High Prevalence Of Multimorbidity Research Articles

Non-communicable diseases related multimorbidity, catastrophic health expenditure, and associated factors in Ernakulam district

BackgroundMultimorbidity, the coexistence of two or more chronic conditions in an individual, has emerged as a significant public health challenge with profound economic implications, exerting substantial strain on healthcare systems and economies worldwide. This study aimed to estimate the prevalence of non-communicable diseases (NCD) related multimorbidity, catastrophic health expenditure (CHE), and associated factors among adults aged ≥40 years in Ernakulam district.MethodsA community-based cross-sectional study was conducted among 420 individuals aged ≥40 years using population probability sampling. The tools used were the Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC), the WHO STEPS Questionnaire, and the Patient Health Questionnaire-9 (PHQ-9), which assessed non-communicable diseases, diet, physical activity, smoking, alcohol consumption, and depression. A pretested semi-structured questionnaire collected data on health and household expenditures. Multimorbidity was defined as having two or more self-reported NCDs, and CHE was identified when health costs exceeded 10% of a household’s expenditure in the past month. Multivariable logistic regression was performed to find independent predictors of multimorbidity and CHE.ResultsThe mean age of participants was 60.02 ± 10 years. The prevalence of NCD multimorbidity was 42.6% (95% CI: 37.9–47.3%). The most common dyad was diabetes and hypertension (24.5, 95% CI: 20.4–28.6%). Higher odds of multimorbidity were observed in those aged ≥60 years (aOR = 3.03, 95% CI: 1.95–4.73), unmarried/widowed/divorced (aOR = 2.15, 95% CI: 1.28–3.63), unemployed (aOR = 1.81, 95% CI: 1.14–2.87), and tobacco users (aOR = 3.72, 95% CI: 1.85–7.48). Approximately 32.4% (95% CI: 25.5–39.3%) of households incurred catastrophic health expenditure (CHE) by treating adults with multimorbidity. Age ≥ 60 (aOR = 2.39, 95% CI: 1.99–5.77) and use of outpatient services (aOR = 4.09, 95% CI: 2.01–8.32) were independently associated with higher odds of CHE. IP services and each additional morbidity add ₹22,082.37 (β = 0.557, p < 0.001, 95% CI: ₹17,139.88– ₹27,024.86) and ₹1,278.75 (β = 0.128, p = 0.044, 95%CI: ₹35.58–₹2,521.92) to healthcare costs, respectively.ConclusionThe high prevalence of multimorbidity and associated CHE among individuals over 60 years highlights the urgent need for the National Programme for the Prevention and Control of Non-Communicable Diseases to prioritise multimorbidity and its management, especially above 60 years within this age group.

Abstract B148: Prevalence of Multimorbidity Among Patients with Newly Diagnosed Cancer at a Safety-Net Health System

Abstract Background: Multimorbidity (MM) presents challenges for cancer care and may require coordination between oncologists and primary or specialty care providers. Nevertheless, U.S.-based studies of MM among cancer patients have mostly been conducted in non-Hispanic White and insured populations, which limits understanding of strategic care planning and resource allocation among more diverse populations. Therefore, we aimed to assess the prevalence of MM among adults with newly diagnosed cancer at a large, racial/ethnically diverse safety-net health system. Methods: We used electronic health record and cancer registry data from JPS Health Network, an urban safety-net health system in North Texas. Our eligible population included patients ≥18 years of age diagnosed with first primary cancer in 2016 – 2020 (excluding in situ cases), whose diagnosis or first-course cancer treatment was received at JPS. Our outcomes of interest were MM (≥2 chronic conditions) and severe MM (≥3 chronic conditions) based on 30 chronic conditions defined by the Centers for Medicare & Medicaid Services with up to a 2-year lookback period before cancer diagnosis. We assessed overall and sub-group specific (age group, sex, and race/ethnicity) prevalence of MM and severe MM. We estimated prevalence differences (PD) and 95% confidence intervals between groups using pairwise comparisons with Bonferroni correction. Results: Our study population comprised 5,019 newly diagnosed adult cancer patients. The median age was 58 years and the majority were females (51%), racial/ethnic minorities (59%), uninsured (51%), and overweight or obese (69%). The most common cancer types were breast (13%), lung (12%), and colorectal (11%). Nearly half (45%) were diagnosed with advanced stage cancer. A high proportion of cancer patients had MM (79%) and severe MM (62%). The most common conditions were hypertension (55%), anemia (36%), hyperlipidemia (31%), diabetes (27%), and depressive mood disorders (22%). MM increased by age: 56% among patients aged 18 – 39 years, 78% among patients aged 40 – 64 years, and 91% among patients aged ≥65 years. A higher proportion of males had MM (PD: 6.0% [95% CI: 3.8%, 8.3%]) and severe MM (PD: 7.5% [95% CI: 4.9%, 10%]) compared with females. By race/ethnicity, Non-Hispanic Black patients had the highest prevalence of MM (PD: 8.1% [95% CI: 4.3%, 12%]) and severe MM (PD: 11% [95% CI: 6.7%, 16%]) compared with the lowest prevalences among Hispanic patients. Conclusions: We observed a high prevalence of MM and severe MM among adult cancer patients, particularly among patients aged ≥45 years and non-Hispanic Black patients. Our estimates were >15% higher than prior studies that included mostly non-Hispanic White adult cancer survivors with higher socioeconomic status. Our findings provide insight about the burden of MM among racially diverse cancer patients with low socioeconomic status, which may inform resource allocation and care coordination initiatives to manage MM. Citation Format: Anand B. Singh, Yan Lu, Aaron W Gehr, Kalyani Narra, Bhavna Tanna, Jolonda Bullock, Rachel J. Meadows. Prevalence of Multimorbidity Among Patients with Newly Diagnosed Cancer at a Safety-Net Health System [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B148.

Demographic Profile and Clinical Characteristics of Adults with Down Syndrome in North-Eastern Romania.

(1) Background: Down syndrome is characterized by physical abnormalities, intellectual disability (ID), and specific patterns of other health issues. Additionally, individuals with DS are known to experience premature aging and early onset of certain age-related medical conditions. These conditions are linked to higher incident disability and reduced survival rates compared to the general population. (2) Methods: Between July 2022 and February 2024, we conducted a prospective, observational study in the Cardiovascular Rehabilitation Clinic at Iasi Clinical Rehabilitation Hospital. The study included 28 patients diagnosed with Down Syndrome and a control group. Interdisciplinary interventions were tailored to address the needs of a complex patient, incorporating cardiological, endocrinological, genetical, biological and developmental support. Data on physical health, cognitive development, and psychosocial well-being were collected. (3) Results: Our DS group consisted of 11 (39%) females and 17 (61%) males. Their age ranged from 20 to 55 years with a mean of 28.07 ± 9.51. All patients were unmarried, living in urban areas, without a partner but with family support. In the study sample, 96.4% of participants had three or more comorbidities. (4) Conclusions: The high prevalence of multimorbidity, combined with little medication, contributes to a high level of clinical complexity, which appears to be similar to the one of the older non-trisomic population. As individuals with Down syndrome transition into adulthood, they may require a more comprehensive and holistic approach to their healthcare.

General practitioners’ assessment and management of chronic kidney disease in older patients- a mixed methods study

BackgroundChronic kidney disease (CKD) is commonly managed in general practice, with established guidelines for diagnosis and management. CKD is more prevalent in the older population, and is associated with lifestyle diseases as well as social deprivation. Older patients also commonly experience multimorbidity. Current CKD guidelines do not take age into account, with the same diagnostic and management recommendations for patients regardless of their age. We sought to investigate general practitioners’ (GPs’) approach to older patients with CKD, and whether their assessment and management differed from guideline recommendations. We explored the reasons for variation from guideline recommendations.MethodsThis was a mixed methods study of Australian GPs. An online anonymous survey about the use of CKD guidelines, and assessment and management of CKD was sent to 9500 GPs. Four hundred and sixty-nine (5%) of GPs responded, and the survey was completed by 399 GPs. Subsequently, 27 GPs were interviewed in detail about their diagnostic and management approach to older patients with declining kidney function.ResultsIn the survey, 48% of GPs who responded found the CKD guidelines useful for diagnosis and management. Four themes arose from our interviews: age-related decline in kidney function; whole person care; patient-centred care; and process of care that highlighted the importance of continuity of care. GPs recognised that older patients have an inherently high risk of lower kidney function. The GPs reported management of that higher risk focused on managing the whole person (not just a single disease focus) and being patient-centred. Patient-centred care expressed the importance of quality of life, shared decision making and being symptom focused. There was also a recognition that there is a difference between a sudden decline in kidney function and a stable but low kidney function and GPs would manage these situations differently.ConclusionsGPs apply guidelines in the management of CKD in older patients using a patient-centred and whole person approach to care. Older patients have a high prevalence of multimorbidity, which GPs carefully considered when applying existing CKD-specific guidelines. Future iterations of CKD Guidelines need to give due consideration to multimorbidity in older patients that can adversely impact on kidney function in addition to the expected age-related functional decline.

Multimorbidity in people living with HIV and cancer in Mexico.

The proportion of older people living with HIV (PLWH) has increased. Non-communicable diseases occur earlier in PLWH than in the general population. The goal of this study was to estimate the prevalence of comorbidities in PLWH and cancer in a tertiary referral center in Mexico City. In this retrospective study, we included PLWH > 40 years with a history of cancer, coming to Instituto Nacional de Cancerologia from 2010 through 2019. All patients needed to be on antiretrovirals for at least six months. Data collected included cancer type, comorbidities, frequency of polypharmacy, FRAX score and 10-year cardiovascular risk. Patients were evaluated for depression with the Beck Inventory Depression-II Scale. Variables associated to multimorbidity (2 or more comorbidities) were evaluated. Of 125 patients, 69% had at least one comorbidity; 32% had ≥ 2. Common comorbidities were dyslipidemia (54%), hypertension (19%), obesity (14%) and Diabetes (12%). In patients ≥ 50 years, 29 (62%) already undergone a densitometry and 9 (31%) had osteoporosis; 56 depression questionnaires were used: 30% had mild-to-severe depression. Being ≥ 50 years was associated with multimorbidity (aOR 2.57 (1.18-5.58), p = 0.017). A high prevalence of multimorbidity and poor screening of bone disease and mental health is reported in patients with PLWH and cancer. A holistic approach to the PLWH in the Infectious Diseases consultation is needed to improve the detection and management of non-communicable diseases, to go beyond viral suppression and towards an improved quality of life.

Multimorbidity in people living with HIV and cancer in Mexico.

The proportion of older people living with HIV (PLWH) has increased. Non-communicable diseases occur earlier in PLWH than in the general population. The goal of this study was to estimate the prevalence of comorbidities in PLWH and cancer in a tertiary referral center in Mexico City. In this retrospective study, we included PLWH > 40 years with a history of cancer, coming to Instituto Nacional de Cancerologia from 2010 through 2019. All patients needed to be on antiretrovirals for at least six months. Data collected included cancer type, comorbidities, frequency of polypharmacy, FRAX score and 10-year cardiovascular risk. Patients were evaluated for depression with the Beck Inventory Depression-II Scale. Variables associated to multimorbidity (2 or more comorbidities) were evaluated. Of 125 patients, 69% had at least one comorbidity; 32% had ≥ 2. Common comorbidities were dyslipidemia (54%), hypertension (19%), obesity (14%) and Diabetes (12%). In patients ≥ 50 years, 29 (62%) already undergone a densitometry and 9 (31%) had osteoporosis; 56 depression questionnaires were used: 30% had mild-to-severe depression. Being ≥ 50 years was associated with multimorbidity (aOR 2.57 (1.18-5.58), p = 0.017). A high prevalence of multimorbidity and poor screening of bone disease and mental health is reported in patients with PLWH and cancer. A holistic approach to the PLWH in the Infectious Diseases consultation is needed to improve the detection and management of non-communicable diseases, to go beyond viral suppression and towards an improved quality of life.

Prevalence and pattern of multimorbidity in China: a cross-sectional study of 224,142 adults over 60 years old.

To examine the prevalence and potential risk factors of multimorbidity among older adult in China. In addition, we investigated the pattern of multimorbidity. This study is based on data from the fourth Sample Survey of the Aged Population in Urban and Rural China (SSAPUR) in 2015, a comprehensive survey of individuals aged 60 years or older in China. We calculated baseline data and prevalence rates for comorbidities, stratified by household registration, age, sex, education, exercise, and health insurance. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for comorbidities. Furthermore, we determined the prevalence rates for the three most frequent disease combinations. A total of 215,040 participants were included in our analysis. The prevalence of multimorbidity was 50.5% among the older adult in China. The prevalence rate was slightly higher in rural areas than in urban areas, with rates of 51.5 and 49.6%, respectively (p < 0.001). Moreover, the prevalence rate was higher in females than in males, with rates of 55.2 and 45.3%, respectively (p < 0.001). Multivariate logistic regression analysis revealed that individuals aged 70-79 years (OR:1.40, 95% CI: 1.38-1.43, p < 0.001) and over 80 years (OR:1.41, 95% CI: 1.38-1.45, p < 0.001) had a higher prevalence of multimorbidity than those aged 60-69 years. The most prevalent pair of comorbidities was hypertension and osteoarthropathy, with 19.6% of the participants having these two conditions, accounting for 5.4% of the total participants. Our findings indicate a high prevalence of multimorbidity among the older adult in China. Increased expenditure on preventive health care, popularization of general medicine and popular medical education may be adopted by the Government to cope with the high prevalence of multimorbidity.

STEP-Home transdiagnostic group reintegration workshop to improve mental health outcomes for post-9/11 Veterans: Design, methods, and rationale for a randomized controlled behavioral trial

BackgroundMany post-9/11 U.S. combat Veterans experience difficulty readjusting to civilian life after military service, including relationship problems, reduced work productivity, substance misuse, and increased anger control problems. Mental health problems are frequently cited as causing these difficulties, driven by unparalleled rates of mild traumatic brain injury, posttraumatic stress, and other co-occurring emotional and physical conditions. Given the high prevalence of multimorbidity in this cohort, acceptable, non-stigmatizing, transdiagnostic interventions targeting reintegration are needed. The STEP-Home reintegration workshop has the potential to significantly improve skills to foster civilian reintegration, increase engagement in VA services, and improve mental health outcomes in Veterans with and without diagnosed clinical conditions. Methods/designOngoing from 2019, a prospective, two-site, randomized trial of 206 post-9/11 U.S. military Veterans randomized to receive either 12 sessions of the STEP-Home transdiagnostic reintegration workshop (SH; Active Intervention) or Present Centered Reintegration Group Therapy (PCRGT; Active Control Intervention). Primary outcomes are reintegration, anger, and emotional regulation post-intervention and at 3-months post-intervention. Secondary outcomes include measures of mental health, functional and vocational status, and cognition. ConclusionThis study addresses an important gap in transdiagnostic interventions to improve civilian reintegration in post-9/11 Veterans. STEP-Home is designed to promote treatment engagement and retention, opening the door to critically needed VA care, and ultimately reducing long-term healthcare burden of untreated mental health illness in U.S. Veterans.Trial Registration: Clinicaltrials.gov: D2907-R.

Prevalence of and factors associated with multimorbidity among adults in Kuwait

BackgroundThis cross-sectional study aimed to assess the prevalence of morbidity i.e., one morbidity and multimorbidity (≥ 2 morbid conditions) among adults in Kuwait and to examine the sociodemographic and lifestyle factors associated with morbidity as a multinomial outcome in the study population.MethodsThe data were collected from January 26, 2021, to February 3, 2021, using an electronic questionnaire, which was distributed on social media platforms. The consent form was attached with the questionnaire and the participants were requested to sign the consent form before completing the questionnaire. The prevalences (%) of each morbidity and multimorbidity were computed. Multivariable polychotomous logistic regression analysis was used to evaluate the association between the demographic and lifestyle factors with morbidity as a multinomial outcome.ResultsOf 3572 respondents included, 89% were Kuwaiti, 78.3% females and 66% were 21- 40 years old. The prevalence of multimorbidity and one morbidity respectively was 27.4% and 29.7%. The prevalence of multimorbidity with two, three, four or five ill-health conditions were 14.3%, 7.4%, 3.5%, and 1.2%, respectively. A higher prevalence of multimorbidity was among respondents over 60 years of age (71%) and Kuwaiti nationals (28.9%). The final multivariable polychotomous logistic regression model revealed that age, sex, nativity, sedentary lifestyle, smoking, and alcohol drinking were significantly (p < 0.05) associated with multimorbidity. However, age and alcohol drinking were significant (p < 0.05) predictors of one morbidity.ConclusionThis study provides evidence that multimorbidity is more prevalent among the elderly, females, and Kuwaiti nationals. Sedentary behaviour, smoking and alcohol consumption were significantly and independently associated with multimorbidity. These findings highlight the burden of multimorbidity and should be considered in the development of future prevention programs.

Multimorbidity patterns and health-related quality of life among community-dwelling older adults: evidence from a rural town in Suzhou, China.

The high prevalence of multimorbidity in aging societies has posed tremendous challenges to the healthcare system. The aim of our study was to comprehensively assess the association of multimorbidity patterns and health-related quality of life (HRQOL) among rural Chinese older adults. This was a cross-sectional study. Data from 4,579 community-dwelling older adults aged 60years and above was collected by the clinical examination and questionnaire survey. Information on 10 chronic conditions was collected and the 3-Level EQ-5D (EQ-5D-3L) was adopted to measure the HRQOL of older adults. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of multimorbidity patterns with specific health dimensions and overall HRQOL. A total of 2,503 (54.7%) participants suffered from multimorbidity, and they reported lower HRQOL compared to those without multimorbidity. Three kinds of multimorbidity patterns were identified including cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases. The associations between psycho-cognitive diseases/organic diseases and overall HRQOL assessed by EQ-5D-3L index score were found to be significant (β = -0.097, 95% CI -0.110, -0.084; β = -0.030, 95% CI -0.038, -0.021, respectively), and psycho-cognitive diseases affected more health dimensions. The impact of cardiovascular-metabolic diseases on HRQOL was largely non-significant. Multimorbidity was negatively associated with HRQOL among older adults from rural China. The presence of the psycho-cognitive diseases pattern or the organic diseases pattern contributed to worse HRQOL. The remarkable negative impact of psycho-cognitive diseases on HRQOL necessiates more attention and relevant medical assistance to older rural adults.

Multimorbidade em idosos e seus fatores associados em 2010 e 2021

Abstract The present study aimed to compare the factors associated with multimorbidity in older adults aged 60 to 69 years, in 2010 and 2021. This is a comparative cross-sectional study, comprised of other two cross-sectional studies. Both data collections were individually conducted by trained interviewers through household surveys in the municipality of Coxilha-RS, Brazil. Bivariate inferential analysis was conducted using Fisher's exact test and chi-square test, while multivariate analysis employed Poisson regression with robust variance with a significance level of p 0.05. It was observed that the prevalence of multimorbidity significantly decreased, decreasing from 66.5% in 2010 to 41.6% in 2021. Dependency for basic and instrumental activities of daily living was associated with higher prevalence of multimorbidity in the year 2010. However, in 2021, being dependent on instrumental activities, being unable to read/write, and being unemployed showed higher prevalence for multimorbidity. In conclusion, it is evident that the health conditions of older adults differed significantly over the years, highlighting the necessity for a reevaluation of healthcare practices to become more effective

RACIAL/ETHNIC AND MULTIMORBIDITY DIFFERENCES IN DEMENTIA ONSET AMONG MIDDLE-AGED AND OLDER ADULTS

Abstract Racial/ethnic minoritized older adults in the U.S. have higher prevalence of multimorbidity and experience higher risk of dementia relative to non-Hispanic White older adults. This study examined the relationship between race/ethnicity and dementia onset within the context of multimorbidity during middle and later life in the U.S. Data from the Health &amp; Retirement Study (1998-2018, HRS and War Babies cohorts, N=8,031) were applied to discrete-time survival models to estimate differences in the risk of dementia onset using the Langa-Weir Classification for up to ten time intervals (1998-2018). Models were adjusted for race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), multimorbidity (no/one disease, advanced cardiovascular multimorbidity, metabolic multimorbidity, advanced cardiovascular-metabolic multimorbidity, and neither advanced cardiovascular nor metabolic multimorbidity), age at baseline, sex, education, and whether a proxy provided the interview. Over the 20 years, 9.8% of the respondents (n=785) developed dementia. In covariate-adjusted models, non-Hispanic Black (adjusted Odds Ratio (aOR) =2.27, 95%CI: 1.90, 2.72) and Hispanic (aOR=1.59, 95%CI: 1.26, 2.01) respondents had higher risk of developing dementia compared with non-Hispanic White respondents. Regarding multimorbidity categories, respondents with advanced cardiovascular-metabolic multimorbidity (aOR=1.80, 95%CI: 1.45, 2.24) had significantly higher odds of dementia onset relative to the neither advanced cardiovascular nor metabolic multimorbidity category. Significant differences were observed in dementia onset for up to 20 years between racial/ethnic minoritized and White adults, as well as among multimorbidity combinations. Our findings highlight the need to intervene earlier on modifiable risk factors, such as multimorbidity, to reduce the risk of developing dementia among racial/ethnic minoritized adults.

1486. The Association of Aging-related Comorbidity Burden and Quality of Life Among Women with and without HIV in the U.S.

Abstract Background Women with HIV (WWH) are at higher and earlier risk of developing aging-related non-AIDS comorbidities (NACM) compared to those without HIV; however, the impact on health-related quality of life (QoL) is largely unknown. Methods We analyzed data from the Women’s Interagency HIV Study to evaluate the effect of comorbidity burden (total NACM of 10 assessed) on nine QoL domains and a summary QoL index (QoLI; measured by the MOS-HIV instrument). We included women followed on/after 2009 (when &amp;gt;80% of WWH reported antiretroviral therapy use) and ascertained covariates, NACM, and QoL through the last study visit by 03/2018. Unadjusted (HIV, age, NACM burden or prevalence separately), partially adjusted (unadjusted + all possible interaction terms) and adjusted (partially adjusted + covariates) linear regression assessed impact on QoL. Results Among 3036 women (2173 HIV+, 863 HIV-), median age was 50 (Q1-Q3 43-56) yrs, 66% were Black, 51% had annual income &amp;lt; $12K, and mean (sd) NACM burden was 3.4 (2.2). In unadjusted models, each additional NACM decreased the mean QoLI by -4.4 (95%CI -4.7,-4.1; p&amp;lt; 0.0001). Mean QoLI did not differ in WWH vs without HIV (68 vs 69, p=0.40) but decreased with older age (&amp;lt; 40, 40-49, 50-59, 60-69 yrs): 75 (95%CI 73,77), 71 (70,73), 65 (63,66), 63 (61,65), respectively (p&amp;lt; 0.0001). Unadjusted QoLI was negatively associated with each prevalent NACM (Table). NACM burden was associated with all nine QoL domains in unadjusted models: physical function, role function, energy/fatigue, social function, cognitive function, emotional well-being, health perception, pain, and perceived health index. In the partially adjusted model, the impact of NACM burden on QoLI was modified by age (p=0.02) but not HIV serostatus (p=0.40) (Figure). In covariate-adjusted models (race, BMI, cigarette, alcohol or crack use, menopausal status, socioeconomic status), NACM burden was associated with QoLI (p&amp;lt; 0.0001) but age and HIV did not modify this effect (age*HIV*NACM burden, p=0.83). Summary quality of life index and aging-related comorbidity burden by HIV serostatus and age Conclusion Among women with a high prevalence of multimorbidity, HIV, and health disparities, total comorbidity burden was associated with QoL, independent of age or HIV serostatus. Research is needed to optimize multimorbidity screening and prevention strategies in this population. Disclosures Lauren F. Collins, MD, MSc, Curio Science: Honoraria Igho Ofotokun, MD, MSc, FIDSA, Merck: Grant/Research Support Phyllis C. Tien, MD, MSc, Merck: Grant/Research Support Cyra Christina Mehta, PhD, MSPH, Merck: Grant/Research Support

Chronic Administration of Ion Channel Blockers Impact Microglia Morphology and Function in a Murine Model of Alzheimer's Disease.

As the population ages, a high prevalence of multimorbidity will affect the way physicians need to think about drug interactions. With microglia's important involvement in the pathology and progression of Alzheimer's disease (AD), understanding whether systemically administered drugs intended for other affections could impact microglia function, already impacted by the presence of beta-amyloid, is important. The aim of this study was to evaluate morphological changes of microglia, using in vivo 2-photon laser scanning microscopy, in a murine model of AD under systemic administration of sodium or calcium ion channel blockers in order to establish potential effects that these drugs might have on microglia under neuro-inflammatory conditions. A total of 30 mice (age 14-16 weeks, weight 20-25 g) were used, with 25 APP randomly divided into three groups. The remaining animals were CX3CR1GFP/GFP male mice (n = 5) used as WT controls. After baseline behavior testing, all animals received daily intraperitoneal injections for 30 days according to the assigned group [WT (n = 5), Control (n = 5), Carbamazepine (n = 10), and Verapamil (n = 10)]. The results showed that the Verapamil treatment improved short-term memory and enhanced exploratory behavior in APP mice. The Carbamazepine treatment also improved short-term memory but did not elicit significant changes in anxiety-related behavior. Both Verapamil and Carbamazepine reduced the surveillance speed of microglia processes and changed microglia morphology in the cortex compared to the Control group. Due to their complex molecular machinery, microglia are potentially affected by drugs that do not target them specifically, and, as such, investigating these interactions could prove beneficial in our management of neurodegenerative pathologies.

Periodontitis is associated with multimorbidity in a large dental school population.

To investigate whether and which diseases co-occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients. A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio-economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self-reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used. Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co-occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30-1.43; multimorbidity = 1.18; 95% CI: 1.11-1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%). This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co-occurring in certain groups of individuals.

20-year trends in multimorbidity by race/ethnicity among hospitalized patient populations in the United States

BackgroundThe challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to multimorbidity has changed over time, and how this varies by race/ethnicity. The objective of this study was to describe trends in multimorbidity by race/ethnicity, as well as to determine the differential contribution of individual chronic conditions to multimorbidity in hospitalized populations over a 20-year period within the United States.MethodsThis is a serial cross-sectional study using the Nationwide Inpatient Sample (NIS) from 1993 to 2012. We identified all hospitalized patients aged ≥ 18 years old with available data on race/ethnicity. Multimorbidity was defined as the presence of 3 or more conditions based on the Elixhauser comorbidity index. The relative change in the proportion of hospitalized patients with multimorbidity, overall and by race/ethnicity (Black, White, Hispanic, Asian/Pacific Islander, Native American) were tabulated and presented graphically. Population attributable fractions were estimated from modified Poisson regression models adjusted for sex, age, and insurance type. These fractions were used to describe the relative contribution of individual chronic conditions to multimorbidity over time and across racial/ethnic groups.ResultsThere were 123,613,970 hospitalizations captured within the NIS between 1993 and 2012. The prevalence of multimorbidity increased in all race/ethnic groups over the 20-year period, most notably among White, Black, and Native American populations (+ 29.4%, + 29.7%, and + 32.0%, respectively). In both 1993 and 2012, Black hospitalized patients had a higher prevalence of multimorbidity (25.1% and 54.8%, respectively) compared to all other race/ethnic groups. Native American populations exhibited the largest overall increase in multimorbidity (+ 32.0%). Furthermore, the contribution of metabolic diseases to multimorbidity increased, particularly among Hispanic patients who had the highest population attributable fraction values for diabetes without complications (15.0%), diabetes with complications (5.1%), and obesity (5.8%).ConclusionsFrom 1993 to 2012, the secular increases in the prevalence of multimorbidity as well as changes in the differential contribution of individual chronic conditions has varied substantially by race/ethnicity. These findings further elucidate the racial/ethnic gaps prevalent in multimorbidity within the United States.Prior presentationsPreliminary finding of this study were presented at the Society of General Internal Medicine (SGIM) Annual Conference, Washington, DC, April 21, 2017.

Prevalence and factors associated with multimorbidity in adults in Brazil, according to sex: a population-based cross-sectional survey.

Multimorbidity, defined as the coexistence of two or more chronic diseases in the same individual, represents a significant health challenge. However, there is limited evidence on its prevalence and associated factors in developing countries, such as Brazil, especially stratified by sex. Thus, this study aims to estimate the prevalence and analyze the factors associated with multimorbidity in Brazilian adults according to sex. Cross-sectional population-based household survey carried out with Brazilian adults aged 18 years or older. The sampling strategy consisted of a three-stage conglomerate plan. The three stages were performed through simple random sampling. Data were collected through individual interviews. Multimorbidity was classified based on a list of 14 self-reported chronic diseases/conditions. Poisson regression analysis was performed to estimate the magnitude of the association between sociodemographic and lifestyle factors with the prevalence of multimorbidity stratified by sex. A total of 88,531 individuals were included. In absolute terms, the prevalence of multimorbidity was 29.4%. The frequency in men and women was 22.7 and 35.4%, respectively. Overall, multimorbidity was more prevalent among women, the older people, residents of the South and Southeast regions, urban area residents, former smokers, current smokers, physically inactive, overweight, and obese adults. Individuals with complete high school/incomplete higher education had a lower prevalence of multimorbidity than those with higher educational level. The associations between education and multimorbidity differed between sexes. In men, multimorbidity was inversely associated with the strata of complete middle school/incomplete high school and complete high school/incomplete higher education, while in women, the association between these variables was not observed. Physical inactivity was positively associated with a higher prevalence of multimorbidity only in men. An inverse association was verified between the recommended fruit and vegetable consumption and multimorbidity for the total sample and both sexes. One in four adults had multimorbidity. Prevalence increased with increasing age, among women, and was associated with some lifestyles. Multimorbidity was significantly associated with educational level and physical inactivity only in men. The results suggest the need to adopt integrated strategies to reduce the magnitude of multimorbidity, specific by gender, including actions for health promotion, disease prevention, health surveillance and comprehensive health care in Brazil.

Multimorbity in brazilian elderly and the relationship with the use of health services

The presence of multimorbidity is considered a public health problem, responsible for a great pressure on health services. The present study aimed to assess the prevalence of multimorbidity and its association to the use of health services by Brazilian elderly people. Method: A cross-sectional, quantitative study with population-based survey data (PNS-2013). The sample consisted of 11,177 Brazilians aged 60 years or older. Multimorbidity was considered as a dependent variable and the use of health services as independent. The results were analyzed by the chi-square test. The sample consisted mostly of individuals aged among 60 and 69 years (55.8%), men (59.2%), white (47.5%), married (43.0%), who studied up to primary education (37.6%) and with an income of less than 1 minimum wage (45.5%). The prevalence of multimorbidity was 46.9%. Elderly people with multimorbidity used health services significantly more, having attended 4 or more medical appointments (p&amp;lt;0.001), required hospitalization (p&amp;lt;0.001) and needed emergency care at home (p&amp;lt;0.001). Brazilian elderly people have a high prevalence of multimorbidity and this condition significantly affects the demand for health services, whether primary and secondary, such as medical consultations and emergency and tertiary care, such as hospitalization.

Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis.

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. 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). 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. 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. None.

Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India

ObjectiveOlder male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in...