Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults.

Roselyne Akugizibwe,Graziano Onder,Davide L Vetrano,Amaia Calderón-Larrañaga,Albert Roso-Llorach,Alberto Zucchelli,Debora Rizzuto,Alessandra Marengoni

doi:10.3390/jcm9124001

Abstract

The presence of multiple chronic conditions (i.e., multimorbidity) increases the risk of hospitalisation in older adults. We aimed to examine the association between different multimorbidity patterns and unplanned hospitalisations over 5 years. To that end, 2,250 community-dwelling individuals aged 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were studied. Participants were grouped into six multimorbidity patterns using a fuzzy c-means cluster analysis. The associations between patterns and outcomes were tested using Cox models and negative binomial models. After 5 years, 937 (41.6%) participants experienced at least one unplanned hospitalisation. Compared to participants in the unspecific multimorbidity pattern, those in the cardiovascular diseases, anaemia and dementia pattern, the psychiatric disorders pattern and the metabolic and sleep disorders pattern presented with a higher hazard of first unplanned hospitalisation (hazard ratio range: 1.49–2.05; p < 0.05 for all), number of unplanned hospitalisations (incidence rate ratio (IRR) range: 1.89–2.44; p < 0.05 for all), in-hospital days (IRR range: 1.91–3.61; p < 0.05 for all), and 30-day unplanned readmissions (IRR range: 2.94–3.65; p < 0.05 for all). Different multimorbidity patterns displayed a differential association with unplanned hospital care utilisation. These findings call for a careful primary care follow-up of older adults with complex multimorbidity patterns.

Highlights

Multimorbidity, the co-occurrence of two or more chronic conditions in an individual [1,2,3,4], is expanding globally due to people’s longer life expectancy [5,6,7]
Subjects in the cardio/anaemia/dementia pattern (HR 2.05, 95% CI 1.62, 2.61), the metabolic/sleep disorders pattern (HR 1.50, 95% CI 1.20, 1.86) and the psychiatric disorders pattern (HR 1.49, 95% CI 1.13, 1.96) showed a significantly higher hazard of a first unplanned hospitalisation, compared to the unspecific pattern
Participants in the sensory/cancer pattern showed a higher hazard of unplanned hospitalisation (HR 1.24, 95% CI 1.01, 1.52), compared to the unspecific pattern

Summary

Introduction

Multimorbidity, the co-occurrence of two or more chronic conditions in an individual [1,2,3,4], is expanding globally due to people’s longer life expectancy [5,6,7]. The consequences of multimorbidity affect both individuals and health care systems [4], since multimorbidity has been associated with poorer quality of life and mental health, impaired functional ability, and increased health care costs [11,12,13]. Such elevated health care costs are attributed, among other factors, to an increased utilisation of primary care and, especially, hospital care [11,12]. Another retrospective study carried out in three developed countries involving patients with multimorbidity discharged from medical inpatient wards revealed that 15.6% of them were readmitted within 30 days from discharge and 9.6% of these readmissions were potentially avoidable [14]

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