Number Of Long-term Conditions Research Articles

Incidence of sick leave and disability pension in adults with musculoskeletal pain and co-occurring long-term conditions: data from the Norwegian HUNT study and national registries

BackgroundMusculoskeletal pain is one of the leading causes of work productivity loss. Long-term conditions (LTCs) commonly occur alongside musculoskeletal pain. However, the incidence of sick leave and disability pension according to LTC status in people with musculoskeletal pain has not been previously described.MethodsWorking-age participants (20–65 years) with persistent musculoskeletal pain who participated in the HUNT3 Study (1995–97) were included. Twenty-five LTCs were classified into 8 LTC groups according to the International Classification of Diseases version 11. Data on sickness and disability benefits were obtained from the National Insurance Database and linked to the HUNT3 data using participants’ personal identification number. Age-adjusted incidence rates (IRs) (per 10,000 person-years) and hazard ratios (HRs) of sick leave during 5-year follow-up and disability pension during ~ 25-year follow-up were estimated with 95% confidence intervals (CIs) and presented according to LTC status.ResultsOverall, 11,080 participants with musculoskeletal pain were included. Of those, 32% reported one LTC and 45% reported ≥ 2 LTCs. During the follow up period, 1,312 participants (12%) received disability pension due to musculoskeletal conditions. The IR of sick leave and disability pension due to musculoskeletal conditions increased with number of LTCs. Specifically, the IR of sick leave was 720 (95% CI 672 to 768) in participants without any LTCs and 968 (95% CI 927 to 1,009) if they had ≥ 2 LTCs. The IRs of disability pension were 87 (95% CI 75 to 98) and 167 (95% CI 154 to 179) among those with no LTCs and ≥ 2 LTCs, respectively. The incidence of sick leave and disability pension due to musculoskeletal conditions was largely similar across LTCs, although the incidence of disability pension was somewhat higher among people with sleep disorders (IR: 223, 95% CI 194 to 252).ConclusionsAmong people with persistent musculoskeletal pain, the incidence of prematurely leaving the work force due to musculoskeletal conditions was twice as high for those with multiple LTCs compared to those without any LTCs. This was largely irrespective of the type of LTC, indicating that the number of LTCs are an important feature when evaluating work participation among people with musculoskeletal pain.

Further development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ)

ObjectivesTo undertake further psychometric testing of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and examine whether reversing the scale reduced floor effects.DesignSurvey.SettingUK primary care.ParticipantsAdults (≥18 years) with three or more long-term...

An observational analysis of frailty in combination with loneliness or social isolation and their association with socioeconomic deprivation, hospitalisation and mortality among UK Biobank participants

Frailty, social isolation, and loneliness have individually been associated with adverse health outcomes. This study examines how frailty in combination with loneliness or social isolation is associated with socioeconomic deprivation and with all-cause mortality and hospitalisation rate in a middle-aged and older population. Baseline data from 461,047 UK Biobank participants (aged 37–73) were used to assess frailty (frailty phenotype), social isolation, and loneliness. Weibull models assessed the association between frailty in combination with loneliness or social isolation and all-cause mortality adjusted for age/sex/smoking/alcohol/socioeconomic-status and number of long-term conditions. Negative binomial regression models assessed hospitalisation rate. Frailty prevalence was 3.38%, loneliness 4.75% and social isolation 9.04%. Frailty was present across all ages and increased with age. Loneliness and social isolation were more common in younger participants compared to older. Co-occurrence of frailty and loneliness or social isolation was most common in participants with high socioeconomic deprivation. Frailty was associated with increased mortality and hospitalisation regardless of social isolation/loneliness. Hazard ratios for mortality were 2.47 (2.27–2.69) with social isolation and 2.17 (2.05–2.29) without social isolation, 2.14 (1.92–2.38) with loneliness and 2.16 (2.05–2.27) without loneliness. Loneliness and social isolation were associated with mortality and hospitalisation in robust participants, but this was attenuated in the context of frailty. Frailty and loneliness/social isolation affect individuals across a wide age spectrum and disproportionately co-occur in areas of high deprivation. All were associated with adverse outcomes, but the association between loneliness and social isolation and adverse outcomes was attenuated in the context of frailty. Future interventions should target people living with frailty or loneliness/social isolation, regardless of age.

Effect of timeframes to define long term conditions and sociodemographic factors on prevalence of multimorbidity using disease code frequency in primary care electronic health records: retrospective study

ObjectiveTo determine the extent to which the choice of timeframe used to define a long term condition affects the prevalence of multimorbidity and whether this varies with sociodemographic factors.DesignRetrospective study...

Development of a brief, generic, modular resource-use measure (ModRUM): piloting with patients

BackgroundBespoke self-report resource-use measures (RUMs) are commonly developed or adapted for each new randomised controlled trial. Consequently, RUMs lack standardisation and validation is rarely conducted. A new generic RUM, ModRUM, has been developed using a rigorous process, including consultation with health economists and patients. ModRUM includes a concise core healthcare module, designed to be included in all trials, and depth-adding questions, which can replace or be added to core questions as needed. Modules covering other sectors are under development. The aim of this study was to test the acceptability, feasibility, and criterion and construct validity of the healthcare module of ModRUM.MethodsPatients who had a recent appointment at their GP practice were invited to complete ModRUM (core module or core module with depth questions), a characteristics form and the EQ-5D-5L. Acceptability was assessed via response rates and questionnaire completion time. Feasibility was assessed by reviewing issues observed in participants’ responses and question completion rates. Construct validity was tested via hypothesis testing and known-group analyses, using Wilcoxon rank-sum and Kruskal–Wallis tests, and a generalised linear model. Criterion validity was tested by comparing ModRUM results with primary care medical records. Sensitivity, specificity, and agreement using Lin’s concordance correlation coefficient (pc) were estimated.ResultsOne hundred patients participated from five GP practices in the South-West of England. Acceptability was higher for the core module (20% versus 10% response rate). Question completion rates were high across both versions (> 90%). Some support was observed for construct validity, with results suggesting that healthcare costs differ dependent on the number of long-term conditions (p < 0.05) and are negatively associated with health-related quality of life (p < 0.01). Sensitivity was high for all questions (> 0.83), while specificity varied (0.33–0.88). There was a good level of agreement for GP contacts and costs, and prescribed medication costs (pc > 0.6).ConclusionThis study provided preliminary evidence of the acceptability, feasibility, and criterion and construct validity of ModRUM. Further testing is required within trials and with groups that were less well represented in this study.

Quantifying unmet need in General Practice: a retrospective cohort study of administrative data

ObjectivesTo assess whether patients attending general practices (GPs) in socioeconomically (SE) deprived areas receive the same amount of care, compared with similar patients (based on age, sex and level of...

The impact of long-term conditions on the progression of frailty.

To explore longitudinally the impact of multiple long-term conditions (LTCs) on frailty progression separately for males and females. A functional frailty measure (FFM) was used to examine putative determinants of frailty progression among participants aged 65 to 90 in the English Longitudinal Study of Ageing (ELSA), across nine waves (18 years) of data collection. A multilevel growth model was fitted to measure the FFM progression over 18 years, grouped by LTC categories (zero, one, two and more). There were 2396 male participants at wave 1, of whom 742 (31.0%) had 1 LTC and 1147 (47.9%) had ≥2 LTCs. There were 2965 females at wave 1 of whom 881 (29.7%) had one LTC and 1584 (53.4%) had ≥2 LTCs. The FFM increased 4% each 10 years for the male participants with no LTCs, while it increased 6% per decade in females. The FFM increased with the number of LTCs, for males and females. The acceleration of FMM increases for males with one long-term health condition or more; however in females the acceleration of FMM increases when they have two LTCs or more. Frailty progression accelerates in males with one LTCs and females with two LTCs or more. Health providers should be aware of planning a suitable intervention once the elderly have two or more health conditions.

PS-P04-9: PULSE PRESSURE AND MEAN ARTERIAL PRESSURE IN HYPERTENSIVES WITH MULTI-MORBIDITY: AN ANALYSIS USING GLOBAL DATA FROM MAY MEASUREMENT MONTH (MMM)

Background: The increasing prevalence of people living with multimorbidity is an increasing challenge for health systems. Mean arterial pressure (MAP) serves as the steady component in a patient's arteries during one cardiac cycle while pulse pressure (PP) is recognized as the pulsatile component. Along with systolic blood pressure (BP) and diastolic BP, both MAP and PP are established risk factors for the development of major adverse cardiovascular events. The knowledge of how PP and MAP vary among hypertensives according to the presence of one or more long-term conditions (LTCs) is limited. May Measurement Month (MMM) is the largest contemporary global BP screening campaign designed to raise awareness of high BP. Purpose: To identify the association between BP parameters and number of LTCs (diabetes, myocardial infarction and stroke) in participants with hypertension. Design and methods: MMM is an opportunistic cross-sectional survey with over 4.8 million volunteers aged over 18 years recruited between 2017–2019, and 2021 in 106 countries. Three sitting BP readings were taken for each participant on a single occasion, with data on demographics, lifestyle, hypertension and LTCs collected. Hypertension was defined as systolic BP greater than 140mmHg and/or diastolic BP greater than 90mmHg (average of the second and third readings) and/or taking antihypertensive medication(s). Mixed-effects linear regression models were applied to compare the BP parameters with different numbers of LTCs, assuming random intercepts for country to account for clustering. Multivariable models were adjusted for age and sex (with an interaction term), medication use, current smoking and alcohol consumption. Findings: We analysed data from 1,107,432 individuals with hypertension, recorded data on LTCs and with all three BP readings. Overall, 860,376 (77.7%) had no LTCs, 188,306 (17.0%) had one, 40,592 (3.7%) had two, and 18,158 (1.6%) had three LTCs. After adjustment for potential confounders, the average PP of hypertensives without LTCs was 52.9mmHg. Compared to those with no LTCs, the PPs were significantly higher at 54.4mmHg, 54.9mmHg, and 53.6mmHg, in hypertensives with one, two or three LTCs, respectively (all p &lt; 0.001). A strong inverse relationship was seen between MAP and numbers of LTCs, with mean MAPs of 104.1mmHg, 103.8mmHg, and 101.5mmHg in those with one, two or three LTCs respectively, compared to participants without (104.4 mmHg) (all p &lt; 0.001). Conclusion: Our study highlights that the presence of one or more LTCs is associated with higher PP and lower MAP. These differences in PP and particularly reduced MAP may have implications for optimal BP management in people with multimorbidity.

Association between risk, duration and cause of hospitalisations in people with rheumatoid arthritis and multimorbidity in the UK Biobank and Scottish Early Rheumatoid Arthritis (SERA) cohorts: Longitudinal observational study

ObjectivesTo investigate association between presence of multimorbidity in people with established and early rheumatoid arthritis (RA) and risk, duration and cause of hospitalisations. DesignLongitudinal observational study. SettingUK Biobank, population-based cohort recruited between 2006 and 2010, and the Scottish Early Rheumatoid Arthritis (SERA), inception cohort recruited between 2011 and 2015. Both linked to mortality and hospitalisation data. Participants4757 UK Biobank participants self-reporting established RA; 825 SERA participants with early RA meeting the 2010 ACR/EULAR classification criteria. Participants stratified by number of long-term conditions (LTCs) in addition to RA (RA only, RA + 1 LTC and RA + ≥ 2 LTCs) and matched to five non-RA controls. Main outcome measuresNumber and duration of hospitalisations and their causes. Incidence rate ratios (IRR) and 95% confidence intervals (CI) calculated using negative binomial regression models. ResultsParticipants with RA + ≥ 2 LTCs experienced higher hospitalisation rates compared to those with RA alone (UK Biobank: IRR 2.10, 95% CI 1.91 to 2.30; SERA: IRR 1.74, 95% CI 1.23 to 2.48). Total duration of hospitalisation in RA + ≥ 2 LTCs was also higher (UK Biobank: IRR 2.48, 95% CI 2.17 to 2.84; SERA: IRR 1.90, 95% CI 1.07 to 3.38) than with RA alone. Rate and total duration of hospitalisations was higher in UK Biobank RA participants than non-RA controls with equivalent number of LTCs. Hospitalisations for respiratory infection were higher in early RA than established RA and were the commonest cause of hospital admission in early RA. ConclusionsParticipants with established or early RA with multimorbidity experienced a higher rate and duration of hospitalisations than those with RA alone and with non-RA matched controls.

Treatment burden and associated factors: a population-based survey in Central Denmark Region 2017

Abstract Background Exploring treatment burden at a population level can provide evidence of the types of patients who need special attention and support. We aimed to determine factors associated with high perceived treatment burden in a population-based survey of adults living in the Central Denmark Region (23% of the Danish population). Methods The Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) was included in the 2017 Danish population health survey. 28,627 individuals aged 25 years or over participated (64% response rate). Individuals who reported having one or more medical conditions or attending regular health check-ups were asked to complete the MTBQ. A global MTBQ score was calculated (range 0-100) and both the continuous scores and a four-category grouping of the scores into no, low, medium and high burden were used to statistically assess the association between treatment burden and sociodemographic and health-related factors. Results 13,407 individuals completed the Danish MTBQ (mean age 59 years). Treatment burden was negatively associated with self-related health (rs = -0.45, P &amp;lt; 0.0001), health-related quality of life (rs = -0.46/-0.51, P &amp;lt; 0.0001) and positively associated with the number of long-term conditions (rs = 0.26, P &amp;lt; 0.0001) and perceived stress (rs = 0.44, P &amp;lt; 0.0001). Higher treatment burden was associated with young age, male sex, high educational level, unemployment, not living with a spouse/cohabitant, living with child(ren) and specific long-term conditions, including heart disease, stroke, diabetes and mental illness. Conclusions This is the first known population-based study of treatment burden. The findings provide important evidence to policy makers and clinicians about sociodemographic groups at risk of higher treatment burden. We recommend that patient-perceived treatment burden is included when evaluating interventions targeting patients with long-term conditions and multimorbidity and health-care system reorganisations. Key messages • Treatment burden is associated with poor health and health-related quality of life and, among others, young age, male sex, unemployment, not living with a spouse, and specific long-term conditions. • We recommend that patient-perceived treatment burden is included when evaluating interventions targeting patients with long-term conditions and multimorbidity and health-care system reorganisations.

Sarcopenia definition, diagnosis and treatment: consensus is growing.

Sarcopenia is a skeletal muscle disorder that commonly occurs with advancing age as well as with a number of long-term conditions. Recognition in clinical practice is relatively recent but important because of the association between sarcopenia and a range of adverse effects on health including impaired mobility, increased morbidity and mortality. Originally characterised as loss of muscle mass, the definition has evolved to focus on loss of skeletal muscle function, particularly strength, through a number of international definitions such as that of the European Working Group on Sarcopenia in Older People most recently revised in 2019. Progress in the decades ahead is likely to be seen with regard to use of routine health data, prescription of resistance exercise, translation of biology and epidemiology into first in man studies for new treatments, and focus on sarcopenia in low and middle-income countries. Immediate next steps include the newly formed Global Leadership Initiative on Sarcopenia to develop international consensus on definition and diagnosis.

Variation in multimorbidity prevalence by number of long-term conditions counted: primary care population cross-sectional study.

ObjectivesMultimorbidity poses a major challenge to healthcare systems worldwide, but there is no standardised approach to measuring multimorbidity. Existing studies include a median of 17 (IQR 11-23, range 2-285) long-term conditions (LTCs), making it difficult to compare or replicate research, particularly research examining the prevalence of multimorbidity.&#x0D; ApproachIn this cross-sectional study of 1,168,620 people from the Clinical Practice Research Datalink, we extracted data on 99 LTCs defined by validated code-sets, including all conditions recommended as core by a recent Delphi study. We examined how the prevalence of multimorbidity defined as ≥2 LTCs, varied when including different numbers of LTCs in the measure. We calculated multimorbidity prevalence when including only the two most prevalent LTCs, repeating the calculation for 3,4,5, through to 99 LTCs, added in order of descending prevalence. Results were stratified by age, sex, and socioeconomic status (SES).&#x0D; ResultsUsing only the two most prevalent LTCs, 16.8% of people had multimorbidity, compared to 39.3% for 10 LTCs, 42.0% for 25 LTCs, 42.5% for 50 LTCs, 42.6% for 75 LTCs, and 42.6% for all 99 LTCs. Whole population prevalence was essentially stable once 46+ LTCs were included (estimated prevalence change from adding any additional LTC &lt;0.01%) and this was true in all age strata. The absolute difference in estimated prevalence using 99 versus using two LTCs was smallest in younger people (0.3% difference aged 0-4yrs), large in older people (20.4% ≥90yrs), largest in middle age (37.0% 55-59yrs), and was socially patterned, being lowest for people living in the most affluent areas (SES decile 1= 24.2%) and highest in the most deprived areas (SES decile 10=28.9%).&#x0D; ConclusionEstimates of multimorbidity prevalence vary markedly depending on how many LTCs are counted, with absolute differences in estimated prevalence largest for people in middle-age and with lowest SES. Further research is needed to support implementation of a uniform approach to defining how many conditions to include in multimorbidity measures.

Body mass index trajectories and mortality in community-dwelling older adults: population-based cohort study

ObjectiveBoth low and high body mass index (BMI) have been associated with greater mortality in older adults. This study aimed to evaluate the trajectory of BMI in the final years...

Mortality of Care Home Residents and Community-Dwelling Controls During the COVID-19 Pandemic in 2020: Matched Cohort Study.

ObjectiveThis study aimed to estimate and compare mortality of care home residents, and matched community-dwelling controls, during the COVID-19 pandemic from primary care electronic health records in England.DesignMatched cohort study.Setting and ParticipantsFamily practices in England in the Clinical Practice Research Datalink Aurum database. There were 83,627 care home residents in 2020, with 26,923 deaths; 80,730 (97%) were matched on age, sex, and family practice with 300,445 community-dwelling adults.MethodsAll-cause mortality was evaluated and adjusted rate ratios by negative binomial regression were adjusted for age, sex, number of long-term conditions, frailty category, region, calendar month or week, and clustering by family practice.ResultsUnderlying mortality of care home residents was higher than community controls (adjusted rate ratio 5.59, 95% confidence interval 5.23‒5.99, P < .001). During April 2020, there was a net increase in mortality of care home residents over that of controls. The mortality rate of care home residents was 27.2 deaths per 1000 patients per week, compared with 2.31 per 1000 for controls. Excess deaths for care home residents, above that predicted from pre-pandemic years, peaked between April 13 and 19 (men, 27.7, 95% confidence interval 25.1‒30.3; women, 17.4, 15.9‒18.8 per 1000 per week). Compared with care home residents, long-term conditions and frailty were differentially associated with greater mortality in community-dwelling controls.Conclusions and ImplicationsIndividual-patient data from primary care electronic health records may be used to estimate mortality in care home residents. Mortality is substantially higher than for community-dwelling comparators and showed a disproportionate increase in the first wave of the COVID-19 pandemic. Care home residents require particular protection during periods of high infectious disease transmission.

Multimorbidity and co-occurring musculoskeletal pain do not modify the effect of the selfBACK app on low back pain-related disability

BackgroundselfBACK, an artificial intelligence (AI)-based app delivering evidence-based tailored self-management support to people with low back pain (LBP), has been shown to reduce LBP-related disability when added to usual care. LBP commonly co-occurs with multimorbidity (≥ 2 long-term conditions) or pain at other musculoskeletal sites, so this study explores if these factors modify the effect of the selfBACK app or influence outcome trajectories over time.MethodsSecondary analysis of a randomized controlled trial with 9-month follow-up. Primary outcome is as follows: LBP-related disability (Roland Morris Disability Questionnaire, RMDQ). Secondary outcomes are as follows: stress/depression/illness perception/self-efficacy/general health/quality of life/physical activity/global perceived effect. We used linear mixed models for continuous outcomes and logistic generalized estimating equation for binary outcomes. Analyses were stratified to assess effect modification, whereas control (n = 229) and intervention (n = 232) groups were pooled in analyses of outcome trajectories.ResultsBaseline multimorbidity and co-occurring musculoskeletal pain sites did not modify the effect of the selfBACK app. The effect was somewhat stronger in people with multimorbidity than among those with LBP only (difference in RMDQ due to interaction, − 0.9[95 % CI − 2.5 to 0.6]). Participants with a greater number of long-term conditions and more co-occurring musculoskeletal pain had higher levels of baseline disability (RMDQ 11.3 for ≥ 2 long-term conditions vs 9.5 for LBP only; 11.3 for ≥ 4 musculoskeletal pain sites vs 10.2 for ≤ 1 additional musculoskeletal pain site); along with higher baseline scores for stress/depression/illness perception and poorer pain self-efficacy/general health ratings. In the pooled sample, LBP-related disability improved slightly less over time for people with ≥ 2 long-term conditions additional to LBP compared to no multimorbidity and for those with ≥4 co-occurring musculoskeletal pain sites compared to ≤ 1 additional musculoskeletal pain site (difference in mean change at 9 months = 1.5 and 2.2, respectively). All groups reported little improvement in secondary outcomes over time.ConclusionsMultimorbidity or co-occurring musculoskeletal pain does not modify the effect of the selfBACK app on LBP-related disability or other secondary outcomes. Although people with these health problems have worse scores both at baseline and 9 months, the AI-based selfBACK app appears to be helpful for those with multimorbidity or co-occurring musculoskeletal pain.Trial registrationNCT03798288. Date of registration: 9 January 2019

Danish validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and findings from a population health survey: a mixed-methods study

ObjectiveTo validate the Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) and obtain a population-based evaluation of treatment burden.DesignMixed-methods.SettingDanish population-based survey.ParticipantsTranslation by professional translators and an expert group. The scale was tested...

MO488HOSPITALISATION EVENTS IN PEOPLE WITH CHRONIC KIDNEY DISEASE AND MULTIPLE LONG-TERM CONDITIONS

Abstract Background and Aims: Chronic Kidney Disease (CKD) typically co-exists with multiple long-term conditions (LTCs). The impact of CKD combined with multiple LTCs on hospitalisation rates is not known. We hypothesised that hospitalisation rates would be high in people with multiple LTCs, particularly in those with CKD. We also hypothesised that the association between multiple LTCs and hospitalisation would be greatest in subgroups and with certain patterns of LTCs. Method: Two cohorts were studied in parallel: UK Biobank (2006-2019) and Secure Anonymised Information Linkage Databank (SAIL: 2011-2018, Wales, UK). UK Biobank is a prospective research cohort. SAIL is a routine care database. Participants were included if their kidney function was measured at baseline. LTCs were obtained from self-report (UK Biobank) and primary care read codes (SAIL). Participants were categorised into zero, one, two, three and four or more LTCs with and without CKD. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73m2 (single blood test for UK Biobank, two blood tests three months apart for SAIL). Hospitalisation events were obtained from linked hospital records. Results: Among 469,344 of 502,503 UK Biobank participants, those without CKD had a median age of 58 and a median of 1 LTC. Those with CKD had a median age of 64 and a median of 2 LTCs. Among 1,620,490 of 2,768,862 SAIL participants, those without CKD had a median age of 50 and a median of 1 LTC. Those with CKD had a median age of 79 and a median of 4 LTCs. Participants with four or more LTCs had high event rates (Rate Ratios (RRs) 5.35 (95% CI 5.20-5.51)/3.77 (95% CI 3.71-3.82)) with higher rates in CKD (RRs 8.99 (95% CI 8.47-9.54)/9.92 (95% CI 9.75-10.09)). Amongst those with CKD, the association between each increase in LTC count and hospitalisation was greatest in those under the age of 50 (RRs 1.93 (95% CI 1.73-2.16)/1.35(95% CI 1.29-1.41)). Event rates were highest in those with eGFR&amp;lt;30ml/min/1.73m2, but the impact of multiple LTCs was weaker in these participants compared to those with higher eGFRs. Event rates were high in certain patterns of LTCs: cardiometabolic LTCs (RRs 4.45 (95% CI 4.02-4.92)/2.81 (95% CI 2.71-2.91)), complex patterns (RRs 3.60 (95% CI 3.26-3.96)/2.91 (95% CI 2.81-3.01)) and physical/mental LTCs (RRs 3.30 (95% CI 2.86-3.80)/3.18 (95% CI 3.06-3.30)). Conclusion: People with multiple LTCs have high rates of hospitalisation and the rates are augmented in those with CKD. The impact of multiple LTCs is greatest in younger patients and in those with certain patterns of LTCs. Strategies should be developed to prevent hospitalisations in these high-risk groups. Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in UK Biobank Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in SAIL

Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services...

Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

ObjectiveTo investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).DesignPopulation-based longitudinal cohort study.SettingUK...

Multimorbidity, glycaemic variability and time in target range in people with type 2 diabetes: A baseline analysis of the GP-OSMOTIC trial

AimsTo explore associations between multimorbidity condition counts (total; concordant (diabetes-related); discordant (unrelated to diabetes)) and glycaemia (HbA1c; glycaemic variability (GV); time in range (TIR)) using data from a randomised controlled trial examining effectiveness of continuous glucose monitoring (CGM) in people with type 2 diabetes (T2D). MethodsCross-sectional study: 279 people with T2D using baseline data from the General Practice Optimising Structured MOnitoring To Improve Clinical outcomes (GP-OSMOTIC) trial from 25 general practices in Australia. Number of long-term conditions (LTCs) in addition to T2D used to quantify total/concordant/discordant multimorbidity counts. GV (measured by coefficient of variation (CV)) and TIR derived from CGM data. Multivariable linear regression models used to examine associations between multimorbidity counts, HbA1c (%), GV and TIR. ResultsMean (SD) age of participants 60.4 (9.9) years; 40.9% female. Multimorbidity was present in 89.2% of participants. Most prevalent comorbid LTCs: hypertension (57.4%), painful conditions (29.8%), coronary heart disease (22.6%) and depression (19.0%). No evidence of associations between multimorbidity counts, HbA1c, GV and TIR. ConclusionsWhile multimorbidity was common in this T2D cohort, it was not associated with HbA1c, CV or TIR. Future studies should explore factors other than glycaemia that contribute to the increased mortality observed in those with multimorbidity and T2D.