Mortalidad y factores asociados de los pacientes con enfermedades crónicas complejas del ámbito rural y zonas de transformación social en Andalucía

Abstract

Objective: To determine one-year mortality and associated factors in patients with complex chronic diseases (CCP) in rural health centres and social transformation needs areas (STNA) in Primary Health Care (PHC) in Andalusia.Material and Methods: Design: 1-Year longitudinal observational prospective open study. Setting: 40 health centre. Subjects: consenting subjects over 18yr according multiple health condition criteria.Sample Size: 814 subjects (confidence interval 95%, alpha risk 0.03%, p=.2; 20% of sample increase due to possible losses).End-point: 1-year Mortality. Independent variables: socio-demographic, socio-familial, clinical, functional (Barthel Index –BI-, Lawton-Brody Index), cognitive (Pfeiffer Test), prescribed drugs, social healthcare resources consumption, and quality of life (EQ-5D). Data source: Interview and computerised clinical historyResults: A total of 832 CCP were included (48.8% women). One-year mortality was 17.8% (n=148). Logistic regression model for mortality included: aged 85 and over, having a caregiver, haemoglobin level less 10g/L, hospital admission in last year, BI under 60 points, and active neoplasia. The calibration obtained from model was good (p=.85 in the Hosmer–Lemeshow goodness-of-fit test), and the discrimination power also good (AUC=0.772 [0.68–0.77] in ROC curve).Conclusions: 1-year mortality of CCP in rural centres and STNA in PHC was 17.8%. Knowledge of the factors related to the mortality of CCP helps to approach the needs and social-health resources management.