Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey

Abstract

Background There is limited evidence about the impact of specific patterns of multi-morbidity on health-related quality of life (HRQoL) from large samples of adult subjects. Methods We used data from the English General Practice Patient Survey 2011-2012. We defined multi-morbidity as the presence of two or more of 12 self-reported conditions or another (unspecified) long-term health problem. We investigated differences in HRQoL (EQ-5D scores) associated with combinations of these conditions after adjusting for age, gender, ethnicity, socio-economic deprivation and the presence of a recent illness or injury. Analyses were based on 831,537 responses from patients aged 18 years or older in 8,254 primary care practices in England.Results Of respondents, 23 % reported two or more chronic conditions (ranging from 7 % of those under 45 years of age to 51 % of those 65 years or older). Multimorbidity was more common among women, White individuals and respondents from socio-economically deprived areas. Neurological problems, mental health problems, arthritis and long-term back problem were associated with the greatest HRQoL deficits. The presence of three or more conditions was commonly associated with greater reduction in quality of life than that implied by the sum of the differences associated with the individual conditions. The decline in quality of life associated with an additional condition in people with two and three physical conditions was less for older people than for younger people. Multimorbidity was associated with a substantially worse HRQoL in diabetes than in other long-term conditions. With the exception of neurological conditions, the presence of a comorbid mental health problem had a more adverse effect on HRQoL than any single comorbid physical condition. Conclusion Patients with multi-morbid diabetes, arthritis, neurological, or long-term mental health problems have significantly lower quality of life than other people. People with long-term health conditions require integrated mental and physical healthcare services.

Is Australian primary care practice equipped to provide multimorbidity care?

“…Multiple long term conditions are associated with a wide range of adverse outcomes for individuals and the health system. These included: increased health service use (14,56,79,(89)(90)(91)(92), polypharmacy (56,90,(93)(94)(95)(96), hospital admissions (14,79,89,90,97,98), out-of-pocket expenses (99-103), and psychological distress (79,93,(104)(105)(106), along with reductions in physical functioning (79,(107)(108)(109)(110)(111)(112), quality-of-life (14,79,(113)(114)(115)(116)(117), employability (118)(119)(120),and continuity of care (56,93,121,122).…”

Evaluación del modelo de descripción de pacientes: Grupo de Riesgo Clínico (CRG) como indicador y predictor de consumo de recursos y su relación con los Factores de Riesgo Cardiovascular y la Calidad de Vida Relacionada con la Salud

“…Estos últimos resultados coinciden con los obtenidos por Mujica-Mota (Mujica-Mota et al, 2015), quien durante los años 2011-12 en Inglaterra, aplicaron un cuestionario sobre el padecimiento de enfermedades crónicas a una población de unas 831.537 personas y obtuvo los siguientes resultados: un 23% de la población tiene dos o más enfermedades crónicas en un rango entre el 7%, en la población menor de 45 años, hasta un 51%, en los mayores de 65 años.…”

“…En prácticamente toda la bibliografía consultada sobre los estudios realizados al respecto (Fortin et al, 2005), (Agborsangaya et al, 2012), (Orueta et al, 2014), (Mujica-Mota et al, 2015); se confirma que es mayor la prevalencia de la multimorbilidad en el género femenino.…”

“…La presencia de tres o más enfermedades crónicas se asocia a una disminución en la CVRS, esta asociación es mayor que la suma de dichas enfermedades de forma individual (Mujica-Mota et al, 2015).…”

“…El 50% de los encuestados con EQ-5D, no VAS, no tienen problemas en ninguna de las 5 dimensiones, 0,02% refiere problemas severos en todas las dimensiones. (Mujica-Mota et al, 2015) …”