial, (ii) parental health and (iii) childhood health. For each group, we calculated cumulative ACE scores, categorised into 0, 1 and ≥2 ACEs. Multimorbidity was estimated as the total score of 18 health disorders.Serial cross-sectional linear regression was used to estimate associations between grouped ACEs and multimorbidity during follow-up. Longitudinal analysis of ACE-associated changes in multimorbidity trajectories across follow-up was estimated using linear mixed-effects modelling for ACE groups (adjusted for sex and childhood socioeconomic circumstances). FINDINGS Accumulation of psychosocial and childhood health ACEs were associated with progressively higher multimorbidity scores throughout follow-up. For example, those with ≥2 psychosocial ACEs experienced 0.20(95% CI 0.07, 0.34) more disorders at age 36 than those with none, rising to 0.61(0.18, 1.04) disorders at age 69.All three grouped ACEs were associated with greater rates of accumulation and higher multimorbidity trajectories across adulthood. For example, individuals with ≥2 psychosocial ACEs developed 0.13(-0.09, 0.34) more disorders between ages 36 and 43, 0.29(0.06, 0.52) disorders between ages 53 and 63, and 0.30(0.09, 0.52) disorders between ages 63 and 69 compared with no psychosocial ACEs. INTERPRETATIONS ACEs are associated with widening inequalities in multimorbidity development in adulthood and early old age. Public health policies should aim to reduce these disparities through individual and population-level interventions.
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Affiliation(s)
| | - Rebecca E Lacey
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
- Centre for Longitudinal Studies, University College London Social Research Institute, London WC1H 0AL, UK
| | - Amal R Khanolkar
- MRC Unit for Lifelong Health and Ageing at University College London, London WC1E 7HB, UK
- Department of Population Health Sciences, King’s College London, London SE1 1UL, UK
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19
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Delpino FM, Dos Santos Rodrigues AP, Petarli GB, Machado KP, Flores TR, Batista SR, Nunes BP. Overweight, obesity and risk of multimorbidity: A systematic review and meta-analysis of longitudinal studies. Obes Rev 2023; 24:e13562. [PMID: 36929143 DOI: 10.1111/obr.13562] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
This study aimed to review and quantify the association between overweight and obesity in the risk of multimorbidity among the general population. We conducted a systematic review and meta-analysis in the databases of Pubmed, Lilacs, Web of Science, Scopus, and Embase. We included cohort studies that assessed the association between overweight and/or obesity with the risk of multimorbidity. The Newcastle-Ottawa assessed the studies' individual quality. A random-effect model meta-analysis was performed to evaluate the association between overweight and obesity with the relative risk (RR) of multimorbidity; the I2 test evaluated heterogeneity. After excluding duplicates, we found 1.655 manuscripts, of which eight met the inclusion criteria. Of these, seven (87.5%) evidenced an increased risk of multimorbidity among subjects with overweight and/or obesity. Overall, we observed an increased risk of multimorbidity among subjects with overweight (RR: 1.26; CI95%: 1.12; 1.40, I2 = 98%) and obesity (RR: 1.99; CI95%: 1.45;2.72, I2 = 99%) compared to normal weight. According to the I2 test, the heterogeneities of the meta-analyses were high. The Newcastle-Ottawa scale showed that all studies were classified as high quality. Further longitudinal studies are needed, including different populations and stratifications by sex, age, and other variables.
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Affiliation(s)
- Felipe Mendes Delpino
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | | | - Karla Pereira Machado
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Thaynã Ramos Flores
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Sandro Rodrigues Batista
- Superintendence of Health Care, Goiás State Health Department, Goiânia, Goiás, Brazil.,Department of Internal Medicine, School of Medicine, Federal University of Goiás, Goiânia, Brazil
| | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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20
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Gummidi B, Gautam V, John O, Ghosh A, Jha V. Patterns of multimorbidity among a community-based cohort in rural India. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565221149623. [PMID: 36644651 PMCID: PMC9832245 DOI: 10.1177/26335565221149623] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Background Multimorbidity estimates are expected to increase in India primarily due to the population aging. However, there is a lack of research estimating the burden of multimorbidity in the Indian context using a validated tool. We estimated the prevalence and determinants of multimorbidity amongst the adult population of the rural Uddanam region, Andhra Pradesh. Methods This community-based cross-sectional study was conducted as a part of an ongoing research program. Multistage cluster sampling technique was used to select 2419 adult participants from 40 clusters. Multimorbidity was assessed using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool, collecting information on 13 chronic diseases. Patient Health Questionnaire (PHQ-12) was used to screen for depression. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity. Results Of the 2419 participants, 2289 completed the MAQ-PC tool. Mean age (standard deviation) of participants was 48.1 (13.1) years. The overall prevalence of multimorbidity was 58.5% (95% CI 56.5-60.6); with 30.7%, 15.6%, and 12.2% reporting two, three, and four chronic conditions, respectively. Acid peptic disease-musculoskeletal disease (44%) and acid peptic disease-musculoskeletal disease-hypertension (14.9%) were the most common dyad and triad. Among metabolic diseases, diabetes-hypertension (28.3%) and diabetes-hypertension-chronic kidney disease (7.6%) were the most common dyad and triad, respectively. Advancing age, female gender, and being obese were the strongest determinates of the presence of multimorbidity. Depression was highly prevalent among the study population, and participants with higher PHQ-12 score had 3.7 (2.5-5.4) greater odds of having multimorbidity. Conclusions Our findings suggest that six of 10 adults in rural India are affected with multimorbidity. We report a higher prevalence of multimorbidity as compared with other studies conducted in India. We also identified vulnerable groups which would guide policy makers in developing holistic care packages for individuals with multimorbidity.
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Affiliation(s)
- Balaji Gummidi
- The George Institute for Global
Health, New Delhi, India
| | | | - Oommen John
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India
| | - Arpita Ghosh
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India
| | - Vivekanand Jha
- The George Institute for Global
Health, New Delhi, India,Manipal Academy of Higher
Education, Manipal, India,Faculty of
Medicine, Imperial College
London, London, UK,University of New South
Wales, Sydney, Australia,Vivekanand Jha, George Institute for Global
Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre,
New Delhi 110025 India.
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St Sauver JL, Grossardt BR, Chamberlain AM, Kapoor E, Rocca WA. Synergistic interactions of obesity with sex, education, and smoking and accumulation of multi-morbidity (MM) across the lifespan. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231160139. [PMID: 36860667 PMCID: PMC9969451 DOI: 10.1177/26335565231160139] [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: 10/19/2022] [Accepted: 02/03/2023] [Indexed: 02/27/2023]
Abstract
Objectives Obesity is a potentially modifiable risk factor that has been consistently associated with the development and progression of multi-morbidity (MM). However, obesity may be more problematic for some persons compared to others because of interactions with other risk factors. Therefore, we studied the effect of interactions between patient characteristics and overweight and obesity on the rate of accumulation of MM. Methods We studied 4 cohorts of persons ages 20-, 40-, 60-, and 80-years residing in Olmsted County, Minnesota between 2005 and 2014 using the Rochester Epidemiology Project (REP) medical records-linkage system. Body mass index, sex, race, ethnicity, education, and smoking status were extracted from REP indices. The rate of accumulation of MM was calculated as the number of new chronic conditions accumulated per 10 person years through 2017. Poisson rate regression models were used to identify associations between characteristics and rate of MM accumulation. Additive interactions were summarized using relative excess risk due to interaction, attributable proportion of disease, and the synergy index. Results Greater than additive synergistic associations were observed between female sex and obesity in the 20- and 40-year cohorts, between low education and obesity in the 20-year cohort (both sexes), and between smoking and obesity in the 40-year cohort (both sexes). Conclusions Interventions targeted at women, persons with lower education, and smokers who also have obesity may result in the greatest reduction in the rate of MM accumulation. However, interventions may need to focus on persons prior to mid-life to have the greatest effect.
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Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Brandon R Grossardt
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alanna M Chamberlain
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ekta Kapoor
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
- Menopause and Women's Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA
- Menopause and Women's Sexual Health Clinic, Mayo Clinic, Rochester, MN, USA
| | - Walter A Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Women's Health Research Center, Mayo Clinic, Rochester, MN, USA
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22
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Nichols L, Taverner T, Crowe F, Richardson S, Yau C, Kiddle S, Kirk P, Barrett J, Nirantharakumar K, Griffin S, Edwards D, Marshall T. In simulated data and health records, latent class analysis was the optimum multimorbidity clustering algorithm. J Clin Epidemiol 2022; 152:164-175. [PMID: 36228971 PMCID: PMC7613854 DOI: 10.1016/j.jclinepi.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the reproducibility and validity of latent class analysis (LCA) and hierarchical cluster analysis (HCA), multiple correspondence analysis followed by k-means (MCA-kmeans) and k-means (kmeans) for multimorbidity clustering. METHODS We first investigated clustering algorithms in simulated datasets with 26 diseases of varying prevalence in predetermined clusters, comparing the derived clusters to known clusters using the adjusted Rand Index (aRI). We then them investigated the medical records of male patients, aged 65 to 84 years from 50 UK general practices, with 49 long-term health conditions. We compared within cluster morbidity profiles using the Pearson correlation coefficient and assessed cluster stability using in 400 bootstrap samples. RESULTS In the simulated datasets, the closest agreement (largest aRI) to known clusters was with LCA and then MCA-kmeans algorithms. In the medical records dataset, all four algorithms identified one cluster of 20-25% of the dataset with about 82% of the same patients across all four algorithms. LCA and MCA-kmeans both found a second cluster of 7% of the dataset. Other clusters were found by only one algorithm. LCA and MCA-kmeans clustering gave the most similar partitioning (aRI 0.54). CONCLUSION LCA achieved higher aRI than other clustering algorithms.
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Affiliation(s)
- Linda Nichols
- Research Fellow, Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Tom Taverner
- Research Fellow, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Francesca Crowe
- Lecturer in Epidemiology and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Sylvia Richardson
- Emeritus Director, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Christopher Yau
- Professor of Artificial Intelligence, Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Steven Kiddle
- Director, Health Data Science, AstraZeneca, 1 Francis Crick Avenue, Cambridge, Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Paul Kirk
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Jessica Barrett
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Krishnarajah Nirantharakumar
- Professor of Public Health and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Simon Griffin
- Professor of General Practice, Primary Care Unit, Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN, UK
| | - Duncan Edwards
- Senior Clinical Research Associate, Primary Care Unit, Primary Care Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Tom Marshall
- Professor of Public Health and Primary Care, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK.
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23
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Quiñones AR, Valenzuela SH, Huguet N, Ukhanova M, Marino M, Lucas JA, O'Malley J, Schmidt TD, Voss R, Peak K, Warren NT, Heintzman J. Prevalent Multimorbidity Combinations Among Middle-Aged and Older Adults Seen in Community Health Centers. J Gen Intern Med 2022; 37:3545-3553. [PMID: 35088201 PMCID: PMC9585110 DOI: 10.1007/s11606-021-07198-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/01/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multimorbidity (≥ 2 chronic diseases) is associated with greater disability and higher treatment burden, as well as difficulty coordinating self-management tasks for adults with complex multimorbidity patterns. Comparatively little work has focused on assessing multimorbidity patterns among patients seeking care in community health centers (CHCs). OBJECTIVE To identify and characterize prevalent multimorbidity patterns in a multi-state network of CHCs over a 5-year period. DESIGN A cohort study of the 2014-2019 ADVANCE multi-state CHC clinical data network. We identified the most prevalent multimorbidity combination patterns and assessed the frequency of patterns throughout a 5-year period as well as the demographic characteristics of patient panels by prevalent patterns. PARTICIPANTS The study included data from 838,642 patients aged ≥ 45 years who were seen in 337 CHCs across 22 states between 2014 and 2019. MAIN MEASURES Prevalent multimorbidity patterns of somatic, mental health, and mental-somatic combinations of 22 chronic diseases based on the U.S. Department of Health and Human Services Multiple Chronic Conditions framework: anxiety, arthritis, asthma, autism, cancer, cardiac arrhythmia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, dementia, depression, diabetes, hepatitis, human immunodeficiency virus (HIV), hyperlipidemia, hypertension, osteoporosis, post-traumatic stress disorder (PTSD), schizophrenia, substance use disorder, and stroke. KEY RESULTS Multimorbidity is common among middle-aged and older patients seen in CHCs: 40% have somatic, 6% have mental health, and 24% have mental-somatic multimorbidity patterns. The most frequently occurring pattern across all years is hyperlipidemia-hypertension. The three most frequent patterns are various iterations of hyperlipidemia, hypertension, and diabetes and are consistent in rank of occurrence across all years. CKD-hyperlipidemia-hypertension and anxiety-depression are both more frequent in later study years. CONCLUSIONS CHCs are increasingly seeing more complex multimorbidity patterns over time; these most often involve mental health morbidity and advanced cardiometabolic-renal morbidity.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA.
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.
| | - Steele H Valenzuela
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
| | - Maria Ukhanova
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
| | - Jean O'Malley
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
- Research Department, OCHIN Inc., Portland, OR, USA
| | | | - Robert Voss
- Research Department, OCHIN Inc., Portland, OR, USA
| | - Katherine Peak
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
| | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: FM, Portland, OR, 97239, USA
- Research Department, OCHIN Inc., Portland, OR, USA
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24
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Barboza LLS, Werneck AO, Araujo RHO, Porto LGG, Silva DR. Multimorbidity is associated with TV-viewing, but not with other types of screen-based behaviors in Brazilian adults. BMC Public Health 2022; 22:1991. [PMID: 36316727 PMCID: PMC9623956 DOI: 10.1186/s12889-022-14365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background The presence of multimorbidity increases the risk of mortality, and identifying correlates of multimorbidity can direct interventions by targeting specific modifiable correlates. Here we aimed to investigate the association between two types of screen-based behaviors and multimorbidity. Methods We used data from 87,678 Brazilian adults from the National Health Survey (2019). Multimorbidity (presence of two or more chronic conditions among 12 possibilities), TV-viewing, and time on other types of screens (computer, tablet, or cell phone), were self-reported. Crude and adjusted binary and multinominal logistic regression models were performed stratified by sex, age group, and the number of chronic conditions. Results Considering adjusted values, 2 h/day as a reference, and reporting values in odds ratio (OR) and prevalence ratio (PR) with 95% confidence intervals (95%CI), multimorbidity presented associations with TV-viewing in general [from OR (95%CI) 1.10 (1.03–1.18) in 2 to < 3 h/d, to OR (95%CI) 1.57 (1.40–1.76) in ≥ 6 h/d], except in 2 to < 3 h/d time category for male and 35 to 49 years, and all time categories for 18 to 34 years. In addition, TV-viewing was associated with an increasing number of chronic conditions, all greater in ≥ 6 h/d [2 conditions - PR (95%CI) 1.24 (1.08–1.43); 3 conditions - PR (95%CI) 1.74 (1.45–2.08); 4 or more conditions - PR (95%CI) 2.29 (1.93–2.73)], except in 2 conditions on 2 to < 3 h/d. Other types of screen-based behaviors were only associated with multimorbidity among males [≥ 6 h/d: OR (95%CI) 1.22 (1.01–1.48)] and older individuals (65 years) in some time categories [3 to < 6 h/d: OR (95%CI) 1.98 (1.42–2.77) and ≥ 6 h/d: OR (95%CI) 1.73 (1.06–2.84)]. Conclusion Intervention strategies for reducing screen time in Brazilian adults should focus mainly on TV-viewing, which seems to be associated with more harmful conditions than time on other types of screen-based behaviors. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14365-5.
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Affiliation(s)
- Luciana L. S. Barboza
- grid.7632.00000 0001 2238 5157Study Group in Physiology and Epidemiology of Exercise and Physical Activity (GEAFS), Postgraduate Program in Physical Education, University of Brasília (UnB), Brasília, DF Brazil ,grid.7632.00000 0001 2238 5157Postgraduate Program in Physical Education, University of Brasília, Campos Darcy Ribeiro, 70910-900 Brasília, Distrito Federal Brazil
| | - André O Werneck
- grid.11899.380000 0004 1937 0722Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo, SP Brazil
| | - Raphael H O Araujo
- grid.411400.00000 0001 2193 3537Graduation Program in Health Sciences, Londrina State University (UEL), Londrina, PR Brazil
| | - Luiz G G Porto
- grid.7632.00000 0001 2238 5157Study Group in Physiology and Epidemiology of Exercise and Physical Activity (GEAFS), Postgraduate Program in Physical Education, University of Brasília (UnB), Brasília, DF Brazil
| | - Danilo R Silva
- grid.441837.d0000 0001 0765 9762Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile ,grid.15449.3d0000 0001 2200 2355 Department of Sports and Computer Science, Universidad Pablo de Olavide (UPO), 41013 Seville, Spain
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25
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Bishop NJ, Haas SA, Quiñones AR. Cohort Trends in the Burden of Multiple Chronic Conditions Among Aging U.S. Adults. J Gerontol B Psychol Sci Soc Sci 2022; 77:1867-1879. [PMID: 35642746 PMCID: PMC9535783 DOI: 10.1093/geronb/gbac070] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Multimorbidity, also referred to as multiple chronic conditions (MCCs), is the concurrent presence of 2 or more chronic health conditions. Increasing multimorbidity represents a substantial threat to the health of aging populations. Recent trends suggest greater risk of poor health and mortality among later-born cohorts, yet we are unaware of work examining cohort differences in multimorbidity among aging U.S. adults. METHODS We examine intercohort variation in MCC burden in adults aged 51 years and older using 20 years (n = 33,598; 1998-2018) of repeated assessment drawn from the Health and Retirement Study. The index of MCCs included 9 chronic conditions (heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer excluding skin cancer, high depressive symptoms, and cognitive impairment). We used linear mixed models with various approaches to estimate age/period/cohort effects to model intercohort patterns in MCC burden. We also explored variation in the specific conditions driving cohort differences in multimorbidity. RESULTS More recent cohorts had greater MCC burden and developed multimorbidity at earlier ages than those born to prior generations. The burden of chronic conditions was patterned by life-course sociodemographic factors and childhood health for all cohorts. Among adults with multimorbidity, arthritis and hypertension were the most prevalent conditions for all cohorts, and there was evidence that high depressive symptoms and diabetes contributed to the observed cohort differences in multimorbidity risk. DISCUSSION Our results suggest increasing multimorbidity burden among more recently born cohorts of aging U.S. adults and should inform policy to address diminishing health in aging populations.
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Affiliation(s)
- Nicholas J Bishop
- Human Development and Family Sciences, Texas State University, San Marcos, Texas, USA
| | - Steven A Haas
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Ana R Quiñones
- Department of Family Medicine, and OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
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26
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Wister A, Li L, Whitmore C, Ferris J, Klasa K, Linkov I. Multimorbidity resilience and health behaviors among older adults: A longitudinal study using the Canadian Longitudinal Study on Aging. Front Public Health 2022; 10:896312. [PMID: 36211713 PMCID: PMC9539554 DOI: 10.3389/fpubh.2022.896312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/01/2022] [Indexed: 01/22/2023] Open
Abstract
Objective There has been a growing interest in examining why some individuals adapt and bounce back from multimorbidity (resilience) better than others. This paper investigates the positive role of protective health behaviors on multimorbidity resilience (MR) among older adults focusing on older persons with two or more concurrent chronic conditions, and separately for three multimorbidity chronic illness clusters. Methods Using Baseline and Follow-up One data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 10,628 participants aged 65 years and older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: Cardiovascular/metabolic, Musculoskeletal, and Mental health. Associations between health behaviors and MR were evaluated using Linear Mixed Models, adjusting for socio-demographic, social/environmental, and illness context social determinants of health. Results Among older adults with two or more illnesses, smoking, satisfaction with sleep, appetite, and skipping meals were associated with MR in the expected direction. Also, obesity (compared to normal weight) and skipping meals showed longitudinal interaction effects with survey wave. Most of the results were replicated for the physical multimorbidity clusters (Cardiovascular/metabolic and Musculoskeletal) compared to the full 2+ multimorbidity analyses; however, for the Mental health cluster, only satisfaction with sleep was supported as a lifestyle predictor of MR. Discussion Several modifiable health behaviors identified in the broader health and aging literature are important in affecting levels of multimorbidity resilience in older age. These factors are important strength-based areas to target. Additionally, several social determinants of health are also supported and parallel research on multimorbidity risk. The effects of lifestyle factors for resilience among older adults is dependent on the type of multimorbidity measured. We conclude that the results have significant public health, program intervention, and clinical implications for healthy aging among persons coping with multimorbidity.
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Affiliation(s)
- Andrew Wister
- Department of Gerontology, Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Lun Li
- School of Social Work, MacEwan University, Edmonton, AB, Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jennifer Ferris
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
- BC Observatory for Population and Public Health, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Katarzyna Klasa
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Igor Linkov
- United States Army Corps of Engineers, Engineering Research and Development Center, Vicksburg, MS, United States
- Carnegie Mellon University, Pittsburg, PA, United States
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27
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Newsom JT, Denning EC, Elman MR, Botoseneanu A, Allore HG, Nagel CL, Dorr DA, Quiñones AR. Physical Activity as a Mediator Between Race/Ethnicity and Changes in Multimorbidity. J Gerontol B Psychol Sci Soc Sci 2022; 77:1529-1538. [PMID: 34374757 PMCID: PMC9371457 DOI: 10.1093/geronb/gbab148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Studies report racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time as well as differences in physical activity. Our study aimed to investigate whether racial/ethnic differences in the accumulation of multimorbidity were mediated by physical activity among middle-aged and older adults. METHOD We assessed racial/ethnic differences in the accumulation of multimorbidity (of 9 conditions) over 12 years (2004-2016) in the Health and Retirement Study (N = 18,264, mean age = 64.4 years). Structural equation modeling was used to estimate latent growth curve models of changes in multimorbidity and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White participants) to changes in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, household wealth, insurance coverage, smoking, alcohol, and body weight. RESULTS There was a significant increase in multimorbidity over time. Initial levels and changes in multimorbidity over time varied significantly across individuals. Indirect effects of the relationship between race/ethnicity and changes in multimorbidity as mediated by physical activity were significant, consistent with the mediational hypothesis. Black respondents engaged in significantly lower levels of physical activity than White respondents after controlling for covariates, but there were no differences between Hispanic and White respondents once education was included. Discussion: These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in mid-to-late life, suggesting greater need to intervene to reduce sedentary behavior and increase physical activity.
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Affiliation(s)
- Jason T Newsom
- Address correspondence to: Jason T. Newsom, PhD, Department of Psychology, Portland State University, P.O. Box 751, Portland, OR 97207, USA. E-mail:
| | - Emily C Denning
- Department of Psychology, Portland State University, Oregon, USA
| | - Miriam R Elman
- School of Public Health, Oregon Health & Science University/Portland State University, USA
| | - Anda Botoseneanu
- Department of Health and Human Services and Institute of Gerontology, University of Michigan, Ann Arbor, USA
- Department of Health and Human Services, University of Michigan, Dearborn, USA
| | - Heather G Allore
- Internal Medicine and Department of Biostatistics, Yale University, New Haven, Connecticut, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health and Science University, Portland, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, USA
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Paukkonen L, Oikarinen A, Kähkönen O, Kaakinen P. Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings. Health Sci Rep 2022; 5:e735. [PMID: 35873391 PMCID: PMC9297377 DOI: 10.1002/hsr2.735] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Multimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self-management in everyday life, the effects of patient activation - a patient's knowledge, skills, and confidence in managing own health - on the capacity for self-management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self-management behavior, related perceptions, and health-related quality of life (HRQoL). Methods A cross-sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM-13®. Responses from 122 patients were analyzed using descriptive statistics, t-tests, analysis of variance, linear modeling, the χ 2 test, and binary regression analysis. Results The mean score of patient activation was 56.12 (SD 12.82) on a scale 0-100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self-management including motivation and energy, sense of normality, and support from physicians, nurses, and close people. Conclusion Patient activation among multimorbid outpatients was rather low. Findings indicate that patients' perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient's activation level may also be useful when developing interventions and care strategies for this patient group.
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Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
| | - Pirjo Kaakinen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
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29
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Multimorbidity patterns across race/ethnicity as stratified by age and obesity. Sci Rep 2022; 12:9716. [PMID: 35690677 PMCID: PMC9188579 DOI: 10.1038/s41598-022-13733-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of our study is to assess differences in prevalence of multimorbidity by race/ethnicity. We applied the FP-growth algorithm on middle-aged and elderly cohorts stratified by race/ethnicity, age, and obesity level. We used 2016–2017 data from the Cerner HealthFacts electronic health record data warehouse. We identified disease combinations that are shared by all races/ethnicities, those shared by some, and those that are unique to one group for each age/obesity level. Our findings demonstrate that even after stratifying by age and obesity, there are differences in multimorbidity prevalence across races/ethnicities. There are multimorbidity combinations distinct to some racial groups—many of which are understudied. Some multimorbidities are shared by some but not all races/ethnicities. African Americans presented with the most distinct multimorbidities at an earlier age. The identification of prevalent multimorbidity combinations amongst subpopulations provides information specific to their unique clinical needs.
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Life course socioeconomic conditions and multimorbidity in old age - A scoping review. Ageing Res Rev 2022; 78:101630. [PMID: 35430301 DOI: 10.1016/j.arr.2022.101630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 01/23/2023]
Abstract
Multimorbidity disproportionally affects individuals exposed to socioeconomic disadvantage. It is, however, unclear how adverse socioeconomic conditions (SEC) at different periods of the life course predict the occurrence of multimorbidity in later life. In this scoping review, we investigate the association between life course SEC and later-life multimorbidity, and assess to which extent it supports different life course causal models (critical period, sensitive period, accumulation, pathway, or social mobility). We identified four studies (25,209 participants) with the first measure of SEC in childhood (before age 18). In these four studies, childhood SEC was associated with multimorbidity in old age, and the associations were partially or fully attenuated upon adjustment for later-life SEC. These results are consistent with the sensitive period and the pathway models. We identified five studies (91,236 participants) with the first measure of SEC in young adulthood (after age 18), and the associations with multimorbidity in old age as well as the effects of adjustment for later-life SEC differed from one study to the other. Among the nine included studies, none tested the social mobility or the accumulation models. In conclusion, SEC in early life could have an effect on multimorbidity, attenuated at least partly by SEC in adulthood.
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Balakrishnan S, Karmacharya I, Ghimire S, Mistry SK, Singh DR, Yadav OP, Gudi N, Rawal LB, Yadav UN. Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal. BMC Geriatr 2022; 22:425. [PMID: 35570271 PMCID: PMC9109315 DOI: 10.1186/s12877-022-03115-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background The number of people with multimorbidity is surging around the world. Although multimorbidity has been introduced in policy and practice in developed countries, developing countries like Nepal have not considered it as a matter of public health urgency due to the lack of enough epidemiological data. Multimorbidity profoundly affects older adults’ wellbeing; therefore, it is crucial to estimate its prevalence and determinants. This study aimed to estimate the prevalence of multimorbidity among older adults in Eastern Nepal and identify its correlates. Methodology A community-based cross-sectional survey was conducted in three districts of Eastern Nepal. Data were collected between July and September 2020, among 847 Nepali older adults, aged 60 and older, where study participants were recruited through a multi-stage cluster sampling technique. Semi-structured interviews were conducted at the community settings to collect data. Logistic regression assessed correlates of multimorbidity. SAS 9.4 was used to run all statistical tests and analyses. Results More than half (66.5%) of the participants had at least one of the five non-communicable chronic conditions; hypertension (31.6%), osteoarthritis (28.6%), chronic respiratory disease (18.0%), diabetes (13.5%), and heart disease (5.3%). The prevalence of multimorbidity was 22.8%. In the adjusted model, increased age (for 70–79 years, OR: 3.11, 95% CI: 1.87–5.18; for 80 + years, OR: 4.19, 95% CI: 2.32–7.57), those without a partner (OR: 1.52, 95% CI: 1.00–2.30), residing in urban areas (OR: 1.71, 95% CI: 1.16–2.51), and distant from health center (OR: 1.66, 95% CI: 1.04–2.64) were significantly associated with multimorbidity. Conclusions This study found one in five study participants had multimorbidity. The findings will assist policymakers and stakeholders in understanding the burden of multimorbidity among the older population and identifying the groups in most need of health promotion intervention. Future interventions may include developing horizontal multimorbid approaches and multisectoral strategies specifically tailored to meet the needs of those populations.
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Affiliation(s)
| | - Isha Karmacharya
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | | | - Nachiket Gudi
- Public Health Evidence South Asia (PHESA), Department of Health Information, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Lal Bahadur Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia. .,National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia. .,Centre for Research Policy and Implementation (CRPIN), Biratnagar, Nepal.
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Vos R, Boesten J, van den Akker M. Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns. PLoS One 2022; 17:e0264343. [PMID: 35213615 PMCID: PMC8880753 DOI: 10.1371/journal.pone.0264343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objective After stratifying for age, sex and multimorbidity at baseline, our aim is to analyse time trends in incident multimorbidity and polypharmacy in the 15-year clinical trajectories of individual patients in a family medicine setting. Methods This study was carried out using data from the Registration Network Family Medicine in the South of the Netherlands. The clinical trajectories of 10037 subjects during the 15-year period (2000–2014) were analyzed in a repeated measurement of using a generalized estimating equations model as well as a multilevel random intercept model with repeated measurements to determine patterns of incident multimorbidity and polypharmacy. Hierarchical age-period-cohort models were used to generate age and cohort trajectories for comparison with prevalence trends in multimorbidity literature. Results Multimorbidity was more common in females than in males throughout the duration of the 15-year trajectory (females: 39.6%; males: 33.5%). With respective ratios of 11.7 and 5.9 between the end and the beginning of the 15-year period, the youngest female and male groups showed a substantial increase in multimorbidity prevalence. Ratios in the oldest female and male groups were 2.2 and 1.9 respectively. Females had higher levels of multimorbidity than males in the 0-24-year and 25-44-year age groups, but the levels converged to a prevalence of 92.2% in the oldest male and 90.7% in the oldest female group. Similar, albeit, moderate differences were found in polypharmacy patterns. Conclusions We sought to specify the progression of multimorbidity from an early age. As a result, our study adds to the multimorbidity literature by specifying changes in chronic disease accumulation with relation to polypharmacy, and by tracking differences in patient trajectories according to age and sex. Multimorbidity and polypharmacy are common and their prevalence is accelerating, with a relatively rapid increase in younger groups. From the point of view of family medicine, this underlines the need for a longitudinal approach and a life course perspective in patient care.
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Affiliation(s)
- Rein Vos
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Jos Boesten
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
- * E-mail:
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Fleitas Alfonzo L, King T, You E, Contreras-Suarez D, Zulkelfi S, Singh A. Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review. BMJ Open 2022; 12:e055264. [PMID: 35197348 PMCID: PMC8882654 DOI: 10.1136/bmjopen-2021-055264] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/09/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity. DESIGN Scoping review. METHODS A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results. RESULTS A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity. CONCLUSION Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Diana Contreras-Suarez
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Syafiqah Zulkelfi
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ankur Singh
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Schramm S, Møller SP, Tolstrup JS, Laursen B. Effects of individual and parental educational levels on multimorbidity classes: a register-based longitudinal study in a Danish population. BMJ Open 2022; 12:e053274. [PMID: 35197340 PMCID: PMC8867340 DOI: 10.1136/bmjopen-2021-053274] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the effects of individual educational level in adulthood and parental educational level during childhood, as well as combinations of individual and parental educational levels, on multimorbidity classes. DESIGN AND SETTING In this longitudinal study, we used data from a random sample of the Danish population aged 32-56 years without multimorbidity in 2010 (n=102 818). The study population was followed until 2018. Information on individual and parental educational levels and chronic conditions was obtained from national registers. Multinomial logistic regression analyses were adjusted for sex, age and ethnicity. OUTCOME MEASURE Seven multimorbidity classes were identified using latent class analysis based on 47 chronic conditions. Persons deceased during follow-up comprised a separate class. RESULTS We found an independent effect of individual educational level on five multimorbidity groups and death, most pronounced for the multimorbidity group 'Many conditions' (OR=1.89, 95% CI 1.58 to 2.26 for medium and OR=3.22, 95% CI 2.68 to 3.87 for short compared with long educational level) and of parental education on four groups and death, most pronounced for the multimorbidity group 'Many conditions' (OR=1.36, 95% CI 1.07 to 1.73 for medium and OR=1.48, 95% CI 1.15 to 1.89 for short compared with long educational level). Odds of belonging to four multimorbidity classes increased with lower combination of individual and parental educational levels, most pronounced for the multimorbidity group 'Many conditions'. CONCLUSION As both individual and parental educational levels contribute to the risk of multimorbidity, it is important to address inequality throughout the life course to mitigate multimorbidity. Future studies could adopt a life course approach to investigate the mediating role of behavioural, clinical, environmental and other social factors.
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Affiliation(s)
- Stine Schramm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sanne Pagh Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Bjarne Laursen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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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: 9] [Impact Index Per Article: 4.5] [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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Multimorbidity and simultaneity of health risk factors, from adolescence to early adulthood: 1993 Pelotas Birth Cohort. Prev Med 2022; 155:106932. [PMID: 34954241 DOI: 10.1016/j.ypmed.2021.106932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022]
Abstract
The co-occurrence of two or more diseases is called multimorbidity, and the occurrence of two or more risk factors is called simultaneity of risk factors. Multimorbidity and simultaneity of risk factors are not widely understood in adolescence and early adulthood. This paper aims to describe how multimorbidity and simultaneity of risk factors are distributed throughout adolescence and early adulthood, considering demographic and socioeconomic characteristics, among the 1993 Pelotas Birth Cohort members. This study was carried out using data from the 11, 15, 18, and 22y of the 1993 Pelotas Birth Cohort, Brazil (n = 5249). A self-reported questionnaire assessed allergies, asthma/bronchitis/wheezing, diabetes, vision problems, hypertension, common mental disorders, other mental disorders, physical inactivity, sedentary behaviour, insufficient sleep time, smoking, alcohol abuse behaviour, and illicit drugs. Glucose, cholesterol, blood pressure, weight, and height were objectively collected. The prevalence of multimorbidity was 26.3%, 31.3%, 37.9%, and 44.4% at 11, 15, 18, and 22y, respectively. Around 70% of all ages presented simultaneity of risk factors. Women presented a higher prevalence of simultaneity of risk factors, and the multimorbidity gradually increased from 11 to 22y. The presence of both multimorbidity and simultaneity of risk factors was 19.7% at 11 and 35.4% at 22y. Less than 2% have no morbidity and no risk factors at each age assessed. This study highlighted the early emergence and accelerated growth of diseases and risk factors in a young population, especially their co-occurrence.
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Mechili EA, Saliaj A, Xhindoli J, Bucaj J, Sifaki-Pistolla D, Peto E, Zahaj M, Chatzea VE. Primary healthcare personnel challenges and barriers on the management of patients with multimorbidity in Albania. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:380-388. [PMID: 33956363 DOI: 10.1111/hsc.13411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The number of people living with chronic conditions is increasing worldwide with most of these people receiving the needed healthcare services in primary healthcare (PHC) settings. The objective of this study was to explore the main challenges and barriers that PHC providers confront while treating multimorbid patients. This is a qualitative study utilising semi-structured individual in-depth interviews. The study took place in Vlora City, which is the biggest city located in south Albania. Τhe two biggest PHC centres of the city were enrolled. Purposive sampling method was used to recruit PHC practitioners. Main criteria of participation in the study were being fully employed at the enrolled primary care centres, having worked for at least 1 year and to deal with multimorbid patients in daily practice. Data collection took place from September 2019 to January 2020. In total, 36 semi-structured interviews took place with 23 (63.9%) nurses and 12 (33.3%) physicians (general practitioners/family doctors). Communication problems and disputes, lack of materials/equipment and the inappropriate infrastructure, miscommunication and problems in doctor-nurse relationships, coordination problems, lack of protocols and problems in the referral system were reported as the main challenges and barriers that the PHC personnel confront. The findings of this study are critical in understanding challenges that PHC personnel face when dealing with multimorbid patients in PHC settings. The emerged knowledge contributes significantly in a better understanding of the actual situation and to inform health policy makers on how to deal with the existing problems.
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Affiliation(s)
- Enkeleint A Mechili
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Aurela Saliaj
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Juliana Xhindoli
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Jorgjia Bucaj
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
| | - Ela Peto
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Majlinda Zahaj
- Department of Nursing, Faculty of Public Health, University of Vlora, Vlora, Albania
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Delpino FM, Wendt A, Crespo PA, Blumenberg C, Teixeira DSDC, Batista SR, Malta DC, Miranda J, Flores TR, Nunes BP, Wehrmeister FC. Occurrence and inequalities by education in multimorbidity in Brazilian adults between 2013 and 2019: evidence from the National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210016. [PMID: 34910070 DOI: 10.1590/1980-549720210016.supl.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aims of this study were: 1) to estimate the prevalence of multimorbidity in 2013 and 2019 in adults aged 20-59 years; 2) to assess inequalities in the prevalence of multimorbidity in 2013 and 2019 according to educational level. METHODS Data from two cross-sectional surveys from the Brazilian National Health Survey in 2013 and 2019 were used. Multimorbidity was assessed from 14 lifetime self-reported morbidities (except back problems) and defined using the cutoff point of ≥2 diseases. The prevalence of multimorbidity and individual morbidities were described according to gender, age, skin color, and education. For education, crude, and relative inequalities in prevalence of multimorbidity were calculated using the Slope Index of Inequality and the Concentration Index, respectively. RESULTS The prevalence of multimorbidity increased from 18.7% (95%CI 18.0-19.3) in 2013 to 22.3% (95%CI 21.7-22.9) in 2019, being higher among women and adults between 30-59 years in both periods. Asthma/bronchitis, depression, and back problems were the conditions that increased the most in the study period. Absolute and relative inequalities by education status were observed in the study period, with worse multimorbidity profiles among the less educated. CONCLUSION The prevalence of multimorbidity increased between 2013 and 2019. Inequalities in the prevalence of multimorbidity were observed according to educational level.
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Affiliation(s)
- Felipe Mendes Delpino
- Postgraduate Program in Nursing, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - Andrea Wendt
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - Pedro Augusto Crespo
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | | | - Sandro Rodrigues Batista
- School of Medicine, Secretaria de Estado da Saúde de Goiás, Universidade Federal de Goiás - Goiânia (GO), Brazil
| | - Deborah Carvalho Malta
- School of Nursing, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, - Lima, Peru
| | - Thaynã Ramos Flores
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, Universidade Federal de Pelotas - Pelotas (RS), Brazil
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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: 39] [Impact Index Per Article: 13.0] [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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Paukkonen L, Oikarinen A, Kähkönen O, Kyngäs H. Adherence to self-management in patients with multimorbidity and associated factors: A cross-sectional study in primary health care. J Clin Nurs 2021; 31:2805-2820. [PMID: 34704303 DOI: 10.1111/jocn.16099] [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: 05/10/2021] [Revised: 08/03/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. BACKGROUND Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients' lives. DESIGN A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari's FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. RESULTS Most patients' responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. CONCLUSIONS Multimorbid patients' adherence to self-management is not an 'all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. RELEVANCE TO CLINICAL PRACTICE The findings highlight needs for an individualised whole-person approach in multimorbid patients' care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need.
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Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Social Determinants and Health Behaviours among Older Adults Experiencing Multimorbidity Using the Canadian Longitudinal Study on Aging. Can J Aging 2021; 41:327-347. [DOI: 10.1017/s0714980821000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
This study examines associations between lifestyle behavioural factors and appraisals of “healthy aging” among older adults experiencing multimorbidity. A Social Determinants and Health Behaviour Model (SDHBM) is used to frame the analyses. Using baseline data from the Canadian Longitudinal Study on Aging (CLSA), we studied 12,272 Canadians 65 years of age or older who reported 2 or more of 27 chronic conditions. Additional analyses were conducted using three multimorbidity clusters: cardiovascular/metabolic, musculoskeletal, and mental health. Using hierarchical logistic regression, it was found that, for multmorbidity and the three illness clusters, healthy aging is consistently associated with not smoking (except for the mental health cluster), an absence of obesity (except for the cardiovascular and metabolic cluster), better sleep, and a better appetite. It is not associated with inactivity. Several socio-demographic, environmental, and illness covariates were also supported. The findings are examined using the SDHBM coupled with a resilience lens in order to elucidate how modifiable health behaviours can act as resources to mitigate multimorbidity adversities. This has implications for healthy aging for persons with multimorbidity, especially during the COVID-19 pandemic.
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Thygesen LC, Christensen K, Rørth M, Sørensen HT, Vandenbroucke JP, Westendorp RGJ. Tipping Points - Do the Prognostic Values of Multimorbidity and Functional Status Vary with Age? Clin Epidemiol 2021; 13:853-857. [PMID: 34588816 PMCID: PMC8473562 DOI: 10.2147/clep.s325348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Aging of the population is a pressing challenge for healthcare systems and knowledge of a patient’s prognosis is a key to shaping effective interventions. As the prevalence of multimorbidity strongly increases with age, the prognostic value of multiple disease diagnoses for survival among older people may diminish, whereas other measures of health, such as functional status (defined as a measure of an individual’s ability to perform activities of daily living), may become more important. In this commentary, the impact of age on the prognostic value of multimorbidity is discussed, with the aim of identifying relevant alternative risk indicators for different age groups. The key question is to determine at what age the prognostic value of multimorbidity for meaningful clinical outcomes decreases and is overridden by the prognostic value of functional status. This tipping point likely depends on age, calendar time, and birth cohort. The public health and clinical implications of these tipping points are important. Among younger and middle-aged persons, interventions could be directed towards prevention and treatment of specific diseases, while among older persons efforts should focus more on improving functional levels that include physical, emotional, and social dimensions.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kaare Christensen
- The Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mikael Rørth
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Aarhus University Hospital, Aarhus, Denmark
| | - Jan P Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Medical Statistics and Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rudi G J Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Khanolkar AR, Chaturvedi N, Kuan V, Davis D, Hughes A, Richards M, Bann D, Patalay P. Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National Survey of Health and Development in the UK. PLoS Med 2021; 18:e1003775. [PMID: 34520470 PMCID: PMC8601600 DOI: 10.1371/journal.pmed.1003775] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/18/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We aimed to estimate multimorbidity trajectories and quantify socioeconomic inequalities based on childhood and adulthood socioeconomic position (SEP) in the risks and rates of multimorbidity accumulation across adulthood. METHODS AND FINDINGS Participants from the UK 1946 National Survey of Health and Development (NSHD) birth cohort study who attended the age 36 years assessment in 1982 and any one of the follow-up assessments at ages 43, 53, 63, and 69 years (N = 3,723, 51% males). Information on 18 health conditions was based on a combination of self-report, biomarkers, health records, and prescribed medications. We estimated multimorbidity trajectories and delineated socioeconomic inequalities (based on childhood and adulthood social class and highest education) in multimorbidity at each age and in longitudinal trajectories. Multimorbidity increased with age (0.7 conditions at 36 years to 3.7 at 69 years). Multimorbidity accumulation was nonlinear, accelerating with age at the rate of 0.08 conditions/year (95% CI 0.07 to 0.09, p < 0.001) at 36 to 43 years to 0.19 conditions/year (95% CI 0.18 to 0.20, p < 0.001) at 63 to 69 years. At all ages, the most socioeconomically disadvantaged had 1.2 to 1.4 times greater number of conditions on average compared to the most advantaged. The most disadvantaged by each socioeconomic indicator experienced an additional 0.39 conditions (childhood social class), 0.83 (adult social class), and 1.08 conditions (adult education) at age 69 years, independent of all other socioeconomic indicators. Adverse adulthood SEP was associated with more rapid accumulation of multimorbidity, resulting in 0.49 excess conditions in partly/unskilled compared to professional/intermediate individuals between 63 and 69 years. Disadvantaged childhood social class, independently of adulthood SEP, was associated with accelerated multimorbidity trajectories from age 53 years onwards. Study limitations include that the NSHD cohort is composed of individuals of white European heritage only, and findings may not be generalizable to the non-white British population of the same generation and did not account for other important dimensions of SEP such as income and wealth. CONCLUSIONS In this study, we found that socioeconomically disadvantaged individuals have earlier onset and more rapid accumulation of multimorbidity resulting in widening inequalities into old age, with independent contributions from both childhood and adulthood SEP.
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Affiliation(s)
- Amal R. Khanolkar
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Valerie Kuan
- Institute of Health Informatics, UCL, London, United Kingdom
- Institute of Cardiovascular Science, UCL, London, United Kingdom
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - David Bann
- Centre for Longitudinal Studies, UCL, London, United Kingdom
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
- Centre for Longitudinal Studies, UCL, London, United Kingdom
- * E-mail:
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Singh A, Contreras Suarez D, You E, Fleitas Alfonzo L, King T. Role of social support in the relationship between financial hardship and multimorbidity-a causal mediation analysis. Eur J Public Health 2021; 31:482-487. [PMID: 33724381 DOI: 10.1093/eurpub/ckab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Social disadvantage is a key determinant of multimorbidity. Pathways through which social disadvantage leads to multimorbidity are yet undefined. In this study, we first examined the causal effect of moving into financial hardship on multimorbidity among Australian adults, and then the role of social support as a mediator of the relationship between financial hardship and multimorbidity. METHODS Data were obtained from the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2009-2013). We identified individuals who moved into financial hardship between 2010 and 2011 (n = 5775). Inverse probability treatment weighting with regression adjustment was used to examine the relationship between financial hardship and multimorbidity. Causal mediation analysis was applied to decompose the total effect of financial hardship on multimorbidity into the proportion attributable to social support and the proportion not occurring through measured pathways. We accounted for baseline covariates including age, sex, marital status, educational attainment, employment status, income, country of birth, multimorbidity and social support. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs). RESULTS The risk of multimorbidity was higher in those with financial hardship by 19% [relative risk 1.19 (95% CI: 1.02-1.37) and absolute risk difference 0.036 (95% CI: 0.004-0.067)] than those without financial hardship. Social support accounted for 30% of the total effect of financial hardship on multimorbidity, risk difference 0.009 (95% CI: 0.003-0.018). CONCLUSIONS Financial hardship leads to increased risk of multimorbidity. Interventions directed at increasing social support among those in financial hardship may reduce their risk of multimorbidity.
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Affiliation(s)
- Ankur Singh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Diana Contreras Suarez
- Melbourne Institute: Applied Economic & Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Head A, Fleming K, Kypridemos C, Schofield P, Pearson-Stuttard J, O'Flaherty M. Inequalities in incident and prevalent multimorbidity in England, 2004–19: a population-based, descriptive study. THE LANCET HEALTHY LONGEVITY 2021; 2:e489-e497. [DOI: 10.1016/s2666-7568(21)00146-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 01/28/2023]
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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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Kolpashnikova K. Ageing and dementia: age-period-cohort effects of policy intervention in England, 2006-2016. BMC Geriatr 2021; 21:387. [PMID: 34174814 PMCID: PMC8235903 DOI: 10.1186/s12877-021-02341-4] [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: 03/13/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Dementia is one of the most critical challenges of our time. According to the Dementia Statistics Hub, only about 66 % of all UK residents with dementia were diagnosed in 2017–2018. Yet, there are reservations about the early diagnosis of dementia-related diseases. As a result, the UK National Screening Committee does not recommend systematic population screening of dementia, although case-finding strategies are still applied for high-risk groups. Methods This study added additional evidence of the effectiveness of the National Dementia Strategy and increased numbers of diagnosis of dementia on the younger cohorts of the older people, using the intrinsic estimator age-period-cohort (APC) models and the English Longitudinal Study of Ageing data. Results Age effects show that diagnosis increases in volume only among those aged 75 and above, suggesting that many of those aged below 75 might not be diagnosed in time. Period effects show that although there was an initial increase due to the new policy implementation, the trend stalled in later years, indicating that the increase might not have been even across the period when controlled for age and cohort. The study also shows that cohort effects indicate lower prevalence in younger cohorts controlled for age and period effects. Conclusions Although more research in diverse contexts is warranted, this study cautions against the abandonment of timely diagnosis, increased screening and case-finding, and shows some effectiveness of prevention strategies on the national level.
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Madlock-Brown CR, Reynolds RB, Bailey JE. Increases in multimorbidity with weight class in the United States. Clin Obes 2021; 11:e12436. [PMID: 33372406 PMCID: PMC8454494 DOI: 10.1111/cob.12436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 01/28/2023]
Abstract
Little is known regarding how multimorbidity combinations associated with obesity change with increase in body weight. This study employed data from the national Cerner HealthFacts Data Warehouse to identify changes in multimorbidity patterns by weight class using network analysis. Networks were generated for 154 528 middle-aged patients in the following categories: normal weight, overweight, and classes 1, 2, and 3 obesity. The results show significant differences (P-value<0.05) in prevalence by weight class for all but three of 82 diseases considered. The percentage of patients with multimorbidity (excluding obesity) increases from in 55.1% in patients with normal weight, to 57.88% with overweight, 70.39% with Class 1 obesity, 73.99% with Class 2 obesity, and 71.68% in Class 3 obesity, increasing most substantially with the progression from overweight to class 1 obesity. Most prevalent disease clusters expand from only hypertension and dorsalgia in normal weight, to add joint disorders in overweight, lipidemias in class 1 obesity, diabetes in class 2 obesity, and sleep disorders and chronic kidney disease in class 3 obesity. Recognition of multimorbidity patterns associated with weight increase is essential for true precision care of obesity-associated chronic conditions and can help clinicians identify and address preclinical disease before additional complications arise.
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Affiliation(s)
- Charisse R. Madlock-Brown
- Health Informatics and Information Management Program, University of Tennessee Health Science Center, Memphis, Tennessee
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rebecca B. Reynolds
- Health Informatics and Information Management Program, University of Tennessee Health Science Center, Memphis, Tennessee
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James E. Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Flores TR, Rodrigues APDS, Neves RG, Batista SR, Teixeira DSDC, Silveira EAD, Malta DC, Nunes BP. The Risk of Multimorbidity Associated with Overweight and Obesity: Data from the Brazilian National Health Survey 2013. J Obes Metab Syndr 2021; 30:155-162. [PMID: 33972471 PMCID: PMC8277594 DOI: 10.7570/jomes20110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/27/2020] [Accepted: 02/16/2021] [Indexed: 12/17/2022] Open
Abstract
Background An increase in body mass index (BMI) is strongly associated with the occurrence of multimorbidity, and overweight and obesity are contributing factors for the increase in morbidities. Thus, the present study aimed to evaluate the occurrence of multimorbidity and associated factors in Brazilian adults with and without overweight or obesity. Methods This was a cross-sectional population-based study with data from the National Health Survey (2013) including individuals aged 18 years or older. Multimorbidity was defined as having ≥2 diseases from the list of 15 morbidities on the self-reported questionnaire (self-reported medical diagnosis in life). BMI was categorized as: ≤24.9 kg/m2 (low weight and eutrophy), 25.0–29.9 kg/m2 (overweight), and ≥30.0 kg/m2 (obesity). Sex, age, and schooling were the covariates. Poisson regression was used for crude and adjusted analyses for the variables representing access to health services estimating the prevalence ratio (PR) and 95% confidence interval (CI). Results The total sample consisted of 59,402 individuals. The prevalence of multimorbidity was 25% overall and was higher among overweight (25.8%) and obese (32.5%) individuals. Obese women 60 years or older had a higher occurrence of multimorbidity (80%). In the adjusted analysis, a lower prevalence of multimorbidity was observed among those with higher educational levels in all BMI classifications: low weight/eutrophy, PR=0.66 (95% CI, 0.58–0.75); overweight, PR=0.62 (95% CI, 0.56–0.70); and obesity, PR=0.75 (95% CI, 0.67–0.85). Conclusion A higher prevalence of multimorbidity was found among obese women who were 60 years of age or older. Schooling was an associated factor regardless of BMI.
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Affiliation(s)
- Thaynã Ramos Flores
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | | | | | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Pereira Nunes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Department of Nursing in Collective Health and the Postgraduate Program in Nursing at the Federal University of Pelotas, Pelotas, Brazil
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Maxwell CJ, Mondor L, Pefoyo Koné AJ, Hogan DB, Wodchis WP. Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada. PLoS One 2021; 16:e0250567. [PMID: 33901232 PMCID: PMC8075196 DOI: 10.1371/journal.pone.0250567] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Multimorbidity is increasing among older adults, but the impact of these recent trends on the extent and complexity of polypharmacy and possible variation by sex remains unknown. We examined sex differences in multimorbidity, polypharmacy (5+ medications) and hyper-polypharmacy (10+ medications) in 2003 vs 2016, and the interactive associations between age, multimorbidity level, and time on polypharmacy measures. Methods and findings We employed a repeated cross-sectional study design with linked health administrative databases for all persons aged ≥66 years eligible for health insurance in Ontario, Canada at the two index dates. Descriptive analyses and multivariable logistic regression models were conducted; models included interaction terms between age, multimorbidity level, and time period to estimate polypharmacy and hyper-polypharmacy probabilities, risk differences and risk ratios for 2016 vs 2003. Multimorbidity, polypharmacy and hyper-polypharmacy increased significantly over the 13 years. At both index dates prevalence estimates for all three were higher in women, but a greater absolute increase in polypharmacy over time was observed in men (6.6% [from 55.7% to 62.3%] vs 0.9% [64.2%-65.1%] for women) though absolute increases in multimorbidity were similar for men and women (6.9% [72.5%-79.4%] vs 6.2% [75.9%-82.1%], respectively). Model findings showed that polypharmacy decreased over time among women aged < 90 years (especially for younger ages and those with fewer conditions), whereas it increased among men at all ages and multimorbidity levels (with larger absolute increases typically at older ages and among those with 4 or fewer conditions). Conclusions There are sex and age differences in the impact of increasing chronic disease burden on changes in measures of multiple medication use among older adults. Though the drivers and health consequences of these trends warrant further investigation, the findings support the heterogeneity and complexity in the evolving association between multimorbidity and polypharmacy measures in older populations.
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Affiliation(s)
- Colleen J. Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- * E-mail:
| | - Luke Mondor
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
| | - Anna J. Pefoyo Koné
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Walter P. Wodchis
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada
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