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Blayney MC, Reed MJ, Masterson JA, Anand A, Bouamrane MM, Fleuriot J, Luz S, Lyall MJ, Mercer S, Mills NL, Shenkin SD, Walsh TS, Wild SH, Wu H, McLachlan S, Guthrie B, Lone NI. Multimorbidity and adverse outcomes following emergency department attendance: population based cohort study. BMJ MEDICINE 2024; 3:e000731. [PMID: 39184567 PMCID: PMC11344864 DOI: 10.1136/bmjmed-2023-000731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 05/22/2024] [Indexed: 08/27/2024]
Abstract
ABSTRACT Objectives To describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department. Design Population based cohort study. Setting Emergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019. Participants Adults (≥18 years) attending emergency departments. Data sources Linked data from emergency departments, hospital discharges, and cancer registries, and national mortality data. Main outcome measures Multimorbidity was defined as at least two conditions from the Elixhauser comorbidity index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30 day mortality (primary outcome), hospital admission, reattendance at the emergency department within seven days, and time spent in emergency department (secondary outcomes). Primary analysis was stratified by age (<65 v ≥65 years). Results 451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 v 43 years), more likely to arrive by emergency ambulance (57.8% v 23.7%), and more likely to be triaged as very urgent (23.5% v 9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2% v 1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1% v 20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8% v 3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older. Conclusions Almost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.
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Affiliation(s)
- Michael C Blayney
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Matthew J Reed
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John A Masterson
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Matt M Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Jacques Fleuriot
- Artificial Intelligence and its Applications, University of Edinburgh School of Informatics, Edinburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Saturnino Luz
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | | | - Stewart Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Susan D Shenkin
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Timothy S Walsh
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Honghan Wu
- Institute of Health Informatics, University College London, London, UK
- The Alan Turing Institute, British Library, London, UK
| | - Stela McLachlan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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Knudsen AM, Dalgård Dunvald AC, Hangaard S, Hejlesen O, Kronborg T. The Effectiveness of Collaborative Care Interventions for the Management of Patients With Multimorbidity: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis. JMIR Res Protoc 2024; 13:e58296. [PMID: 39115256 PMCID: PMC11342003 DOI: 10.2196/58296] [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: 03/12/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Collaborative care interventions have been proposed as a promising strategy to support patients with multimorbidity. Despite this, the effectiveness of collaborative care interventions requires further evaluation. Existing systematic reviews describing the effectiveness of collaborative care interventions in multimorbidity management tend to focus on specific interventions, patient subgroups, and settings. This necessitates a comprehensive review that will provide an overview of the effectiveness of collaborative care interventions for adult patients with multimorbidity. OBJECTIVE This systematic review aims to systematically assess the effectiveness of collaborative care interventions in comparison to usual care concerning health-related quality of life (HRQoL), mental health, and mortality among adult patients with multimorbidity. METHODS Randomized controlled trials evaluating collaborative care interventions designed for adult patients (18 years and older) with multimorbidity compared with usual care will be considered for inclusion in this review. HRQoL will be the primary outcome. Mortality and mental health outcomes such as rating scales for anxiety and depression will serve as secondary outcomes. The systematic search will be conducted in the CENTRAL, PubMed, CINAHL, and Embase databases. Additional reference and citation searches will be performed in Google Scholar, Web of Science, and Scopus. Data extraction will be comprehensive and include information about participant characteristics, study design, intervention details, and main outcomes. Included studies will be assessed for limitations according to the Cochrane Risk of Bias tool. Meta-analysis will be conducted to estimate the pooled effect size. Meta-regression or subgroup analysis will be undertaken to explore if certain factors can explain the variation in effect between studies, if feasible. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. RESULTS The preliminary literature search was performed on February 16, 2024, and yielded 5255 unique records. A follow-up search will be performed across all databases before submission. The findings will be presented in forest plots, a summary of findings table, and in narrative format. This systematic review is expected to be completed by late 2024. CONCLUSIONS This review will provide an overview of pooled estimates of treatment effects across HRQoL, mental health, and mortality from randomized controlled trials evaluating collaborative care interventions for adults with multimorbidity. Furthermore, the intention is to clarify the participant, intervention, or study characteristics that may influence the effect of the interventions. This review is expected to provide valuable insights for researchers, clinicians, and other decision-makers about the effectiveness of collaborative care interventions targeting adult patients with multimorbidity. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42024512554; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=512554. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/58296.
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Affiliation(s)
- Anne-Maj Knudsen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Ann-Cathrine Dalgård Dunvald
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Andersen JD, Stoltenberg CW, Jensen MH, Vestergaard P, Hejlesen O, Hangaard S. Machine Learning-Driven Prediction of Comorbidities and Mortality in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241267779. [PMID: 39091237 DOI: 10.1177/19322968241267779] [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] [Indexed: 08/04/2024]
Abstract
BACKGROUND Comorbidities such as cardiovascular disease (CVD) and diabetic kidney disease (DKD) are major burdens of type 1 diabetes (T1D). Predicting people at high risk of developing comorbidities would enable early intervention. This study aimed to develop models incorporating socioeconomic status (SES) to predict CVD, DKD, and mortality in adults with T1D to improve early identification of comorbidities. METHODS Nationwide Danish registry data were used. Logistic regression models were developed to predict the development of CVD, DKD, and mortality within five years of T1D diagnosis. Features included age, sex, personal income, and education. Performance was evaluated by five-fold cross-validation with area under the receiver operating characteristic curve (AUROC) and the precision-recall area under the curve (PR-AUC). The importance of SES was assessed from feature importance plots. RESULTS Of the 6572 included adults (≥21 years) with T1D, 379 (6%) developed CVD, 668 (10%) developed DKD, and 921 (14%) died within the five-year follow-up. The AUROC (±SD) was 0.79 (±0.03) for CVD, 0.61 (±0.03) for DKD, and 0.87 (±0.01) for mortality. The PR-AUC was 0.18 (±0.01), 0.15 (±0.03), and 0.49 (±0.02), respectively. Based on feature importance plots, SES was the most important feature in the DKD model but had minimal impact on models for CVD and mortality. CONCLUSIONS The developed models showed good performance for predicting CVD and mortality, suggesting they could help in the early identification of these outcomes in individuals with T1D. The importance of SES in individual prediction within diabetes remains uncertain.
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Affiliation(s)
- Jonas Dahl Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Carsten Wridt Stoltenberg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Morten Hasselstrøm Jensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Data Science, Novo Nordisk, Søborg, Denmark
| | - Peter Vestergaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
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Lolk K, Werenberg Dreier J, Christensen J. Individual and neighborhood-level socioeconomic deprivation and risk of epilepsy after traumatic brain Injury: A register-based cohort study. Epilepsy Behav 2024; 156:109807. [PMID: 38678986 DOI: 10.1016/j.yebeh.2024.109807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Kasper Lolk
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark.
| | - Julie Werenberg Dreier
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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5
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Rasmussen NF, Moos C, Gregersen LHK, Hikmat Z, Andersen V, Green A, Jess T, Madsen GI, Pedersen AK, Petersen SR, Kjeldsen LJ. Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis. Syst Rev 2024; 13:164. [PMID: 38915086 PMCID: PMC11194997 DOI: 10.1186/s13643-024-02584-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs) are associated with high healthcare utilization. This systematic review aimed to summarize what is known about the impact of sex, income, and education on the likelihood of bowel surgery, hospitalization, and use of corticosteroids and biologics among patients with IBD. METHODS We used EMBASE, MEDLINE, CINAHL, and Web of Science to perform a systematic literature search. Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects meta-analysis for the impact of sex on the likelihood of surgery and hospitalization. In addition, we performed subgroup analyses of the effect of IBD type (Crohn's disease or ulcerative colitis) and age. Finally, meta-regression was undertaken for the year of publication. RESULTS In total, 67 studies were included, of which 23 studies were eligible for meta-analysis. In the main meta-analysis, male sex was associated with an increased likelihood of bowel surgery (HR 1.42 (95% CI 1.13;1.78), which was consistent with the subgroup analysis for UC only (HR 1.78, 95% CI 1.16; 2.72). Sex did not impact the likelihood of hospitalization (OR 1.05 (95% CI 0.86;1.30), although the subgroup analysis revealed an increased likelihood of hospitalization in CD patients (OR 1.42, 95% CI 1.28;1.58). In 9 of 10 studies, no significant sex-based differences in the use of biologics were reported, although in 6 of 6 studies, female patients had lower adherence to biologics. In 11 of 13 studies, no significant sex-based difference in the use of corticosteroids was reported. The evidence of the impact of income and education on healthcare utilization was sparse and pointed in different directions. The substantial heterogeneity between studies was explained, in part, by differences in IBD type and age. CONCLUSIONS The results of this systematic review indicate that male patients with IBD are significantly more likely to have surgery than female patients with IBD but are not, overall, more likely to be hospitalized, whereas female patients appear to have statistically significantly lower adherence to biologics compared to male patients. Thus, clinicians should not underestimate the impact of sex on healthcare utilization. Evidence for income- and education-based differences remains sparse. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022315788.
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Affiliation(s)
- Nathalie Fogh Rasmussen
- Hospital Pharmacy Research Unit, Department of Regional Health Research-IRS, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.
- National Center of Excellence for Molecular Prediction of Inflammatory Bowel Disease- PREDICT, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Copenhagen, Denmark.
| | - Caroline Moos
- Department of Clinical Research, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Laura Helene Keiding Gregersen
- Molecular Diagnostics and Clinical Research Unit, Department of Regional Health Research-IRS, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Zainab Hikmat
- Molecular Diagnostics and Clinical Research Unit, Department of Regional Health Research-IRS, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
- Clincial Genome Center, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Vibeke Andersen
- Molecular Diagnostics and Clinical Research Unit, Department of Regional Health Research-IRS, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Anders Green
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Tine Jess
- National Center of Excellence for Molecular Prediction of Inflammatory Bowel Disease- PREDICT, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunvor Iben Madsen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
| | - Andreas Kristian Pedersen
- Department of Clinical Research, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Sofie Ronja Petersen
- Department of Clinical Research, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Lene Juel Kjeldsen
- Hospital Pharmacy Research Unit, Department of Regional Health Research-IRS, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
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Bugge SJ, Henriksen DP, Damkier P, Rahbek MT, Schousboe K, Rothmann MJ, Poulsen MK, Hansen C, Nagarajah S, Jensen PB, Johansson SL, Panou V, Schneider IR, Pedersen CG, Andersen JD, Hangaard J, Zwisler ADO. Network of doctors for multimorbidity and diabetes - the NOMAD intervention: protocol for feasibility trial of multidisciplinary team conferences for people with diabetes and multimorbidity. Pilot Feasibility Stud 2024; 10:91. [PMID: 38879561 PMCID: PMC11179232 DOI: 10.1186/s40814-024-01517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/06/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The prevalence of diabetes and coexisting multimorbidity rises worldwide. Treatment of this patient group can be complex. Providing an evidence-based, coherent, and patient-centred treatment of patients with multimorbidity poses a challenge in healthcare systems, which are typically designed to deliver disease-specific care. We propose an intervention comprising multidisciplinary team conferences (MDTs) to address this issue. The MDT consists of medical specialists in five different specialities meeting to discuss multimorbid diabetes patients. This protocol describes a feasibility test of MDTs designed to coordinate care and improve quality of life for people with diabetes and multimorbidity. METHODS A mixed-methods one-arm feasibility test of the MDT. Feasibility will be assessed through prospectively collected data. We will explore patient perspectives through patient-reported outcomes (PROs) and assess the feasibility of electronic questionnaires. Feasibility outcomes are recruitment, PRO completion, technical difficulties, impact of MDT, and doctor preparation time. During 17 months, up to 112 participants will be recruited. We will report results narratively and by the use of descriptive statistics. The collected data will form the basis for a future large-scale randomised trial. DISCUSSION A multidisciplinary approach focusing on better management of diabetic patients suffering from multimorbidity may improve functional status, quality of life, and health outcomes. Multimorbidity and diabetes are highly prevalent in our healthcare system, but we lack a solid evidence-based approach to patient-centred care for these patients. This study represents the initial steps towards building such evidence. The concept can be efficiency tested in a randomised setting, if found feasible to intervention providers and receivers. If not, we will have gained experience on how to manage diabetes and multimorbidity as well as organisational aspects, which together may generate hypotheses for research on how to handle multimorbidity in the future. ADMINISTRATIVE INFORMATION Protocol version: 01 TRIAL REGISTRATION: NCT05913726 - registration date: 21 June 2023.
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Affiliation(s)
- Stine Jorstad Bugge
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark.
- Department of Pharmacology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Daniel Pilsgaard Henriksen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Torp Rahbek
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karoline Schousboe
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Kjær Poulsen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Hansen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
| | - Subagini Nagarajah
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Per Bruno Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Sofie Lock Johansson
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Vasiliki Panou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Ida Ransby Schneider
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte Gjørup Pedersen
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jonas Dahl Andersen
- Steno Diabetes Centre Northern Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jørgen Hangaard
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Olsen Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
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Witt CT, Mols RE, Bakos I, Horváth-Puhó E, Christensen B, Løgstrup BB, Nielsen JC, Eiskjær H. Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae029. [PMID: 38828270 PMCID: PMC11143480 DOI: 10.1093/ehjopen/oeae029] [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: 11/27/2023] [Revised: 02/01/2024] [Accepted: 03/14/2024] [Indexed: 06/05/2024]
Abstract
Aims We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional healthcare utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. Methods and results We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data on chronic conditions, use of healthcare services, and demographics were obtained from Danish national administrative and health registries. Healthcare utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using a negative binomial regression model. The association between SEP, multimorbidity, and prognostic outcomes was analysed using Cox proportional hazards regression. We followed 2007 patients (median age of 70 years), 79% were male, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level for a median of 5.2 [inter-quartile range: 2.2-7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased healthcare utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on healthcare utilization. Patients living alone and those with low educational level had a trend towards a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.17, 95% confidence interval (CI) 1.03-1.33, and aHR 1.09, 95% CI 0.96-1.24). Conclusion Multimorbidity increased the use of cross-sectional healthcare services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend towards a higher risk of mortality after CRT implantation.
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Affiliation(s)
- Christoffer Tobias Witt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Bo Christensen
- Department of Public Health, Research Unit for General Practice, Aarhus University Bartholins Allé 2, 8000 Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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Stockmarr A, Frølich A. Clusters from chronic conditions in the Danish adult population. PLoS One 2024; 19:e0302535. [PMID: 38687772 PMCID: PMC11060538 DOI: 10.1371/journal.pone.0302535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
Multimorbidity, the presence of 2 or more chronic conditions in a person at the same time, is an increasing public health concern, which affects individuals through reduced health related quality of life, and society through increased need for healthcare services. Yet the structure of chronic conditions in individuals with multimorbidity, viewed as a population, is largely unmapped. We use algorithmic diagnoses and the K-means algorithm to cluster the entire 2015 Danish multimorbidity population into 5 clusters. The study introduces the concept of rim data as an additional tool for determining the number of clusters. We label the 5 clusters the Allergies, Chronic Heart Conditions, Diabetes, Hypercholesterolemia, and Musculoskeletal and Psychiatric Conditions clusters, and demonstrate that for 99.32% of the population, the cluster allocation can be determined from the diagnoses of 4-5 conditions. Clusters are characterized through most prevalent conditions, absent conditions, over- or under-represented conditions, and co-occurrence of conditions. Clusters are further characterized through socioeconomic variables and healthcare service utilizations. Additionally, geographical variations throughout Denmark are studied at the regional and municipality level. We find that subdivision into municipality levels suggests that the Allergies cluster frequency is positively associated with socioeconomic status, while the subdivision suggests that frequencies for clusters Diabetes and Hypercholesterolemia are negatively correlated with socioeconomic status. We detect no indication of association to socioeconomic status for the Chronic Heart Conditions cluster and the Musculoskeletal and Psychiatric Conditions cluster. Additional spatial variation is revealed, some of which may be related to urban/rural populations. Our work constitutes a step in the process of characterizing multimorbidity populations, leading to increased comprehension of the nature of multimorbidity, and towards potential applications to individual-based care, prevention, the development of clinical guidelines, and population management.
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Affiliation(s)
- Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Li X, Mohanty I, Chai P, Niyonsenga T. Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study. PLoS One 2024; 19:e0297025. [PMID: 38483924 PMCID: PMC10939203 DOI: 10.1371/journal.pone.0297025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/26/2023] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Healthcare utilization often favors the higher-socioeconomic status (SES) and having chronic diseases may exacerbate this inequality. This study aims to examine the trends in health service use over time, the effect of SES on healthcare utilization, and the role of chronic diseases in this association. METHODS Data used in this study were from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, which is the first nationally representative survey of the middle-aged and older. The sample included people aged 45 years and older who responded to all the waves. A total of 10,922 adults were included in this study. Healthcare utilization was categorized into outpatient and inpatient service use and SES was measured by per-capita household expenditure. A multilevel zero-inflated negative binomial regression model was performed to analyze outpatient and inpatient service use, separately. RESULTS The rates of outpatient service use in 2011, 2013, 2015, and 2018 were 19.11%, 21.45%, 20.12%, and 16.32%, respectively, while the rates of inpatient service use were 8.40%, 13.04%, 14.17%, and 18.79%, respectively. Compared to individuals in the lowest quintile of per-capita household expenditure, those in higher quintiles had higher odds of outpatient service use (Q2: odds ratio = 1.233, p < 0.0001; Q3: 1.416, p < 0.0001; Q4: 1.408, p < 0.0001; or Q5: 1.439, p < 0.0001) and higher rates of inpatient service use (Q2: incidence rate ratio = 1.273, p < 0.0001; Q3: 1.773, p < 0.0001; Q4: 2.071, p < 0.0001; or Q5: 1.992, p < 0.0001). Additionally, having morbidity generally increased healthcare utilization, but did not play a significant role in moderating the relationship between SES and healthcare utilization. CONCLUSIONS Healthcare utilization rates were overall low in China, but relatively high for people in higher quintiles of per-capita household expenditure or those with morbidity, compared to their counterparts. Policy actions are required to provide more health education to the public, to further optimize health insurance schemes targeting outpatient services, especially for the low-SES, and to establish new health delivery models for NCD management in the primary health care setting.
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Affiliation(s)
- Xi Li
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Itismita Mohanty
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Peipei Chai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Theo Niyonsenga
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
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Valabhji J, Barron E, Pratt A, Hafezparast N, Dunbar-Rees R, Turner EB, Roberts K, Mathews J, Deegan R, Cornelius V, Pickles J, Wainman G, Bakhai C, Johnston DG, Gregg EW, Khunti K. Prevalence of multiple long-term conditions (multimorbidity) in England: a whole population study of over 60 million people. J R Soc Med 2024; 117:104-117. [PMID: 37905525 PMCID: PMC11046366 DOI: 10.1177/01410768231206033] [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: 06/09/2023] [Accepted: 09/17/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES To determine the prevalence of multiple long-term conditions (MLTC) at whole English population level, stratifying by age, sex, socioeconomic status and ethnicity. DESIGN A whole population study. SETTING Individuals registered with a general practice in England and alive on 31 March 2020. PARTICIPANTS 60,004,883 individuals. MAIN OUTCOME MEASURES MLTC prevalence, defined as two or more of 35 conditions derived from a number of national patient-level datasets. Multivariable logistic regression was used to assess the independent associations of age, sex, ethnicity and deprivation decile with odds of MLTC. RESULTS The overall prevalence of MLTC was 14.8% (8,878,231), varying from 0.9% (125,159) in those aged 0-19 years to 68.2% (1,905,979) in those aged 80 years and over. In multivariable regression analyses, compared with the 50-59 reference group, the odds ratio was 0.04 (95% confidence interval (CI): 0.04-0.04; p < 0.001) for those aged 0-19 years and 10.21 (10.18-10.24; p < 0.001) for those aged 80 years and over. Odds were higher for men compared with women, 1.02 (1.02-1.02; p < 0.001), for the most deprived decile compared with the least deprived, 2.26 (2.25-2.27; p < 0.001), and for Asian ethnicity compared with those of white ethnicity, 1.05 (1.04-1.05; p < 0.001). Odds were lower for black, mixed and other ethnicities (0.94 (0.94-0.95) p < 0.001, 0.87 (0.87-0.88) p < 0.001 and 0.57 (0.56-0.57) p < 0.001, respectively). MLTC for persons aged 0-19 years were dominated by asthma, autism and epilepsy, for persons aged 20-49 years by depression and asthma, for persons aged 50-59 years by hypertension and depression and for those aged 60 years and older, by cardiometabolic factors and osteoarthritis. There were large numbers of combinations of conditions in each age group ranging from 5936 in those aged 0-19 years to 205,534 in those aged 80 years and over. CONCLUSIONS While this study provides useful insight into the burden across the English population to assist health service delivery planning, the heterogeneity of MLTC presents challenges for delivery optimisation.
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Affiliation(s)
- Jonathan Valabhji
- NHS England, Wellington House, London SE1 8UG, UK
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, SW7 2BU, UK
| | - Emma Barron
- NHS England, Wellington House, London SE1 8UG, UK
| | - Adrian Pratt
- NHS Arden & Greater East Midlands Commissioning Support Unit, Westgate House, Warwick CV34 4DE, UK
| | | | | | | | - Kate Roberts
- National Institute for Health and Care Research Clinical Research Network National Coordination Centre, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Jacqueline Mathews
- National Institute for Health and Care Research Clinical Research Network National Coordination Centre, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Robbie Deegan
- NHS Arden & Greater East Midlands Commissioning Support Unit, Westgate House, Warwick CV34 4DE, UK
| | | | | | - Gary Wainman
- NHS England, Wellington House, London SE1 8UG, UK
| | - Chirag Bakhai
- NHS England, Wellington House, London SE1 8UG, UK
- Bedfordshire, Luton and Milton Keynes Integrated Care Board, LU1 2LJ, UK
| | - Desmond G Johnston
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, SW7 2BU, UK
| | - Edward W Gregg
- School of Public Health, Imperial College London, London, SW7 2BU, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
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Holm A, Lyhnebeck AB, Rozing M, Buhl SF, Willadsen TG, Prior A, Christiansen AKL, Kristensen J, Andersen JS, Waldorff FB, Siersma V, Brodersen JB, Reventlow S. Effectiveness of an adaptive, multifaceted intervention to enhance care for patients with complex multimorbidity in general practice: protocol for a pragmatic cluster randomised controlled trial (the MM600 trial). BMJ Open 2024; 14:e077441. [PMID: 38309759 PMCID: PMC10840032 DOI: 10.1136/bmjopen-2023-077441] [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: 07/05/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Patients with complex multimorbidity face a high treatment burden and frequently have low quality of life. General practice is the key organisational setting in terms of offering people with complex multimorbidity integrated, longitudinal, patient-centred care. This protocol describes a pragmatic cluster randomised controlled trial to evaluate the effectiveness of an adaptive, multifaceted intervention in general practice for patients with complex multimorbidity. METHODS AND ANALYSIS In this study, 250 recruited general practices will be randomly assigned 1:1 to either the intervention or control group. The eligible population are adult patients with two or more chronic conditions, at least one contact with secondary care within the last year, taking at least five repeat prescription drugs, living independently, who experience significant problems with their life and health due to their multimorbidity. During 2023 and 2024, intervention practices are financially incentivised to provide an extended consultation based on a patient-centred framework to eligible patients. Control practices continue care as usual. The primary outcome is need-based quality of life. Outcomes will be evaluated using linear and logistic regression models, with clustering considered. The analysis will be performed as intention to treat. In addition, a process evaluation will be carried out and reported elsewhere. ETHICS AND DISSEMINATION The trial will be conducted in compliance with the protocol, the Helsinki Declaration in its most recent form and good clinical practice recommendations, as well as the regulation for informed consent. The study was submitted to the Danish Capital Region Ethical Committee (ref: H-22041229). As defined by Section 2 of the Danish Act on Research Ethics in Research Projects, this project does not constitute a health research project but is considered a quality improvement project that does not require formal ethical approval. All results from the study (whether positive, negative or inconclusive) will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05676541.
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Affiliation(s)
- Anne Holm
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Bernhardt Lyhnebeck
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Rozing
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sussi Friis Buhl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tora Grauers Willadsen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Ann-Kathrin Lindahl Christiansen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jette Kristensen
- The Center for General Practice, Aalborg University, Aalborg, Denmark
| | - John Sahl Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Centre of Research & Education in General Practice Primary Health Care Research Unit, Zealand Region, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Haaber RS, Iversen KG, Klenø AS, Stisen MB, Mechlenburg I, Pedersen AB. Multimorbidity measured with Charlson Comorbidity Index is not associated with clinically relevant risk of revision after primary total hip arthroplasty: a population-based cohort study on 98,647 patients from the Danish Hip Arthroplasty Register. Acta Orthop 2024; 95:1-7. [PMID: 38193361 PMCID: PMC10775175 DOI: 10.2340/17453674.2024.35225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND PURPOSE Evidence for guiding healthcare professionals on the risks of total hip arthroplasty (THA) in multimorbid patients is sparse. We aimed to examine the association between multimorbidity and the risk of revision due to any cause and specific causes after primary THA due to osteoarthritis. PATIENTS AND METHODS We identified 98,647 THA patients and subsequent revisions in the Danish Hip Arthroplasty Register from 1995 to 2018. Multimorbidity was measured with the Charlson Comorbidity Index (CCI). Using the CCI (low, medium, high), we calculated the cumulative incidence function (CIF) of first revision up to 10 years after THA. Adjusted cause-specific hazard ratios (aHRs) were estimated using Cox regressions. All estimates are presented with 95% confidence intervals (CI). RESULTS Overall, the prevalence of patients with low, medium, and high CCI was 70%, 24%, and 6%. The CIF of any revision within 10 years was 6.5% (CI 6.2-6.7) in low and 6.5% (CI 5.8-7.3) in high CCI, with an aHR of 1.4 (CI 1.2-1.6) for patients with high compared with low CCI. The corresponding aHRs for cause-specific revision were 1.3 (CI 1.0-1.6) for aseptic loosening within 10 years, 1.2 (CI 0.9-1.6) for infection, and 1.7 (CI 1.3-2.2) for dislocation, both within 2 years. CONCLUSION Multimorbidity is associated with a minor but not clinically relevant increased risk of revision up to 10 years after primary THA.
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Affiliation(s)
- Rikke S Haaber
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus.
| | - Katrine G Iversen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus
| | - André S Klenø
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - Martin B Stisen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
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Zacarías-Pons L, Turró-Garriga O, Saez M, Garre-Olmo J. Multimorbidity patterns and disability and healthcare use in Europe: do the associations change with the regional socioeconomic status? Eur J Ageing 2024; 21:1. [PMID: 38170397 PMCID: PMC10764705 DOI: 10.1007/s10433-023-00795-6] [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] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Multimorbidity, the concurrence of several chronic conditions, is a rising concern that increases the years lived with disability and poses a burden on healthcare systems. Little is known on how it interacts with socioeconomic deprivation, previously associated with poor health-related outcomes. We aimed to characterize the association between multimorbidity and these outcomes and how this relationship may change with socioeconomic development of regions. 55,915 individuals interviewed in 2017 were drawn from the Survey of Health, Ageing and Retirement in Europe, a population-based study. A Latent Class Analysis was conducted to fit multimorbidity patterns based on 16 self-reported conditions. Physical limitation, quality-of-life and healthcare utilization outcomes were regressed on those patterns adjusting for additional covariates. Those analyses were then extended to assess whether such associations varied with the region socioeconomic status. We identified six different patterns, labelled according to their more predominant chronic conditions. After the "healthy" class, the "metabolic" and the "osteoarticular" classes had the best outcomes involving limitations and the lowest healthcare utilization. The "neuro-affective-ulcer" and the "several conditions" classes yielded the highest probabilities of physical limitation, whereas the "cardiovascular" group had the highest probability of hospitalization. The association of multimorbidity over physical limitations appeared to be stronger when living in a deprived region, especially for metabolic and osteoarticular conditions, whereas no major effect differences were found for healthcare use. Multimorbidity groups do differentiate in terms of limitation and healthcare utilization. Such differences are exacerbated with socioeconomic inequities between regions even within Europe.
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Affiliation(s)
- Lluís Zacarías-Pons
- Research Group on Aging, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain.
| | - Oriol Turró-Garriga
- Glòria Compte Research Institute, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Josep Garre-Olmo
- Research Group on Aging, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain
- Serra-Húnter Professor, Department of Nursing, University of Girona, Girona, Spain
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Wasan T, Hayhoe B, Cicek M, Lammila-Escalera E, Nicholls D, Majeed A, Greenfield G. The effects of community interventions on unplanned healthcare use in patients with multimorbidity: a systematic review. J R Soc Med 2024; 117:24-35. [PMID: 37449474 PMCID: PMC10858714 DOI: 10.1177/01410768231186224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplanned healthcare usage. Community-based interventions allow for continued care of patients outside hospitals, but few studies have explored the effects of these interventions on unplanned healthcare usage. DESIGN A systematic review was conducted. MEDLINE, EMBASE, PsychINFO and Cochrane Library online databases were searched. Studies were screened and underwent risk of bias assessment. Data were synthesised using narrative synthesis. SETTING Community-based interventions. PARTICIPANTS Patients with multimorbidity. MAIN OUTCOME MEASURES Unplanned healthcare usage. RESULTS Thirteen studies, including a total of 6148 participants, were included. All included studies came from high-income settings and had elderly populations. All studies measured emergency department attendances as their primary outcome. Risk of bias was generally low. Most community interventions were multifaceted with emphasis on education, self-monitoring of symptoms and regular follow-ups. Four studies looked at improved care coordination, advance care planning and palliative care. All 13 studies found a decrease in emergency department visits post-intervention with risk reduction ranging from 0 (95% confidencec interval [CI]: -0.37 to 0.37) to 0.735 (95% CI: 0.688-0.785). CONCLUSIONS Community-based interventions have potential to reduce emergency department visits in patients with multimorbidity. Identification of specific successful components of interventions was challenging given the overlaps between interventions. Policymakers should recognise the importance of community interventions and aim to integrate aspects of these into existing healthcare structures. Future research should investigate the impact of such interventions with broader participant characteristics.
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Affiliation(s)
- Tavleen Wasan
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Meryem Cicek
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Elena Lammila-Escalera
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Dasha Nicholls
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
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Rafferty J, Lee A, Lyons RA, Akbari A, Peek N, Jalali-najafabadi F, Ba Dhafari T, Lyons J, Watkins A, Bailey R. Using hypergraphs to quantify importance of sets of diseases by healthcare resource utilisation: A retrospective cohort study. PLoS One 2023; 18:e0295300. [PMID: 38100428 PMCID: PMC10723667 DOI: 10.1371/journal.pone.0295300] [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: 07/23/2022] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
Rates of Multimorbidity (also called Multiple Long Term Conditions, MLTC) are increasing in many developed nations. People with multimorbidity experience poorer outcomes and require more healthcare intervention. Grouping of conditions by health service utilisation is poorly researched. The study population consisted of a cohort of people living in Wales, UK aged 20 years or older in 2000 who were followed up until the end of 2017. Multimorbidity clusters by prevalence and healthcare resource use (HRU) were modelled using hypergraphs, mathematical objects relating diseases via links which can connect any number of diseases, thus capturing information about sets of diseases of any size. The cohort included 2,178,938 people. The most prevalent diseases were hypertension (13.3%), diabetes (6.9%), depression (6.7%) and chronic obstructive pulmonary disease (5.9%). The most important sets of diseases when considering prevalence generally contained a small number of diseases, while the most important sets of diseases when considering HRU were sets containing many diseases. The most important set of diseases taking prevalence and HRU into account was diabetes & hypertension and this combined measure of importance featured hypertension most often in the most important sets of diseases. We have used a single approach to find the most important sets of diseases based on co-occurrence and HRU measures, demonstrating the flexibility of the hypergraph approach. Hypertension, the most important single disease, is silent, underdiagnosed and increases the risk of life threatening co-morbidities. Co-occurrence of endocrine and cardiovascular diseases was common in the most important sets. Combining measures of prevalence with HRU provides insights which would be helpful for those planning and delivering services.
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Affiliation(s)
- James Rafferty
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Alexandra Lee
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Farideh Jalali-najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Thamer Ba Dhafari
- Division of Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
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Svendsen ML, Andersen TV, Soendergaard H. Developing quality measures for non-pharmacological prevention and rehabilitation in primary health care for chronic conditions: a consensus study. Int J Qual Health Care 2023; 35:mzad097. [PMID: 38079511 PMCID: PMC10712901 DOI: 10.1093/intqhc/mzad097] [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: 03/17/2023] [Revised: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
Poor health-related behaviours are root causes of a large number of chronic conditions; however, this study is the first to develop guideline-based quality measures targeting health-related behaviours through generic non-pharmacological secondary prevention and rehabilitation in municipal primary health care for persons with chronic conditions. From January 2020 to September 2021, a consensus study was conducted in accordance with the current scientific recommendations for developing guideline-based quality measures. A clinical expert panel (n = 11) was established and included a patient representative, health care professionals, researchers, and key specialists. The process for developing quality measures was led by methodologists and encompassed a modified Research and Development/University of California at Los Angeles (RAND/UCLA) study to evaluate consensus in the expert panel. The consensus recommendations were directed to a steering group including the Danish Ministry of Health, the Danish Regions, and the Local Government Denmark. The expert panel rated 102 clinical practice recommendations. Consensus was demonstrated on 13 quality measures assessing whether the patients are offered participation in and adhere to: self-management, smoking cessation, physical exercise training, nutritional efforts, and preventive consultation on excessive alcohol consumption; whether the patients participate in a closing meeting, whether they are offered follow-up, and whether reasons for dropout are documented. The identified quality measures constitute a framework for assessing the quality of non-pharmacological prevention and rehabilitation in municipal primary health care for persons with chronic conditions. The next steps focus on field testing of the quality measures to refine measure criteria and assess implementation. A close link between clinical practice, the evidence and practice recommendations, the data infrastructure, economic considerations, and national priorities was a key to the consensus process.
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Affiliation(s)
| | - Tina Veje Andersen
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200 Aarhus N, Denmark
| | - Hanne Soendergaard
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200 Aarhus N, Denmark
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Schjødt I, Mols RE, Eiskjær H, Bakos I, Horváth-Puhó E, Gustafsson F, Kristensen SL, Larsson JE, Løgstrup BB. Long-Term Medical Treatment and Adherence in Patients With Left Ventricular Assist Devices: A Danish Nationwide Cohort Study. ASAIO J 2023; 69:e482-e490. [PMID: 37792681 DOI: 10.1097/mat.0000000000002057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
The use of a left ventricular assist device (LVAD) in treating advanced heart failure has increased. However, data regarding medical treatment and adherence following LVAD implantation is sparse, particularly whether socioeconomic factors (cohabitation status, educational level, employment status, and income) and multimorbidity influence these aspects, which are known to impact adherence in heart failure patients. We performed a nationwide cohort study of 119 patients with LVAD implanted between January 1, 2006, and December 31, 2018, who were discharged alive with LVAD therapy. We linked individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish medical and administrative registers. Medical treatment 90-day pre-LVAD and 720-day post-LVAD were assessed using descriptive statistics in 90-day intervals. Medication adherence (proportion of days covered ≥80%) was assessed 181- to 720-day post-LVAD. The proportions of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (88.7%), beta-blockers (67.0%), mineralocorticoid receptor antagonists (62.9%), warfarin (87.6%), and aspirin (55.7%) within 90-day post-LVAD were higher than pre-LVAD and were stable during follow-up. Medication adherence ranged from 86.7% (aspirin) to 97.8% (warfarin). Socioeconomic factors and multimorbidity did not influence medical medication use and adherence. Among LVAD patients, medical treatment and adherence are at high levels, regardless of socioeconomic background and multimorbidity.
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Affiliation(s)
- Inge Schjødt
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke E Mols
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Eiskjær
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Johan E Larsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Brian B Løgstrup
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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18
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Lambrecht J, Abir M, Seiler K, Kamdar N, Peterson T, Lin P, Nham W, Greenwood-Ericksen M. Conceptualizing lifer versus destination patients for optimized care delivery. BMC Health Serv Res 2023; 23:1190. [PMID: 37915060 PMCID: PMC10619315 DOI: 10.1186/s12913-023-10214-2] [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: 09/08/2022] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Patients presenting to academic medical centers (AMC) typically receive primary care, specialty care, or both. Resources needed for each type of care vary, requiring different levels of care coordination. We propose a novel method to determine whether a patient primarily receives primary or specialty care to allow for optimization of care coordination. OBJECTIVES We aimed to define the concepts of a Lifer Patient and Destination Patient and analyze the current state of care utilization in those groups to inform opportunities for improving care coordination. METHODS Using AMC data for a 36-month study period (FY17-19), we evaluated the number of unique patients by residence zip code. Patients with at least one primary care visit and patients without a primary care visit were classified as Lifer and Destination patients, respectively. Cohen's effect sizes were used to evaluate differences in mean utilization of different care delivery settings. RESULTS The AMC saw 35,909 Lifer patients and 744,037 Destination patients during the study period. Most patients were white, non-Hispanic females; however, the average age of a Lifer was seventy-two years whereas that of a Destination patient was thirty-eight. On average, a Lifer had three times more ambulatory care visits than a Destination patient. The proportion of Inpatient encounters is similar between the groups. Mean Inpatient length of stay (LOS) is similar between the groups, but Destination patients have more variance in LOS. The rate of admission from the emergency department (ED) for Destination patients is nearly double Lifers'. CONCLUSION There were differences in ED, ambulatory care, and inpatient utilization between the Lifer and Destination patients. Furthermore, there were incongruities between rate of hospital admissions and LOS between two groups. The Lifer and Destination patient definitions allow for identification of opportunities to tailor care coordination to these unique groups and to allocate resources more efficiently.
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Affiliation(s)
- Jacob Lambrecht
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Kristian Seiler
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Tim Peterson
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine Research, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Greenwood-Ericksen
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
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Axon DR, Grieser M. Characteristics Associated with Multimorbidity among Older United States Adult Opioid Users with Pain. J Clin Med 2023; 12:6684. [PMID: 37892821 PMCID: PMC10607778 DOI: 10.3390/jcm12206684] [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: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
The objective of this study was to investigate the variables associated with multimorbidity status among older United States (US) adults with self-reported pain and opioid use. This study used a cross-sectional retrospective database design that included US adults aged ≥50 years with self-reported pain who used an opioid in 2019 in the Medical Expenditure Panel Survey data. Multivariable logistic regression models, weighted to produce nationally representative estimates, were used to determine variables significantly associated with multimorbidity status (≥2 versus <2 chronic conditions). Significance was determined using an a priori alpha level of 0.05. In the adjusted logistic regression analysis, those aged 50-64 (vs. ≥65 years), Hispanic (vs. non-Hispanic), employed (vs. unemployed), and who performed frequent exercise (vs. no frequent exercise) were associated with lower odds of having multimorbidity. In conclusion, these characteristics may be targets for pain management and opioid use interventions among older US adults. Further research is needed to investigate the variables associated with multimorbidity in greater detail.
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Affiliation(s)
- David R. Axon
- Department of Pharmacy Practice & Science, R. Ken Coit College of Pharmacy, University of Arizona, 1295 N Martin Ave., P.O. Box 210202, Tucson, AZ 85721, USA;
- Center for Health Outcomes and PharmacoEconomic Research (HOPE Center), R. Ken Coit College of Pharmacy, University of Arizona, 1295 N Martin Ave., P.O. Box 210202, Tucson, AZ 85721, USA
| | - Megan Grieser
- Department of Pharmacy Practice & Science, R. Ken Coit College of Pharmacy, University of Arizona, 1295 N Martin Ave., P.O. Box 210202, Tucson, AZ 85721, USA;
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Chlabicz M, Jamiołkowski J, Sowa P, Zalewska M, Kiszkiel Ł, Ciołkiewicz M, Motkowski R, Kowalska I, Minarowski Ł, Kamiński KA. Multimorbidity Patterns in the Urban Population in Poland. J Clin Med 2023; 12:5860. [PMID: 37762801 PMCID: PMC10531963 DOI: 10.3390/jcm12185860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
A number of studies have been conducted on multimorbidity; however, there are different patterns in various countries, ethnicities and social groups. The aim of this study is to estimate the prevalence of multimorbidity (physical diseases) in the urban population in Poland. In this population-based study, we examined multimorbidity stratified by sex, age, educational attainment and professional activity. Sixty-seven conditions were identified based on self-reported history (known conditions) and completed examinations (unknown conditions). Among the overall individuals aged 20-80 years, 1422 (88.2%) of the total 1612 individuals, 787 (88.9%) of 885 women and 635 (87.3%) of 727 men were diagnosed with at least two chronic conditions. On average, 5.25 ± 3.5 conditions occurred in the study population. The number of diagnosed conditions per individual increased with age and decreased with higher educational levels, with differing pathways in women and men. Women showed a higher number of conditions than men in the same age groups and educational levels. Only among students, the level of multimorbidity was lower in women than in men. In the other occupational activity categories, it was already higher in women. The level of multimorbidity in employed and unemployed individuals in a particular sex cluster was similar. We identified a high prevalence of multimorbidity in the urban population in Poland varying by age, sex, education attainment and professional activity. Our work may help in the selection of appropriate screening tests based on age, sex and educational attainment in order to recognise multimorbidity based on both known and unknown conditions. Ultimately, it may impact clinical practice, service delivery and study design.
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Affiliation(s)
- Małgorzata Chlabicz
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (P.S.); (M.Z.)
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Jacek Jamiołkowski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (P.S.); (M.Z.)
| | - Paweł Sowa
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (P.S.); (M.Z.)
| | - Magdalena Zalewska
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (P.S.); (M.Z.)
| | - Łukasz Kiszkiel
- Society and Cognition Unit, Institute of Sociology, University of Bialystok, 15-403 Bialystok, Poland;
| | - Mariusz Ciołkiewicz
- Department of Rehabilitation, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Radosław Motkowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, University Children’s Hospital, Medical University of Bialystok, 15-274 Bialystok, Poland;
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Łukasz Minarowski
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, 15-540 Bialystok, Poland;
| | - Karol A. Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.C.); (J.J.); (P.S.); (M.Z.)
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21
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Hong HA, Fallah N, Wang D, Cheng CL, Humphreys S, Parsons J, Noonan VK. Multimorbidity in persons with non-traumatic spinal cord injury and its impact on healthcare utilization and health outcomes. Spinal Cord 2023; 61:483-491. [PMID: 37604933 DOI: 10.1038/s41393-023-00915-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
STUDY DESIGN Cross-sectional survey in Canada. OBJECTIVES To explore multimorbidity (the coexistence of two/more health conditions) in persons with non-traumatic spinal cord injury (NTSCI) and evaluate its impact on healthcare utilization (HCU) and health outcomes. SETTING Community-dwelling persons. METHODS Data from the Spinal Cord Injury Community Survey (SCICS) was used. A multimorbidity index (MMI) consisting of 30 secondary health conditions (SHCs), the 7-item HCU questionnaire, the Short Form-12 (SF-12), Life Satisfaction-11 first question, and single-item Quality of Life (QoL) measure were administered. Additionally, participants were grouped as "felt needed healthcare was received" (Group 1, n = 322) or "felt needed healthcare was not received" (Group 2, n = 89) using the HCU question. Associations among these variables were assessed using multivariable analysis. RESULTS 408 of 412 (99%) participants with NTSCI reported multimorbidity. Constipation, spasticity, and fatigue were the most prevalent self-reported SHCs. Group 1 had a higher MMI score compared to Group 2 (p < 0.001). A higher MMI score correlated with the feeling of not receiving needed care (OR 1.4, 95% CI 1.08-1.21), lower SF-12 (physical/mental component summary scores), being unsatisfied with life, and lower QoL (all p < 0.001). Additionally, Group 1 had more females (p < 0.001), non-Caucasians (p = 0.034), and lower personal annual income (p = 0.025). CONCLUSIONS Persons with NTSCI have multimorbidity, and the MMI score was associated with increased HCU and worse health outcomes. This work emphasizes the critical need for improved healthcare and monitoring. Future work determining specific thresholds for the MMI could be helpful for triage screening to identify persons at higher risk of poor outcomes.
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Affiliation(s)
- Heather A Hong
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | | | - Jessica Parsons
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
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22
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Kapur S, Sakyi KS, Lohia P, Goble DJ. Potential Factors Associated with Healthcare Utilization for Balance Problems in Community-Dwelling Adults within the United States: A Narrative Review. Healthcare (Basel) 2023; 11:2398. [PMID: 37685432 PMCID: PMC10486920 DOI: 10.3390/healthcare11172398] [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: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Falls are the leading cause of mortality and chronic disability in elderly adults. There are effective fall prevention interventions available. But only a fraction of the individuals with balance/dizziness problems are seeking timely help from the healthcare system. Current literature confirms the underutilization of healthcare services for the management of balance problems in adults, especially older adults. This review article explores factors associated with healthcare utilization as guided by the Andersen Healthcare Utilization Model, a framework frequently used to explore the factors leading to the use of health services. Age, sex, race/ethnicity, BMI, and comorbidities have been identified as some of the potential predisposing factors; socioeconomic status, health insurance, and access to primary care are the enabling and disabling factors; and severity of balance problem, perceived illness, and its impact on daily activities are the factors affecting need for care associated with healthcare utilization for balance or dizziness problems. Knowledge about these barriers can help direct efforts towards improved screening of vulnerable individuals, better access to care, and education regarding effective fall prevention interventions for those who are at risk for underutilization. This can aid in timely identification and management of balance problems, thereby reducing the incidence of falls.
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Affiliation(s)
- Shweta Kapur
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (S.K.); (K.S.S.); (D.J.G.)
| | - Kwame S. Sakyi
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (S.K.); (K.S.S.); (D.J.G.)
| | - Prateek Lohia
- Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Daniel J. Goble
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (S.K.); (K.S.S.); (D.J.G.)
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23
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Prior A, Vestergaard CH, Vedsted P, Smith SM, Virgilsen LF, Rasmussen LA, Fenger-Grøn M. Healthcare fragmentation, multimorbidity, potentially inappropriate medication, and mortality: a Danish nationwide cohort study. BMC Med 2023; 21:305. [PMID: 37580711 PMCID: PMC10426166 DOI: 10.1186/s12916-023-03021-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Patients with multimorbidity are frequent users of healthcare, but fragmented care may lead to suboptimal treatment. Yet, this has never been examined across healthcare sectors on a national scale. We aimed to quantify care fragmentation using various measures and to analyze the associations with patient outcomes. METHODS We conducted a register-based nationwide cohort study with 4.7 million Danish adult citizens. All healthcare contacts to primary care and hospitals during 2018 were recorded. Clinical fragmentation indicators included number of healthcare contacts, involved providers, provider transitions, and hospital trajectories. Formal fragmentation indices assessed care concentration, dispersion, and contact sequence. The patient outcomes were potentially inappropriate medication and all-cause mortality adjusted for demographics, socioeconomic factors, and morbidity level. RESULTS The number of involved healthcare providers, provider transitions, and hospital trajectories rose with increasing morbidity levels. Patients with 3 versus 6 conditions had a mean of 4.0 versus 6.9 involved providers and 6.6 versus 13.7 provider transitions. The proportion of contacts to the patient's own general practice remained stable across morbidity levels. High levels of care fragmentation were associated with higher rates of potentially inappropriate medication and increased mortality on all fragmentation measures after adjusting for demographic characteristics, socioeconomic factors, and morbidity. The strongest associations with potentially inappropriate medication and mortality were found for ≥ 20 contacts versus none (incidence rate ratio 2.83, 95% CI 2.77-2.90) and ≥ 20 hospital trajectories versus none (hazard ratio 10.8, 95% CI 9.48-12.4), respectively. Having less than 25% of contacts with your usual provider was associated with an incidence rate ratio of potentially inappropriate medication of 1.49 (95% CI 1.40-1.58) and a mortality hazard ratio of 2.59 (95% CI 2.36-2.84) compared with full continuity. For the associations between fragmentation measures and patient outcomes, there were no clear interactions with number of conditions. CONCLUSIONS Several clinical indicators of care fragmentation were associated with morbidity level. Care fragmentation was associated with higher rates of potentially inappropriate medication and increased mortality even when adjusting for the most important confounders. Frequent contact to the usual provider, fewer transitions, and better coordination were associated with better patient outcomes regardless of morbidity level.
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Affiliation(s)
- Anders Prior
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark.
- Department of Public Health, Aarhus University, Aarhus C, Denmark.
| | | | - Peter Vedsted
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Trinity College, University of Dublin, Dublin, Ireland
| | | | | | - Morten Fenger-Grøn
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Kantilafti M, Giannakou K, Chrysostomou S. Multimorbidity and food insecurity in adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0288063. [PMID: 37410753 PMCID: PMC10325088 DOI: 10.1371/journal.pone.0288063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Food insecurity is one of the main factors affecting multimorbidity. Previous studies have shown that food insecurity may lead to multimorbidity due to person's inability to consume nutritious diet. However, considering that multimorbidity may cause work-related disabilities and an unstable income, others support the possible effect that multimorbidity has on food insecurity. The purpose of this systematic review and meta-analysis is to examine the relationship between food insecurity and multimorbidity in adults. A systematic literature review of studies was performed using the PubMed, EBSCO and SCOPUS for all articles including adults ≥ 18-year-old with multimorbidity living in developed countries published from August 5th until December 7th 2022. Meta-analysis was performed considering results from the fully adjusted model. The methodological quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. This systematic review was not registered. This research received no specific grant from any funding agency. Four cross-sectional studies involving 45,404 participants were included in order to investigate the possible impact that food insecurity has on multimorbidity. The study findings showed an increased probability of multimorbidity 1.55 (95% CI:1.31-1.79, p<0.001, I2 = 44.1%) among people with food insecurity. Conversely, three of the included studies, involving 81,080 participants concluded that people with multimorbidity, have 2.58 (95% CI: 1.66-3.49, p<0.001, I2 = 89.7%) times higher odds to present food insecurity. This systematic review and meta-analysis provide evidence of a reverse association between food insecurity and multimorbidity. Further cross-sectional studies must be conducted in order to elucidate the association between multimorbidity and food insecurity across age groups and between the two genders.
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Affiliation(s)
- Maria Kantilafti
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Stavri Chrysostomou
- Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
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25
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Levinsen AKG, Kjaer TK, Maltesen T, Jakobsen E, Gögenur I, Borre M, Christiansen P, Zachariae R, Laurberg S, Christensen P, Kroman N, Larsen SB, Degett TH, Hölmich LR, Brown PDN, Johansen C, Kjær SK, Thygesen LC, Dalton SO. Educational differences in healthcare use among survivors after breast, prostate, lung, and colon cancer - a SEQUEL cohort study. BMC Health Serv Res 2023; 23:674. [PMID: 37349718 PMCID: PMC10286377 DOI: 10.1186/s12913-023-09683-2] [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: 03/31/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many cancer survivors experience late effects after cancer. Comorbidity, health literacy, late effects, and help-seeking behavior may affect healthcare use and may differ among socioeconomic groups. We examined healthcare use among cancer survivors, compared with cancer-free individuals, and investigated educational differences in healthcare use among cancer survivors. METHODS A Danish cohort of 127,472 breast, prostate, lung, and colon cancer survivors from the national cancer databases, and 637,258 age- and sex-matched cancer-free individuals was established. Date of entry was 12 months after diagnosis/index date (for cancer-free individuals). Follow-up ended at death, emigration, new primary cancer, December 31st, 2018, or up to 10 years. Information about education and healthcare use, defined as the number of consultations with general practitioner (GP), private practicing specialists (PPS), hospital, and acute healthcare contacts 1-9 years after diagnosis/index date, was extracted from national registers. We used Poisson regression models to compare healthcare use between cancer survivors and cancer-free individuals, and to investigate the association between education and healthcare use among cancer survivors. RESULTS Cancer survivors had more GP, hospital, and acute healthcare contacts than cancer-free individuals, while the use of PPS were alike. One-to-four-year survivors with short compared to long education had more GP consultations (breast, rate ratios (RR) = 1.28, 95% CI = 1.25-1.30; prostate, RR = 1.14, 95% CI = 1.10-1.18; lung, RR = 1.18, 95% CI = 1.13-1.23; and colon cancer, RR = 1.17, 95% CI = 1.13-1.22) and acute contacts (breast, RR = 1.35, 95% CI = 1.26-1.45; prostate, RR = 1.26, 95% CI = 1.15-1.38; lung, RR = 1.24, 95% CI = 1.16-1.33; and colon cancer, RR = 1.35, 95% CI = 1.14-1.60), even after adjusting for comorbidity. One-to-four-year survivors with short compared to long education had less consultations with PPS, while no association was observed for hospital contacts. CONCLUSION Cancer survivors used more healthcare than cancer-free individuals. Cancer survivors with short education had more GP and acute healthcare contacts than survivors with long education. To optimize healthcare use after cancer, we need to better understand survivors' healthcare-seeking behaviors and their specific needs, especially among survivors with short education.
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Affiliation(s)
| | - Trille Kristina Kjaer
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center and Clinic for Late Effects, Aarhus, Denmark
| | - Søren Laurberg
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Danish Cancer Society, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Urological Research Unit, Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thea Helene Degett
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
| | | | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer late effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Institute, 49 Strandboulevarden, Copenhagen, 2100, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Rea F, Ferrante M, Scondotto S, Corrao G. Small-area deprivation index does not improve the capability of multisource comorbidity score in mortality prediction. Front Public Health 2023; 11:1128377. [PMID: 37261238 PMCID: PMC10228715 DOI: 10.3389/fpubh.2023.1128377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background The stratification of the general population according to health needs allows to provide better-tailored services. A simple score called Multisource Comorbidity Score (MCS) has been developed and validated for predicting several outcomes. The aim of this study was to evaluate whether the ability of MCS in predicting 1-year mortality improves by incorporating socioeconomic data (as measured by a deprivation index). Methods Beneficiaries of the Italian National Health Service who in the index year (2018) were aged 50-85 years and were resident in the Sicily region for at least 2 years were identified. For each individual, the MCS was calculated according to his/her clinical profile, and the deprivation index of the census unit level of the individual's residence was collected. Frailty models were fitted to assess the relationship between the indexes (MCS and deprivation index) and 1-year mortality. Akaike information criterion and Bayesian information criterion statistics were used to compare the goodness of fit of the model that included only MCS and the model that also contained the deprivation index. The models were further compared by means of the area under the receiver operating characteristic curve (AUC). Results The final cohort included 1,062,221 individuals, with a mortality rate of 15.6 deaths per 1,000 person-years. Both MCS and deprivation index were positively associated with mortality.The goodness of fit statistics of the two models were very similar. For MCS only and MCS plus deprivation index models, Akaike information criterion were 17,013 and 17,038, respectively, whereas Bayesian information criterion were 16,997 and 17,000, respectively. The AUC values were 0.78 for both models. Conclusion The present study shows that socioeconomic features as measured by the deprivation index did not improve the capability of MCS in predicting 1-year risk of death. Future studies are needed to investigate other sources of data to enhance the risk stratification of populations.
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Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Mauro Ferrante
- Department of Culture and Society, University of Palermo, Palermo, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Directorate General for Health, Lombardy Region, Milan, Italy
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Wang Y, Du M, Qin C, Liu Q, Yan W, Liang W, Liu M, Liu J. Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study. BMC Health Serv Res 2023; 23:403. [PMID: 37101276 PMCID: PMC10131349 DOI: 10.1186/s12913-023-09391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Multimorbidity of non-communicable diseases (NCDs) is increasingly prevalent among older adults around the world, leading a higher risk of household catastrophic health expenditure (CHE). As current powerful evidence was insufficient, we aimed to estimate the association between multimorbidity of NCDs and the risk of CHE in China. METHODS We designed a cohort study using data investigated in 2011-2018 from the China Health and Retirement Longitudinal Study, which is a nationally-representative study covering 150 counties of 28 provinces in China. We used mean ± standard deviation (SD) and frequencies and percentages to describe baseline characteristics. Person χ2 test was employed to compare the differences of baseline characteristics between households with and without multimorbidity. Lorenz curve and concentration index were used to measure the socioeconomic inequalities of CHE incidence. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between multimorbidity and CHE. RESULTS Among 17,708 participants, 17,182 individuals were included for the descriptive analysis of the prevalence of multimorbidity in 2011, and 13,299 individuals (8029 households) met inclusion criteria and were included in the final analysis with a median of 83 (interquartile range: 25-84) person-months of follow-up. 45.1% (7752/17,182) individuals and 56.9% (4571/8029) households had multimorbidity at baseline. Participants with higher family economic level (aOR = 0.91, 95% CI: 0.86-0.97) had lower multimorbidity prevalence than those with lowest family economic level. 82.1% of participants with multimorbidity did not make use of outpatient care. The CHE incidence was more concentrated among participants with higher socioeconomic status (SES) with a concentration index of 0.059. The risk of CHE was 19% (aHR = 1.19, 95% CI: 1.16-1.22) higher for each additional NCD. CONCLUSIONS Approximately half of middle-aged and older adults in China had multimorbidity, causing a 19% higher risk of CHE for each additional NCD. Early interventions for preventing multimorbidity among people with low SES could be intensified to protect older adults from financial hardship. In addition, concerted efforts are needed to increase patients' rational healthcare utilization and strengthen current medical security for people with high SES to reduce economic disparities in CHE.
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Affiliation(s)
- Yaping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Chenyuan Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
- Key Laboratory of Reproductive Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China.
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
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Bell C, Prior A, Appel CW, Frølich A, Pedersen AR, Vedsted P. Multimorbidity and determinants for initiating outpatient trajectories: A population-based study. BMC Public Health 2023; 23:739. [PMID: 37085788 PMCID: PMC10120141 DOI: 10.1186/s12889-023-15453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/15/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Individuals with multimorbidity often receive high numbers of hospital outpatient services in concurrent trajectories. Nevertheless, little is known about factors associated with initiating new hospital outpatient trajectories; identified as the continued use of outpatient contacts for the same medical condition. PURPOSE To investigate whether the number of chronic conditions and sociodemographic characteristics in adults with multimorbidity is associated with entering a hospital outpatient trajectory in this population. METHODS This population-based register study included all adults in Denmark with multimorbidity on January 1, 2018. The exposures were number of chronic conditions and sociodemographic characteristics, and the outcome was the rate of starting a new outpatient trajectory during 2018. Analyses were stratified by the number of existing outpatient trajectories. We used Poisson regression analysis, and results were expressed as incidence rates and incidence rate ratios with 95% confidence intervals. We followed the individuals during the entire year of 2018, accounting for person-time by hospitalization, emigration, and death. RESULTS Incidence rates for new outpatient trajectories were highest for individuals with low household income and ≥3 existing trajectories and for individuals with ≥3 chronic conditions and in no already established outpatient trajectory. A high number of chronic conditions and male gender were found to be determinants for initiating a new outpatient trajectory, regardless of the number of existing trajectories. Low educational level was a determinant when combined with 1, 2, and ≥3 existing trajectories, and increasing age, western ethnicity, and unemployment when combined with 0, 1, and 2 existing trajectories. CONCLUSION A high number of chronic conditions, male gender, high age, low educational level and unemployment were determinants for initiation of an outpatient trajectory. The rate was modified by the existing number of outpatient trajectories. The results may help identify those with multimorbidity at greatest risk of having a new hospital outpatient trajectory initiated.
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Affiliation(s)
- Cathrine Bell
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark.
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
| | - Charlotte Weiling Appel
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Asger Roer Pedersen
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
| | - Peter Vedsted
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
- Research Unit for General Practice, Aarhus, Denmark
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Holm NN, Frølich A, Andersen O, Juul-Larsen HG, Stockmarr A. Longitudinal models for the progression of disease portfolios in a nationwide chronic heart disease population. PLoS One 2023; 18:e0284496. [PMID: 37079591 PMCID: PMC10118194 DOI: 10.1371/journal.pone.0284496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND AIM With multimorbidity becoming increasingly prevalent in the ageing population, addressing the epidemiology and development of multimorbidity at a population level is needed. Individuals subject to chronic heart disease are widely multimorbid, and population-wide longitudinal studies on their chronic disease trajectories are few. METHODS Disease trajectory networks of expected disease portfolio development and chronic condition prevalences were used to map sex and socioeconomic multimorbidity patterns among chronic heart disease patients. Our data source was all Danish individuals aged 18 years and older at some point in 1995-2015, consisting of 6,048,700 individuals. We used algorithmic diagnoses to obtain chronic disease diagnoses and included individuals who received a heart disease diagnosis. We utilized a general Markov framework considering combinations of chronic diagnoses as multimorbidity states. We analyzed the time until a possible new diagnosis, termed the diagnosis postponement time, in addition to transitions to new diagnoses. We modelled the postponement times by exponential models and transition probabilities by logistic regression models. FINDINGS Among the cohort of 766,596 chronic heart disease diagnosed individuals, the prevalence of multimorbidity was 84.36% and 88.47% for males and females, respectively. We found sex-related differences within the chronic heart disease trajectories. Female trajectories were dominated by osteoporosis and male trajectories by cancer. We found sex important in developing most conditions, especially osteoporosis, chronic obstructive pulmonary disease and diabetes. A socioeconomic gradient was observed where diagnosis postponement time increases with educational attainment. Contrasts in disease portfolio development based on educational attainment were found for both sexes, with chronic obstructive pulmonary disease and diabetes more prevalent at lower education levels, compared to higher. CONCLUSIONS Disease trajectories of chronic heart disease diagnosed individuals are heavily complicated by multimorbidity. Therefore, it is essential to consider and study chronic heart disease, taking into account the individuals' entire disease portfolio.
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Affiliation(s)
- Nikolaj Normann Holm
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
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Thanakiattiwibun C, Siriussawakul A, Virotjarumart T, Maneeon S, Tantai N, Srinonprasert V, Chaiwat O, Sriswasdi P. Multimorbidity, healthcare utilization, and quality of life for older patients undergoing surgery: A prospective study. Medicine (Baltimore) 2023; 102:e33389. [PMID: 37000055 PMCID: PMC10063272 DOI: 10.1097/md.0000000000033389] [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: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Abstract
Multimorbidity (≥2 chronic illnesses) is a worldwide healthcare challenge. Patients with multimorbidity have a reduced quality of life and higher mortality than healthy patients and use healthcare resources more intensively. This study investigated the prevalence of multimorbidity; examined the effects of multimorbidity on healthcare utilization; healthcare costs of multimorbidity; and compared the associations between the health-related quality of life (HRQoL) of older patients undergoing surgery and multimorbidity, the Charlson Comorbidity Index (CCI), the Simple Frailty Questionnaire (FRAIL), and the American Society of Anesthesiologists (ASA) physical status classifications. This prospective cohort study enrolled 360 patients aged > 65 years scheduled for surgery at a university hospital. Data were collected on their demographics, preoperative medical profiles, healthcare costs, and healthcare utilization (the quantification or description of the use of services, such as the number of preoperative visits, multiple-department consultations, surgery waiting time, and hospital length of stay). Preoperative-assessment data were collected via the CCI, FRAIL questionnaire, and ASA classification. HRQoL was derived using the EQ-5D-5L questionnaire. The 360 patients had a mean age of 73.9 ± 6.6 years, and 37.8% were men. Multimorbidity was found in 285 (79%) patients. The presence of multimorbidity had a significant effect on healthcare utilization (≥2 preoperative visits and consultations with ≥2 departments). However, there was no significant difference in healthcare costs between patients with and without multimorbidity. At the 3-month postoperative, patients without multimorbidity had significantly higher scores for HRQoL compared to those with multimorbidity (HRQoL = 1.00 vs 0.96; P < .007). While, patients with ASA Class > 2 had a significantly lower median HRQoL than patients with ASA Class ≤2 at postoperative day 5 (HRQoL = 0.76; P = .018), 1-month (HRQoL = 0.90; P = .001), and 3-months (HRQoL = 0.96; P < .001) postoperatively. Multimorbidity was associated with a significant increase in the healthcare utilization of the number of preoperative visits and a greater need for multiple-department consultations. In addition, multimorbidity resulted in a reduced HRQoL during hospital admission and 3-months postoperatively. In particular, the ASA classification > 2 apparently reduced postoperative HRQoL at day 5, 1-month, and 3-months lower than the ASA classification ≤2.
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Affiliation(s)
- Chayanan Thanakiattiwibun
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arunotai Siriussawakul
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Satanun Maneeon
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narisa Tantai
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Geriatrics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Onuma Chaiwat
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patcharee Sriswasdi
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101860. [PMID: 36864977 PMCID: PMC9971315 DOI: 10.1016/j.eclinm.2023.101860] [Citation(s) in RCA: 120] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults. METHODS We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I2 statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945). FINDINGS We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally. INTERPRETATION The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa. FUNDING None.
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Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Dipak Chandra Das
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Global Health Institute, North South University, Dhaka, Bangladesh
- Corresponding author.
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Bradford DRR, Allik M, McMahon AD, Brown D. Assessing the risk of endogeneity bias in health and mortality inequalities research using composite measures of multiple deprivation which include health-related indicators: A case study using the Scottish Index of Multiple Deprivation and population health and mortality data. Health Place 2023; 80:102998. [PMID: 36921377 DOI: 10.1016/j.healthplace.2023.102998] [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: 11/29/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
The inclusion of health-related indicators in composite measures of multiple deprivation introduces a risk of endogeneity bias when using the latter in health inequalities research. This bias may ultimately result in the inappropriate allocation of healthcare resources and maintenance of preventable health inequalities. Mitigation strategies to avoid this bias include removing the health-related indicators or using single constituent domains (such as income or employment class) in isolation. These strategies have not been widely validated. This study used population-level health and mortality data with a contemporary composite measure of multiple deprivation (Scottish Index of Multiple Deprivation; SIMD) to assess these mitigation strategies. The differences between deprivation methods (original, health excluded, and income domain) were negligible. The results of quantitative research on health inequalities are unlikely to be affected by endogeneity bias.
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Affiliation(s)
- D R R Bradford
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom.
| | - M Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom
| | - A D McMahon
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, G2 3JZ, United Kingdom
| | - D Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8TB, United Kingdom
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Roomaney RA, van Wyk B, Cois A, Pillay van-Wyk V. Multimorbidity patterns in South Africa: A latent class analysis. Front Public Health 2023; 10:1082587. [PMID: 36711391 PMCID: PMC9875075 DOI: 10.3389/fpubh.2022.1082587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction South Africa has the largest burden of HIV worldwide and has a growing burden of non-communicable diseases; the combination of which may lead to diseases clustering in ways that are not seen in other regions. This study sought to identify common disease classes and sociodemographic and lifestyle factors associated with each disease class. Methods Data were analyzed from the South African Demographic and Health Survey 2016. A latent class analysis (LCA) was conducted using nine disease conditions. Sociodemographic and behavioral factors associated with each disease cluster were explored. All analysis was conducted in Stata 15 and the LCA Stata plugin was used to conduct the latent class and regression analysis. Results Multimorbid participants were included (n = 2 368). Four disease classes were identified: (1) HIV, Hypertension and Anemia (comprising 39.4% of the multimorbid population), (2) Anemia and Hypertension (23.7%), (3) Cardiovascular-related (19.9%) and (4) Diabetes and Hypertension (17.0%). Age, sex, and lifestyle risk factors were associated with class membership. In terms of age, with older adults were less likely to belong to the first class (HIV, Hypertension and Anemia). Males were more likely to belong to Class 2 (Anemia and Hypertension) and Class 4 (Diabetes and Hypertension). In terms of alcohol consumption, those that consumed alcohol were less likely to belong to Class 4 (Diabetes and Hypertension). Current smokers were more likely to belong to Class 3 (Cardiovascular-related). People with a higher body mass index tended to belong to Class 3 (Cardiovascular-related) or the Class 4 (Diabetes and Hypertension). Conclusion This study affirmed that integrated care is urgently needed, evidenced by the largest disease class being an overlap of chronic infectious diseases and non-communicable diseases. This study also highlighted the need for hypertension to be addressed. Tackling the risk factors associated with hypertension could avert an epidemic of multimorbidity.
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Affiliation(s)
- Rifqah Abeeda Roomaney
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa,School of Public Health, University of the Western Cape, Cape Town, South Africa,*Correspondence: Rifqah Abeeda Roomaney ✉
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Annibale Cois
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa,Division of Health Systems and Public Health, Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
| | - Victoria Pillay van-Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Ahmed A, Khan HT, Lawal M. Systematic Literature Review of the Prevalence, Pattern, and Determinant of Multimorbidity Among Older Adults in Nigeria. Health Serv Res Manag Epidemiol 2023; 10:23333928231178774. [PMID: 37434721 PMCID: PMC10331101 DOI: 10.1177/23333928231178774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Multimorbidity is a rising health issue globally and it is likely to become challenging in developing countries like Nigeria as they experience economic, demographic, and epidemiological transition. Yet, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. This study aims to systematically review studies of the prevalence, patterns, and determinants of multimorbidity in Nigeria. Methods Studies were identified by searching 5 electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, Africa Index Medicus/Global Index Medicus). Multimorbidity as well as other versions of it was used to search. The prevalence and determinants were also searched. According to preestablished inclusion criteria, and using different search strategies, 6 articles were included. The quality and risk of bias were assessed using Joanna Briggs Institute appraisal tool for prevalence studies. Two researchers assessed the eligibility of studies for inclusion. The protocol was registered on PROSPERO Ref no. CRD42021273222. The overall prevalence, pattern, and determinants were analyzed. Results We identified 6 eligible publications describing studies that included a total of 3332 (men 47.5%, women 52.5%) patients from 4 states plus the federal capital territory Abuja. The multimorbidity prevalence ranges from 27% to 74% among elderly Nigerians. Cardiovascular together with metabolic and/or musculoskeletal conditions were the frequent patterns of multimorbidity. A positive association was observed between age and multimorbidity in most studies. Other factors associated with multimorbidity were female gender, low education status, poor monthly income/unemployment, hospitalization, medical visits, and emergency services. Conclusion There has been a growing need for more applied health services research to understand better and manage multimorbidity in developed countries. The scarcity of studies in our review reveals that multimorbidity is not a priority area of research in Nigeria, and this will continue to hinder policy development in that area.
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Affiliation(s)
- Abdulsalam Ahmed
- College of Nursing, Midwifery, and Healthcare, University of West London, London, United Kingdom of Great Britain and Northern Ireland
| | - Hafiz T.A. Khan
- College of Nursing, Midwifery, and Healthcare, University of West London, London, United Kingdom of Great Britain and Northern Ireland
| | - Muili Lawal
- College of Nursing, Midwifery, and Healthcare, University of West London, London, United Kingdom of Great Britain and Northern Ireland
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Kannukene A, Orrego C, Lember M, Uusküla A, Põlluste K. Estonian adverse events study for multimorbid patients using Estonian Trigger Tool (MUPETT-MUltimorbid Patients-Estonian Trigger Tool). Development of Estonian trigger tool for multimorbid patients. A study protocol for mixed-methods study. PLoS One 2023; 18:e0280200. [PMID: 36928658 PMCID: PMC10019657 DOI: 10.1371/journal.pone.0280200] [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: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION It is widely recognized that providing healthcare may produce harm to the patient. Different approaches have been developed to measure the burden of adverse events (AEs) to plan and measure the effects of interventions. One of the most widely used instruments is the Trigger Tool, which has previously been modified to be used on various settings and translated into many languages. Multimorbidity complicates care and may increase the number of AEs patients experience. Currently there is no instrument designed to measure AEs in multimorbid patients. In Estonia, there is currently no validated instrument to measure the burden of AEs. AIMS The aim of this study will be evaluating the characteristics and ocurrence of AEs in multimorbid patients in hospitalised internal medicine patients of Estonia, and describes the development of a trigger tool for this purpose. METHODS AND ANALYSIS We will search for the evidence on measuring AEs in the population of multimorbid patients focusing on trigger tools, and synthesize the data. Data collection of the triggers from the literature will be followed by translating triggers from English to Estonian. An expert multidisciplinary panel will select the suitable triggers for this population. Trigger tool will be pre-tested to assess agreement among professionals and usability of the tool. Validation will be done using 90 medical records. A cross-sectional study in internal medicine departments of two Estonian tertiary care hospitals will be performed to identify the frequency and characteristics of AEs in 960 medical records. We will also provide preventability potential and influencing factors. DISSEMINATION Results will be disseminated to healthcare providers and stakeholders at national and international conferences, and as a doctoral medical thesis.
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Affiliation(s)
- Angela Kannukene
- Department of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- * E-mail:
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margus Lember
- Department of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Clinic of Internal Medicine, Tartu University Hospital, Tartu, Estonia
| | - Anneli Uusküla
- Department of Medicine, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
- Clinic of Dermatology, Tartu Univeristy Hospital, Tartu, Estonia
| | - Kaja Põlluste
- Department of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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Hvidberg MF, Frølich A, Lundstrøm SL. Catalogue of socioeconomic disparities and characteristics of 199+ chronic conditions-A nationwide register-based population study. PLoS One 2022; 17:e0278380. [PMID: 36584039 PMCID: PMC9803180 DOI: 10.1371/journal.pone.0278380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Real-world information on socioeconomic differences within and between chronic conditions represents an important data source for treatments and decision-makers executing and prioritising healthcare resources. AIMS The aim of this study was to estimate the prevalence and mean of socioeconomic disparities from educational, income, and socioeconomic positions of 199 chronic conditions and disease groups, including sex and age group estimates, for use in planning of care services and prioritisation, by healthcare professionals, decision-makers and researchers. METHODS The study population includes all Danish residents 16 years and above, alive on 1 January 2013 (n = 4,555,439). The data was established by linking seven national registers encompassing educational achievements, incomes, socioeconomic positions, hospital- and general practice services, and filled-in out-of-hospital prescriptions. The health register data were used to identify the 199+ chronic conditions. Socioeconomic differences were primarily measured as differences in educational prevalence levels from low to high educational achievements using a ratio. Furthermore, multiple binary logistic regression models were carried out to control for potential confounding and residual correlations of the crude estimates. RESULTS The prevalence of having one or more chronic conditions for patients with no educational achievement was 768 per thousand compared to 601.3 for patients with higher educational achievement (ratio 1.3). Across disease groups, the highest educational differences were found within disease group F-mental and behavioural (ratio 2.5), E-endocrine, nutritional and metabolic disease (ratio 2.4), I-diseases of the circulatory system (ratio 2.1) and, K-diseases of the digestive system (ratio 2.1). The highest educational differences among the 29 common diseases were found among schizophrenia (ratio 5.9), hyperkinetic disorders (ratio 5.2), dementia (ratio 4.9), osteoporosis (ratio 3.9), type 2 diabetes (ratio 3.8), chronic obstructive pulmonary disease COPD (ratio 3.3), heart conditions and stroke (ratios ranging from 2.3-3.1). CONCLUSIONS A nationwide catalogue of socioeconomic disparities for 199+ chronic conditions and disease groups is catalogued and provided. The catalogue findings underline a large scope of socioeconomic disparities that exist across most chronic conditions. The data offer essential information on the socioeconomic disparities to inform future socially differentiated treatments, healthcare planning, etiological, economic, and other research areas.
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Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- University of York, York, United Kingdom
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sanne Lykke Lundstrøm
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region of Denmark
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Inequity in the healthcare utilization among latent classes of elderly people with chronic diseases and decomposition analysis in China. BMC Geriatr 2022; 22:846. [PMID: 36357825 PMCID: PMC9650823 DOI: 10.1186/s12877-022-03538-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies have shown chronic disease-based healthcare utilization inequity is common. Hence, exploring this issue can help in establishing targeted measures and protecting the rights and interests of vulnerable groups. Against this background, the purpose of this study is to explore the latent classification of elderly patients with chronic disease and compare healthcare utilization inequity among latent classes. METHODS This study used the data of 7243 elderly patient with chronic diseases collected from the China Health and Retirement Longitudinal Study in 2018. Latent class analysis was used to classify the patients with chronic diseases, and analysis of variance and [Formula: see text] tests were utilized to test the differences in characteristics among latent classes. Healthcare utilization inequity was measured based on the concentration index (CI), and the CI was decomposed to compare the horizontal index of healthcare utilization among the latent classes. RESULTS The patients with chronic diseases were divided into five latent classes, namely, the musculoskeletal system, hypertension, respiratory system, digestive system and cardiovascular system groups. Statistically significant differences in social demographic characteristics were observed among the five latent classes (P < 0.05). A pro-rich healthcare utilization inequity for all respondents was observed (outpatient CI = 0.080, inpatient CI = 0.135), and a similar phenomenon in latent classes was found except for the musculoskeletal system group in outpatient visits (CI = -0.037). The digestive system group had the worst equity (outpatient CI = 0.197, inpatient CI = 0.157) and the respiratory system group had the best (outpatient CI = 0.001, inpatient CI = 0.086). After balancing the influence of health need factors, healthcare utilization inequity was almost alleviated. Furthermore, for all respondents, the contribution of health need factors (65.227% for outpatient and 81.593% for inpatient) was larger than that of socioeconomic factors (-21.774% for outpatient and 23.707 for inpatient), and self-rated health status was the greatest contributor (57.167% for outpatient and 79.399% for inpatient). The characteristics were shown in latent classes. CONCLUSIONS Healthcare utilization inequity still exists in elderly patients with chronic diseases, and the specific performances of inequity vary among latent classes. Moreover, self-rated health status plays an important role in healthcare utilization inequity. Providing financial support to low-income patients with certain chronic diseases, focusing on their physical and mental feelings and guiding them to evaluate their health status correctly could be essential for alleviating healthcare utilization inequity among elderly patients with chronic diseases.
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Social disparities in unplanned 30-day readmission rates after hospital discharge in patients with chronic health conditions: A retrospective cohort study using patient level hospital administrative data linked to the population census in Switzerland. PLoS One 2022; 17:e0273342. [PMID: 36137092 PMCID: PMC9499293 DOI: 10.1371/journal.pone.0273342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/06/2022] [Indexed: 11/19/2022] Open
Abstract
Unplanned readmissions shortly after discharge from hospital are common in chronic diseases. The risk of readmission has been shown to be related both to hospital care, e.g., medical complications, and to patients’ resources and abilities to manage the chronic disease at home and to make appropriate use of outpatient medical care. Despite a growing body of evidence on social determinants of health and health behaviour, little is known about the impact of social and contextual factors on readmission rates. The objective of this study was to analyse possible effects of educational, financial and social resources of patients with different chronic health conditions on unplanned 30 day-readmission risks. The study made use of nationwide inpatient hospital data that was linked with Swiss census data. The sample included n = 62,109 patients aged 25 and older, hospitalized between 2012 and 2016 for one of 12 selected chronic conditions. Multivariate logistic regressions analysis was performed. Our results point to a significant association between social factors and readmission rates for patients with chronic conditions. Patients with upper secondary education (OR = 1.26, 95% CI: 1.11, 1.44) and compulsory education (OR = 1.51, 95% CI: 1.31, 1.74) had higher readmission rates than those with tertiary education when taking into account demographic, social and health status factors. Having private or semi-private hospital insurance was associated with a lower risk for 30-day readmission compared to patients with mandatory insurance (OR = 0.81, 95% CI: 0.73, 0.90). We did not find a general effect of social resources, measured by living with others in a household, on readmission rates. The risk of readmission for patients with chronic conditions was also strongly predicted by type of chronic condition and by factors related to health status, such as previous hospitalizations before the index hospitalization (+77%), number of comorbidities (+15% higher probability per additional comorbidity) as well as particularly long hospitalizations (+64%). Stratified analysis by type of chronic condition revealed differential effects of social factors on readmissions risks. Compulsory education was most strongly associated with higher odds for readmission among patients with lung cancer (+142%), congestive heart failure (+63%) and back problems (+53%). We assume that low socioeconomic status among patients with chronic conditions increases the risk of unplanned 30-day readmission after hospitalisation due to factors related to their social situation (e.g., low health literacy, material deprivation, high social burden), which may negatively affect cooperation with care providers and adherence to recommended therapies as well as hamper active participation in the medical process and the development of a shared understanding of the disease and its cure. Higher levels of comorbidity in socially disadvantaged patients can also make appropriate self-management and use of outpatient care more difficult. Our findings suggest a need for increased preventive measures for disadvantaged populations groups to promote early detection of diseases and to remove financial or knowledge-based barriers to medical care. Socially disadvantaged patients should also be strengthened more in their individual and social resources for coping with illness.
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Hvidberg MF, Frølich A, Lundstrøm SL, Kamstrup-Larsen N. Catalogue of multimorbidity mean based severity and associational prevalence rates between 199+ chronic conditions-A nationwide register-based population study. PLoS One 2022; 17:e0273850. [PMID: 36103504 PMCID: PMC9473636 DOI: 10.1371/journal.pone.0273850] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Real-world data on multimorbidity represents an important but underutilised source of evidence for the planning of healthcare services, including prevention, treatments, and health economic modelling. AIMS This study aimed to estimate means of multimorbidity and provide associated prevalence rates and frequencies between 199 x 199 chronic conditions and disease groups based on the total adult Danish population and sex, age, and educational attainment. Thus, this study provides an off-the-shelf catalogue for use in treatments and planning by clinicians, decision-makers and researchers. METHODS The study population contained all Danish residents above 16 years on 1 January 2013 (n = 4,555,439). The data was based on the linkage of six national registers covering hospital contacts, services in general practice, filled-in out-of-hospital prescriptions, and educational attainments. The health registers were used to identify the 199 chronic conditions based on the ICD-10 classification system. RESULTS The mean number of chronic conditions (NCC) was 2.2. The mean increased with age, women had a higher mean than men, and there was a social gradient with the mean increasing with lower educational attainment. The mean NCC varied from 3.3-9.8 among all conditions. Across disease groups, the highest mean NCC were found within disease group N (chronic renal failure, mean = 8.8), D (in situ and benign neoplasms; mean = 6.5), K (diseases of the digestive system; mean = 5.7), and H (diseases of the eye and the ear; mean = 5.6). The highest mean NCC among the 29 common diseases was heart failure, ischemic heart diseases, angina pectoris, stroke, and dementia, with a mean above 6.5. Several prevalent conditions like hypertension, arthritis, chronic lower respiratory diseases, depression, type 2 diabetes, and overweight transcended other conditions regarding the associated prevalence rates. As one of the most frequent, hypertensive diseases were highly associated with arthritis (50.4%), depression (37.4%), type 2 diabetes (75.4%), cancers (49.7%), and being overweight (39.7%)-meaning that 50.4% of people with arthritis, 37.4% of people with depression and so on also had hypertensive diseases. The largest differences in means between individuals with no educational attainment and individuals with high educational attainment were found within disease groups J (diseases of the respiratory system, ratio = 1.8), Q (congenital malformations, deformations, and chromosomal abnormalities, ratio = 1.7), and B (viral hepatitis and human immunodeficiency virus disease, ratio = 1.7). CONCLUSIONS The current study provides a nationwide off-the-shelf catalogue of multimorbidity means and real-world associations estimates of 199+ chronic conditions for future clinical treatments and health care systems planning. The findings described are just one example of numerous results and underline that multimorbidity is highly prevalent in the adult Danish population and that it is a vital condition transcending all future medical treatment. The data offer essential information on the multimorbidity burden of disease in future differentiated treatments, healthcare planning, and economic, aetiological, and other research.
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Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- University of York, York, United Kingdom
| | - Anne Frølich
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
| | - Sanne Lykke Lundstrøm
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, København, Denmark
| | - Nina Kamstrup-Larsen
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
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The importance of child characteristics: children’s health and mothers’ subsequent childbearing. JOURNAL OF POPULATION RESEARCH 2022. [DOI: 10.1007/s12546-022-09292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Bayer-Oglesby L, Zumbrunn A, Bachmann N. Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland. PLoS One 2022; 17:e0272265. [PMID: 36001555 PMCID: PMC9401154 DOI: 10.1371/journal.pone.0272265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data. The study sample included n = 141,307 records of n = 92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for a chronic condition. Cross-classified multilevel models and mediation analysis were performed. Patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14-0.33; β 0.37, 95% CI 0.27-0.47, respectively) when taking into account demographic factors, main diagnosis and clustering on patient and hospital level. However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients had also prolonged hospital stays (β 0.34, 95% CI 0.13-0.55). Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system.
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Affiliation(s)
- Lucy Bayer-Oglesby
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Andrea Zumbrunn
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Nicole Bachmann
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - on behalf of the SIHOS Team
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 262] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Rodrigues LP, de Oliveira Rezende AT, Delpino FM, Mendonça CR, Noll M, Nunes BP, de Oliviera C, Silveira EA. Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis. Age Ageing 2022; 51:6649133. [PMID: 35871422 PMCID: PMC9308991 DOI: 10.1093/ageing/afac155] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multimorbidity is defined as the presence of multiple chronic conditions in the same individual. Multimorbidity is more prevalent in older adults and can lead to several adverse health outcomes. Methods We systematically reviewed evidence from observational studies to verify the association between multimorbidity and hospitalization in older adults. Furthermore, we also aimed to identify whether it changes according to gender, advanced age, institutionalization, and wealth of the country of residence. We searched the PubMed, Embase and Scopus databases from December 2020 to April 2021. The analysed outcomes were as follows: hospitalization, length of stay and hospital readmission. Results Of the 6,948 studies identified in the databases, 33 were included in this review. From the meta-analysis results, it was found that multimorbidity, regardless of the country’s wealth, was linked to hospitalization in older adults (OR = 2.52, CI 95% = 1.87–3.38). Both definitions of multimorbidity, ≥2 (OR = 2.35, 95% CI = 1.34–4.12) and ≥3 morbidities (OR = 2.52, 95% CI = 1.87–3.38), were associated with hospitalization. Regardless of gender, multimorbidity was associated with hospitalization (OR = 1.98, 95% CI = 1.67–2.34) and with readmission (OR = 1.07, 95% CI = 1.04–1.09). However, it was not possible to verify the association between multimorbidity and length of stay. Conclusions Multimorbidity was linked to a higher hospitalization risk, and this risk was not affected by the country’s wealth and patient’s gender. Multimorbidity was also linked to a higher hospital readmission rate in older adults. PROSPERO Registration (Registration number: CRD42021229328).
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Affiliation(s)
- Luciana Pereira Rodrigues
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil
| | | | - Felipe Mendes Delpino
- Department of Nursing in Public Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Matias Noll
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil.,Federal Institute Goiano, Campus Ceres, Goiás, Brazil.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Cesar de Oliviera
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil.,Federal Institute Goiano, Campus Ceres, Goiás, Brazil
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Bell C, Prior A, Frølich A, Appel CW, Vedsted P. Trajectories in Outpatient Care for People with Multimorbidity: A Population-Based Register Study in Denmark. Clin Epidemiol 2022; 14:749-762. [PMID: 35686026 PMCID: PMC9172733 DOI: 10.2147/clep.s363654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background Multimorbidity is a global health challenge. Individuals with multimorbidity are frequent users of healthcare services, and many experience fragmented healthcare. We assessed the number of outpatient trajectories and contacts with hospital outpatient clinics for individuals with multimorbidity and explored different time intervals for the occurrence of concurrent outpatient trajectories. Methods A population-based cohort of 1.3 million residents, ≥18 years, with multimorbidity was identified through Danish national health registries. Multimorbidity was defined as having two or more of 39 specific chronic conditions. Nine disease system categories were used to categorize outpatient contacts in 2018 into outpatient trajectories and trajectory-related contacts. We defined an "outpatient trajectory" as two contacts within 12 consecutive months for the same medical condition. All outpatient contacts and trajectories with related contacts were counted for 2018. The impact of different time intervals on the number of concurrent trajectories was analyzed. Results On 1 January 2019, 29% of the adult Danish population was classified as multimorbid. During 2018, 68% of them had ≥1 outpatient contact (median: 2 (IQI: 0-4)). Twenty-six percent had ≥1 outpatient trajectory. The median number of trajectory contacts was 3 (IQI: 2-5). The 4% of individuals with ≥2 outpatient trajectories accounted for 28% of trajectory contacts. During the 6-week period from the latest outpatient contact, 33% of all patients with ≥2 trajectories in 2018 experienced concurrent trajectories with outpatient contact. Conclusion Two-thirds of adult Danes with multimorbidity attended an outpatient clinic in 2018, and one-fourth had at least one outpatient trajectory. Individuals with two or more trajectories represented 4% and comprised 28% of the trajectory contacts; 33% had concurrent trajectories within a 6-week period. It appears that a small proportion place demands on outpatient clinics because of frequent attendance. A more uniform way of organizing outpatient trajectories for these patients merits consideration.
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Affiliation(s)
- Cathrine Bell
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Weiling Appel
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
| | - Peter Vedsted
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
- Research Unit for General Practice, Aarhus, Denmark
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Roomaney RA, van Wyk B, Cois A, Pillay-van Wyk V. One in five South Africans are multimorbid: An analysis of the 2016 demographic and health survey. PLoS One 2022; 17:e0269081. [PMID: 35617298 PMCID: PMC9135225 DOI: 10.1371/journal.pone.0269081] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/13/2022] [Indexed: 01/01/2023] Open
Abstract
Multimorbidity is a global research priority, yet relatively little is known about it in low and middle income countries. South Africa has the largest burden of HIV worldwide but also has a growing burden of non-communicable diseases; potentially leading to uncommon disease combinations. Information about the prevalence of multimorbidity and factors associated with it can assist in healthcare planning and targeting groups of people for interventions. This study aimed to determine the prevalence of multimorbidity by age and sex, as well as factors associated with multimorbidity in people 15 years and older. This study analyses the nationally representative 2016 South African Demographic Health Survey. The sample included 10 336 people who participated in the Adult Health questionnaire and approximately 7 961 people who provided biomarkers. Multivariate logistic regression was used to measure the association of multimorbidity with age, sex, living in an urban or rural area, education level, wealth level, employment status, body mass index, current alcohol or tobacco use. All analyses were conducted using STATA 15. Multimorbidity was present in 20.7% (95% CI: 19.5%- 21.9%) of participants; in 14.8% (95% CI: 13.4% - 16.3%) of males and 26.2% (95% CI: 24.7-27.7%) of females. Multimorbidity increased with age; with the highest odds in the 55-64 years old age group (OR: 24.910, 95% CI: 14.901-41.641, p < 0.001) compared to those aged 15-24 years. The odds of multimorbidity was also higher in young females compared to young males (OR: 2.734, 95% CI: 1.50-4.99, p = 0.001). Possessing tertiary education (OR: 0.722, 95% CI: 0.537-0.97, p = 0.031), being employed (OR: 0.813, 95% CI: 0.675-0.979, p = 0.029) or currently using alcohol (OR: 0.815, 95% CI: 0.686-0.968, p = 0.02) was protective against multimorbidity. Multimorbidity is prevalent within the South African population, with females and older adults being most affected. However, multimorbidity is also observed in younger adults and most likely driven by the high prevalence of HIV and hypertension.
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Affiliation(s)
- Rifqah Abeeda Roomaney
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Annibale Cois
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Division of Health Systems and Public Health, Department of Global Health, University of Stellenbosch, Western Cape South Africa
| | - Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
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Abstract
GOAL The objective of this retrospective, observational study was to assess the mediating effect of medical complexity on the relationship between social vulnerability and four acute care resource use outcomes-number of hospitalizations, emergency department (ED) visits, observation stays, and total visits. Such information may help healthcare managers better anticipate the effects of interventions targeted to the socially vulnerable in their patient population. METHODS Electronic health records of 147,496 adults served by 27 primary care practices in one large health system from 2015 to 2017 were used. Descriptive statistics were applied to characterize patients and the primary care practices included in the study. Causal mediation analyses using a modified Baron and Kenny approach were performed. PRINCIPAL FINDINGS Causal mediation analyses demonstrated that increased social vulnerability was associated with increased medical complexity (incidence rate ratio [IRR] = 1.57) and increased numbers of hospitalizations (IRR = 1.63), ED visits (IRR = 2.14), observation stays (IRR = 1.94), and total visits (IRR = 2.04). Effects remained significant, though attenuated, after adjusting for medical complexity (mediator), demographics, and medications (hospitalizations IRR = 1.44, ED visits IRR = 2.02, observation stays IRR = 1.74, total visits IRR = 1.86). Social vulnerability, given medical complexity, explained between 8% (ED visits) and 26% (hospitalizations) of the variation in outcomes. PRACTICAL APPLICATIONS These findings reinforce the need to modify interventions for medically complex adults to address their social needs and, consequently, reduce costly health services. Health systems seeking to reduce costly care can use these results to estimate savings in the treatment of patients with high social vulnerability-before they get chronic conditions and later as they seek care.
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Sørensen HT. Patients with Chronic Diseases Who Travel: Need for Global Access to Timely Health Care Data. Clin Epidemiol 2022; 14:513-519. [PMID: 35505690 PMCID: PMC9057227 DOI: 10.2147/clep.s360699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/18/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, DK-8200, Denmark
- Clinical Excellence Research Center, Stanford University, Palo Alto, CA, USA
- Correspondence: Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, Aarhus N, DK-8200, Denmark, Email
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Steinmair D, Löffler-Stastka H. Personalized treatment - which interaction ingredients should be focused to capture the unconscious. World J Clin Cases 2022; 10:2053-2062. [PMID: 35321177 PMCID: PMC8895185 DOI: 10.12998/wjcc.v10.i7.2053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/14/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at supporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.
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Affiliation(s)
- Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Wien 1090, Österreich, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Wien 1090, Österreich, Austria
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Puri P, Singh SK. Patterns and predictors of non-communicable disease multimorbidity among older adults in India: evidence from longitudinal ageing study in India (LASI), 2017-2018. J Public Health Policy 2022; 43:109-128. [PMID: 34997210 DOI: 10.1057/s41271-021-00321-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/13/2022]
Abstract
Escalating non-communicable disease multimorbidity rates among older adults is an emerging public health concern in India, but the literature sparsely addresses the epidemiology of multimorbidity. We explore levels, patterns, combinations and predictors of multimorbidity among older adults using information on 59,764 individuals, aged 45 years and older, from the first wave of Longitudinal Ageing Study in India (LASI), 2017-2018. We computed multimorbidity score for sixteen non-communicable diseases to identify frequently occurring morbidity patterns (dyads and triads) and assess the relationship between multimorbidity and selected background characteristics. Near third of the older adult population is affected by multimorbidity, with hypertension, gastrointestinal disorders, musculoskeletal disorders, diabetes and skin diseases being the most common. Policymakers should seek strategies to increase early detection and prevention of chronic diseases, delay the age at onset of disease for those who are not affected and improve management for those affected with multiple disease conditions.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Mumbai, Maharashtra, India.
| | - Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
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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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