Incidence Of Multimorbidity Research Articles

Development of a prognostic prediction model to estimate the risk of multiple chronic diseases: constructing a copula-based model using Canadian primary care electronic medical record data.

IntroductionThe ability to estimate risk of multimorbidity will provide valuable information to patients and primary care practitioners in their preventative efforts. Current methods for prognostic prediction modelling are insufficient for the estimation of risk for multiple outcomes, as they do not properly capture the dependence that exists between outcomes.ObjectivesWe developed a multivariate prognostic prediction model for the 5-year risk of diabetes, hypertension, and osteoarthritis that quantifies and accounts for the dependence between each disease using a copula-based model.MethodsWe used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 2009 onwards, a collection of electronic medical records submitted by participating primary care practitioners across Canada. We identified patients 18 years and older without all three outcome diseases and observed any incident diabetes, osteoarthritis, or hypertension within 5-years, resulting in a large retrospective cohort for model development and internal validation (n=425,228). First, we quantified the dependence between outcomes using unadjusted and adjusted Ø coefficients. We then estimated a copula-based model to quantify the non-linear dependence between outcomes that can be used to derive risk estimates for each outcome, accounting for the observed dependence. Copula-based models are defined by univariate models for each outcome and a dependence function, specified by the parameter θ. Logistic regression was used for the univariate models and the Frank copula was selected as the dependence function.ResultsAll outcome pairs demonstrated statistically significant dependence that was reduced after adjusting for covariates. The copula-based model yielded statistically significant θ parameters in agreement with the adjusted and unadjusted Ø coefficients. Our copula-based model can effectively be used to estimate trivariate probabilities.DiscussionQuantitative estimates of multimorbidity risk inform discussions between patients and their primary care practitioners around prevention in an effort to reduce the incidence of multimorbidity.

A cross-sectional study investigating the relationship between handgrip strength with multimorbidity in Korean adults: Findings from the Korea National Health and Nutrition Examination Survey VI-VII (2014-2017).

To date research investigating the associations between handgrip strength and multimorbidity when stratifying by age and sex is limited. Furthermore, this is the first study in a Korean population, and the first to include adults ≥ 19 years of age. Here we investigated the associations between handgrip strength and multimorbidity in Korean adults aged ≥ 19 years.In this cross-sectional study data from the Korean National Health and Nutrition Examination Survey were used. Multimorbidity was defined as having 2 or more chronic diseases. A total of 19,779 participants were eligible for the study (8730 male and 11,049 female). We grouped and analysed participants based on age and sex (men and women aged 19–49 years, men and women aged 50–80 years) and examined the associations between handgrip strength and multimorbidity using multivariate logistic regressions using stratification by age, sex and body mass index (BMI).Multivariate logistic regressions revealed a significant inverse association irrespective of sex, between relative handgrip strength and multimorbidity. Participants with the lowest handgrip strength had a significantly higher odds ratio (OR) of multimorbidity (men aged 19–49 years: 3.76 and aged 50 years to 80 years: 2.11; women aged 19 years to 49 years: 1.52 and aged 50–80 years: 2.15) when compared to those with highest handgrip strength after adjusting for confounding variables. The highest OR was observed in men aged 19 years to 49 years with a BMI ≥ 25 kg/m2.In the current study we observed a significant inverse relationship between handgrip strength and multimorbidity in males and females with 2 or more chronic diseases. Male participants with a low handgrip strength aged between 19 years to 49 years with a BMI ≥25 kg/m2 may be at greater risk of multimorbidity. This study highlights the need for further longitudinal studies to investigate the effects of increasing handgrip strength combined with weight loss, as an effective strategy to reduce the incidence of multimorbidity.

The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review.

Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.

Effects of Comorbid Factors on Prognosis of Three Different Geriatric Groups with COVID-19 Diagnosis.

Coronavirus disease 2019 (COVID-19) is a new zoonotic infectious disease that was first reported to the World Health Organization (WHO) on December 31, 2019, and declared as a pandemic by WHO on March 11, 2020. Due to the increased incidence of multimorbidity in geriatric age groups, COVID-19 disease leads to more severe consequences in the elderly. We aimed to determine the effects of age, comorbidity factors, symptoms, laboratory findings, and radiological results on prognosis by dividing our patients into 3 different geriatric age groups, using a retrospective descriptive analysis method. Patients included in the retrospective study (n = 483) were divided into the following three different geriatric age groups: young-old (65–74 years), middle-aged (75–84 years), and the oldest-elderly (85 years and over).The length of stay in the intensive care unit of the patients between the ages of 75–84 was higher than the other two groups (p = 0.013). Mortality rates were lowest in patients aged 65–74 years (p < 0.001). The rate of ground glass opacity in thorax CT was higher in patients with mortality (p < 0.001). While the rate of COPD-bronchial asthma was higher in surviving patients (p = 0.001), malignancy (p = 0.005) and cerebrovascular disease (p < 0.001) were higher in patients who died. Patients aged between 75 and 84 (OR: 2.602; 95% CI: 1.306–5.183; p = 0.007) or ≥ 85 (OR: 4.086; 95% CI: 1.687–9.9; p = 0.002) had higher risk for mortality compared to patients aged between 65 and 74. The lowest mortality rates were observed in patients aged 65–74 years. Among the supportive diagnostic methods in 3 different geriatric age groups, PCR positivity has no effect on mortality, while the ground glass opacity on tomography is closely related to the need for intensive care and increased mortality. In patients with COPD-bronchial asthma comorbidity and those with symptoms of fatigue, dry cough, and sore throat, transfer to intensive care and mortality rates were lower, while patients who were transferred to intensive care and who developed mortality had higher malignancy and cerebrovascular disease comorbidities and dyspnea symptoms.

Incidence, Progression, and Patterns of Multimorbidity in Community-Dwelling Middle-Aged Men and Women.

Background: Determining the incidence, progression, and patterns of multimorbidity are important for the prevention, management, and treatment of concurrence of multiple conditions. This study aimed to analyze major multimorbidity patterns and the association of the onset of a primary condition or combinations of a primary and a secondary condition with the progression to subsequent conditions.Methods: We included 53,867 participants aged 45–64 years from the 45 and Up Study who were free of 10 predefined chronic conditions at baseline (2006–2009). The incidence of multimorbidity (coexistence of ≥2, ≥3, and ≥4 conditions) was identified using the claims database until December 31, 2016. The primary, secondary, tertiary, and quaternary condition for each participant was defined according to its temporal order of onset.Results: During a mean 9-years follow-up, the cumulative incidence of primary, secondary, tertiary, and quaternary conditions was 49.6, 23.7, 9.0, and 2.9%, respectively. The time to develop a subsequent condition decreased with the accumulation of conditions (P < 0.0001). Two concurrent cardiometabolic disorders (CMDs, 30.4%) and CMDs clustered with musculoskeletal disorders (15.2%), mental disorders (13.5%), asthma (12.0%), or cancer (8.7%) were the five most common multimorbidity patterns. CMDs tended to occur prior to mental or musculoskeletal disorders but after the onset of cancers or asthma. Compared with all participants who developed cancer as a primary condition, individuals who experienced mental disorders/neurodegenerative disorders and a comorbidity as cardiovascular disease, hypertension, dyslipidemia, diabetes, asthma, or osteoarthritis were 3.36–10.87 times more likely to develop cancer as a tertiary condition. Individuals with neurodegenerative disorders and a comorbidity as hypertension, dyslipidemia, osteoarthritis, or asthma were 5.14–14.15 times more likely to develop mental disorders as a tertiary condition.Conclusions: A high incidence of multimorbidity in middle-aged adults was observed and CMDs were most commonly seen in multimorbidity patterns. There may be accelerated aging after a primary condition occurs. Our findings also reveal a potential preventative window to obviate the development of secondary or tertiary conditions.

Socio-demographic and lifestyle factors associated with multimorbidity in New Zealand.

OBJECTIVESThe incidence of multimorbidity (MM) and its correlates among older adults remain poorly understood. This study aimed to examine the socio-demographic and lifestyle factors associated with MM in New Zealand.METHODSPeople aged 55-70 years were invited to participate in a population-based cohort study, the Health Work and Retirement Study, in 2006. Those who accepted the invitation and completed the baseline questionnaire were followed up on a biennial basis. Data on socio-demographic factors, health and lifestyle behaviours, and diagnoses of chronic diseases were obtained from baseline and 6 waves of follow-up. Generalised estimating equations (GEE) adjusted for both time-constant and time-varying factors were used to model factors associated with the onset of MM.RESULTSA total of 1,673 participants (with 0 or 1 chronic condition) contributed to an overall 8,616 person-years of observation. There were 590 new cases of MM over 10 years of follow-up, corresponding to an overall incidence of 68.5 per 1,000 person-years. The results of the age- and sex-adjusted GEE analysis showed that age, ethnicity, living alone, obesity, hypertension, and having 1 chronic condition at baseline were significant predictors of MM onset. Higher education, income, physical activity, and regular alcohol consumption were protective factors. In a fully adjusted model, marital status (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01 to 1.37; p=0.039), hypertension (OR, 1.23; 95% CI, 1.02 to 1.48; p=0.032) and having 1 chronic condition at baseline (OR, 2.92; 95% CI, 2.33 to 3.67; p<0.001) remained significant.CONCLUSIONSThe higher incidence of MM among Māori people, socioeconomically disadvantaged groups, those with low physical activity, and obese individuals highlights the importance of targeted prevention strategies.

Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study

SummaryBackgroundSocial inequalities in mortality persist in high-income countries with universal health care, and the mechanisms by which these inequalities are generated remain unclear. We aimed to examine whether social inequalities were present before or after the onset of adverse health conditions (multimorbidity, frailty, and disability).MethodsOur analysis was based on data from the ongoing Whitehall II cohort study, which enrolled British civil servants aged 35–55 years in 1985–88. Participants were assessed for three indicators of socioeconomic status (education, occupational position, and literacy) at age 50 years. Participants underwent clinical examinations (in 2002–04, 2007–09, 2012–13, and 2015–16) for assessment of frailty (two or more of low physical activity, slow walking speed, poor grip strength, weight loss, and exhaustion) and disability (two or more difficulties in bathing, dressing, going to the toilet, transferring, feeding, and walking). In addition, electronic health records were used to assess the incidence of multimorbidity (two or more of diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, arthritis, cancer, dementia, and Parkinson's disease) and mortality. In analyses adjusted for sociodemographic factors, we used multistate models to examine social inequalities in transitions from healthy state to adverse health conditions and subsequently to mortality.FindingsOf 10 308 individuals in the Whitehall II study cohort, 6425 had relevant data available at 50 years and to the end of follow-up on Aug 31, 2017, and were included in our analysis. Participants were followed up for a median of 23·6 years (IQR 19·6–28·9). 1694 (26·4%) of 6425 participants developed multimorbidity, 1733 (27·0%) became frail, 692 (10·8%) had a disability, and 611 (9·5%) died. Multimorbidity (hazard ratio [HR] 4·12 [95% CI 3·41–4·98]), frailty (HR 2·38 [95% CI 1·93–2·93]), and disability (HR 1·73 [95% CI 1·34–2·22]) were associated with increased risk of mortality; these associations were not modified by socioeconomic status. In multistate models, occupation was the socioeconomic status indicator that was most strongly associated with inequalities in the transition from healthy state to multimorbidity (HR 1·54 [95% CI 1·37–1·73]), to frailty (HR 2·08 [95% CI 1·85–2·33]), and to disability (HR 1·44 [95% CI 1·18–1·74]). Socioeconomic status indicators did not affect transitions to mortality in those with multimorbidity, frailty, or disability.InterpretationSocioeconomic status affects the risk of multimorbidity, frailty, and disability, but does not affect the risk of mortality after the onset of these adverse health conditions. Therefore, primary prevention is key to reducing social inequalities in mortality. Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health.FundingUK Medical Research Council; National Institute on Aging, National Institutes of Health; British Heart Foundation.

Depressive symptoms and the development and progression of physical multimorbidity in a national cohort of Australian women.

Multiple chronic physical conditions (physical multimorbidity) are common in people with depression. This study investigated the association between elevated depressive symptoms and the development and progression of physical multimorbidity in middle-aged women. A total of 7,407 women aged 45-50 years were followed up from 1996 to 2016. These women were free from diagnosed depression or chronic physical conditions at baseline. Data on depressive symptoms and chronic physical conditions were updated every 3 years, with depressive symptoms assessed using the Center for Epidemiological Studies-Depression scale. A 1-to-1 matched cohort analysis was conducted to compare the cumulative incidence and odds of physical multimorbidity between women with (depressed cohort) and women without (nondepressed cohort) elevated depressive symptoms, adjusted for sociodemographic and health behavioral factors. Over 20 years of follow-up, 3,199 women (43.2%) reported elevated depressive symptoms. Of these, 2,035 (63.6%) developed physical multimorbidity. After the onset of elevated depressive symptoms, women had a more than 4-fold increase in cumulative incidence of multimorbidity. Compared with the nondepressed cohort, the odds of the depressed cohort developing multimorbidity before the onset of depressive symptoms was 1.81 (95% confidence interval = 1.49, 2.20). After the onset of depressive symptoms, the odds ratio was 2.38 (95% confidence interval = 2.20, 2.57). Elevated depressive symptoms were common in women's midlife. Women with elevated depressive symptoms had increased odds of physical multimorbidity both before and after the onset of depressive symptoms. These findings support the emerging integrated management and prevention of mental and physical multimorbidity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Incidence and predictors of multimorbidity among a multiethnic population in Malaysia: a community-based longitudinal study

Multimorbidity in older adults needs to be assessed as it is a risk factor for disability, cognitive decline, and mortality. A community-based longitudinal study was performed to determine the incidence and to identify possible predictors of multimorbidity among multiethnic older adults population in Malaysia. Comprehensive interview-based questionnaires were administered among 729 participants aged 60years and above. Data were analyzed from the baseline data of older adults participating in the Towards Useful Aging (TUA) study (2014-2016) who were not affected by multimorbidity (349 without any chronic diseases and 380 with one disease). Multimorbidity was considered present in an individual reporting two or more chronic diseases. After 1½ years of follow-up, 18.8% of participants who were initially free of any diseases and 40.9% of those with one disease at baseline, developed multimorbidity. The incidence rates were 13.7 per 100 person-years and 34.2 per 100 person-years, respectively. Female gender, smoking, and irregular preparing of food (lifestyle) were predictors for incidence of multimorbidity, especially in those without any disease, while Body Mass Index (BMI) 22-27kg/m2 and inadequate daily intake of iron were identified as predictors of multimorbidity among participants who already have one disease. The incidence rates of multimorbidity among Malaysian older adults were between the ranges of 14-34 per 100 person-years at a 1½-year follow-up. Gender, smoking, BMI 22-27kg/m2, inadequate daily intake of iron and lack of engagement in leisure or lifestyle physical activities were possible predictors in the development of multimorbidity. There is a need to formulate effective preventive management strategies to decelerate multimorbidity among older adults.

Chronic subdural haematomas: a single-centre experience developing an integrated care pathway

Objective: To improve quality of care for patients presenting with chronic subdural haematoma (CSDH) by introducing a multi-disciplinary integrated care pathway.Summary background: CSDH is a common neurological condition. Incidence rises with age and currently affects around 58/100 000 people over 70 years. Six-month mortality is high (26%), however integrated care pathways have been shown to improve patient outcomes in other surgical subspecialties.Materials and methods: A baseline retrospective audit completed in 2012 identified areas for improvement in patient management. Stakeholder meetings were held with subsequent development and implementation of a patient care pathway. A post-implementation prospective audit was completed between January and October 2015. Data collected: patient demographics, medical co-morbidities, use of anti-platelet and anti-coagulant medication, timing of surgery, length of hospital stay, morbidity and mortality data, and reaccumulation rate.Results: Patient groups were similar with a high incidence of multi-morbidity. The key areas targeted for improvement included enhanced pre-operative optimisation and time to surgery. Implementation of the patient care pathway significantly increased the number of patients undergoing surgery within 24 hours of admission (43% vs. 75%, p = 0.0006) but length of hospital stay did not change. Operative morbidity and mortality remained similar and there was no significant difference in CSDH reaccumulation rate.Conclusion: Our patient care pathway appears to have improved pre-operative care and significantly increased the proportion of patients undergoing surgery within 24 hours of admission. Difficulties were encountered with changing existing practice. Prospective research is required to demonstrate the full benefits, which may include a reduction in health and social care costs.

Association Between Lifestyle Factors and the Incidence of Multimorbidity in an Older English Population.

Evidence on the role of lifestyle factors in relation to multimorbidity, especially in elderly populations, is scarce. We assessed the association between five lifestyle factors and incident multimorbidity (presence of ≥2 chronic conditions) in an English cohort aged ≥50 years. We used data from waves 4, 5, and 6 of the English Longitudinal Study of Ageing. Data on smoking, alcohol consumption, physical activity, fruit and vegetable consumption, and body mass index were extracted and combined to generate a sum of unhealthy lifestyle factors for each individual. We examined whether these lifestyle factors individually or in combination predicted multimorbidity during the subsequent wave. We used marginal structural Cox proportional hazard models, adjusted for both time-constant and time-varying factors. A total of 5,476 participants contributed 232,749 person-months of follow-up during which 1,156 cases of incident multimorbidity were recorded. Physical inactivity increased the risk of multimorbidity by 33% (adjusted hazard ratio [aHR]: 1.33, 95% confidence interval [CI]: 1.03-1.73). The risk was about two to three times higher when inactivity was combined with obesity (aHR: 2.87, 95% CI: 1.55-5.31) or smoking (aHR: 2.35, 95% CI: 1.36-4.08) and about four times when combined with both (aHR: 3.98, 95% CI: 1.02-17.00). Any combination of 2, 3, and 4 or more unhealthy lifestyle factors significantly increased the multimorbidity hazard, compared with none, from 42% to 116%. This study provides evidence of a temporal association between combinations of different unhealthy lifestyle factors with multimorbidity. Population level interventions should include reinforcing positive lifestyle changes in the population to reduce the risk of developing multimorbidity.

Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity

ObjectiveTo study the incidence of de novo multimorbidity across all ages in a geographically defined population with an emphasis on sex and ethnic differences.DesignHistorical cohort study.SettingAll persons residing in Olmsted...

Incidence and predictors of multimorbidity in the elderly: a population-based longitudinal study.

BackgroundWe aimed to calculate 3-year incidence of multimorbidity, defined as the development of two or more chronic diseases in a population of older people free from multimorbidity at baseline. Secondly, we aimed to identify predictors of incident multimorbidity amongst life-style related indicators, medical conditions and biomarkers.MethodsData were gathered from 418 participants in the first follow up of the Kungsholmen Project (Stockholm, Sweden, 1991–1993, 78+ years old) who were not affected by multimorbidity (149 had none disease and 269 one disease), including a social interview, a neuropsychological battery and a medical examination.ResultsAfter 3 years, 33.6% of participants who were without disease and 66.4% of those with one disease at baseline, developed multimorbidity: the incidence rate was 12.6 per 100 person-years (95% CI: 9.2–16.7) and 32.9 per 100 person-years (95% CI: 28.1–38.3), respectively. After adjustments, worse cognitive function (OR, 95% CI, for 1 point lower Mini-Mental State Examination: 1.22, 1.00–1.48) was associated with increased risk of multimorbidity among subjects with no disease at baseline. Higher age was the only predictor of multimorbidity in persons with one disease at baseline.ConclusionsMultimorbidity has a high incidence at old age. Mental health-related symptoms are likely predictors of multimorbidity, suggesting a strong impact of mental disorders on the health of older people.

Drug therapy of elderly patients from the viewpoint of the clinical pharmacologist

Polypragmasy (polypharmacotherapy) is often due to the frequent incidence of multimorbidity among elderly patients. This may evoke unpredictable drug-interactions, which often become a reason for hospitalization. Additional medications might be the consequence. Geriatric patients are often characterized by variant pharmacokinetic parameters. Individualized drug-therapy should take into consideration not only the patients' age, liver and kidney functions but also the individual variability of hepatic metabolization and drug-resorption in the intestine based on genetic polymorphisms. Summing up, it is very important to verify a consisting or a new drug-therapy concerning its risk-benefit ratio and if it is needed, to omit or change some of the medications.

Multimorbidity in General Practice: Prevalence, Incidence, and Determinants of Co-Occurring Chronic and Recurrent Diseases

Increasing numbers of people are found to have two or more diseases at the same time, which is termed multimorbidity. We studied the prevalence, incidence, and determinants of multimorbidity and the statistical clustering of chronic and recurrent diseases in a general practice setting. Prevalence of multimorbidity increased with all age groups from 10% in the 0–19-year-old age group up to 78% in subjects aged 80 and over. Increasing age, lower level of education, and public health insurance were related to the occurrence of morbidity, but even more strongly to the occurrence and degree of multimorbidity. The one-year incidence of multimorbidity (the new occurrence of two or more diseases in one year) was related to increasing age, public health insurance, and the presence of prevalent diseases at baseline. Statistical clustering of diseases was stronger than expected, especially among the younger subjects.