Abstract
BackgroundThe prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine the strength of association of single and multimorbid physical chronic diseases with self-rated health in a middle-aged and older population in England, and to determine whether any association is mediated by depression and other psychosocial factors.Methods25 268 individuals aged 39 to 79 years recruited from general practice registers in the European Prospective Investigation of Cancer (EPIC-Norfolk) study, completed a survey including self-rated health, psychosocial function and presence of common physical chronic conditions (cancer, stroke, heart attack, diabetes, asthma/bronchitis and arthritis). Logistic regression models determined odds of “moderate/poor” compared to “good/excellent” health by condition and number of conditions adjusting for psychosocial measures.ResultsOne-third (8252) reported one, around 7.5% (1899) two, and around 1% (194) three or more conditions. Odds of “moderate/poor” self-rated health worsened with increasing number of conditions (one (OR = 1.3(1.2–1.4)) versus three or more (OR = 3.4(2.3–5.1)), and were highest where there was comorbidity with stroke (OR = 8.7(4.6–16.7)) or heart attack (OR = 8.5(5.3–13.6)). Psychosocial measures did not explain the association between chronic diseases and multimorbidity with self-rated health.The relationship of multimorbidity with self-rated health was particularly strong in men compared to women (three or more conditions: men (OR = 5.2(3.0–8.9)), women OR = 2.1(1.1–3.9)).ConclusionsSelf-rated health provides a simple, integrative patient-centred assessment for evaluation of illness in the context of multiple chronic disease diagnoses. Those registering in general practice in particular men with three or more diseases or those with cardiovascular comorbidities and with poorer self-rated health may warrant further assessment and intervention to improve their physical and subjective health.
Highlights
The prevalence of coexisting chronic conditions is rising
We aimed to explore the association between a number of common chronic physical conditions both as single and multimorbid conditions with Self-rated health (SRH), assessing for the mediating effects of psychosocial function using data from a large well-characterised population derived from GP registers [38]
Frequency of “moderate/ poor” SRH rose with the number of chronic conditions and was highest in those with stroke, heart attack and diabetes
Summary
The prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, give little information about impact on subjective health and personal illness experience. In recent international studies up to 50% of those with one chronic disease diagnosis have one or more other diagnoses; known as “multimorbidity”, the Cumulative Illness Rating Scale (CIRS), the Charlson index (Charlson) and the Functional Comorbidity Index (FCI) [16,17,18] While the latter are complex and designed for epidemiological rather than practice use, simple disease counts have shown to be valid and offer an intuitive approach to measurement [19,20,21]. Self-rated health (SRH) is elicited through a single question and could efficiently complement and individualise the count of common chronic diseases currently obtainable from General Practice records It has been widely validated in epidemiological studies, reflects the subjective experience of health associated with more complex measures of health-related quality of life, and independently predicts health outcomes including allcause mortality, disease specific mortality, morbidity and health service utilisation [22,23,24,25,26]
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