Survival in relation to multimorbidity patterns in older adults in primary care in Barcelona, Spain (2010–2014): a longitudinal study based on electronic health records

Ibarra-Castillo, Carolina; Guisado-Clavero, Marina; Violan-Fors, Concepció; Pons‐Vigués, Mariona; López-Jiménez, Tomás; Roso-Llorach, Albert

doi:10.1136/jech-2017-209984

Cited by 25 publications

(27 citation statements)

References 28 publications

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“…As with the multimorbidity (3+) analysis, both males and females 80 years and older with multimorbidity (2+) were twice as likely to die as those without multimorbidity. Our results are consistent with those found in other studies 6 – 13 , 15 – 19 , 30 where the effect of multimorbidity on mortality decreased with age. Our results were consistent with Jani et al 12 that found that “Multimorbidity had a greater impact on all-cause mortality in middle-aged as opposed to older populations particularly males, which deserves exploration” (p. 1).…”

Section: Discussionsupporting

confidence: 93%

“…Studies that included adults across age groups 6 – 12 generally found a higher effect of multimorbidity on mortality than those studies that included only older adults. 13 – 19 A few of these studies studied the relationship between multimorbidity and mortality and levels of deprivation and found higher deprivation was association with higher mortality, including lower education 6 , 20 and ethnicity. 8 …”

Section: Introductionmentioning

confidence: 99%

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Multimorbidity and mortality in Ontario, Canada: A population-based retrospective cohort study

Ryan

Allen²,

Zwarenstein

et al. 2020

J Comorb

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Objective: To examine the relationship between multimorbidity and mortality, and whether relationship varied by material deprivation/rural location and by age. Methods: Retrospective population-based cohort study conducted using 2013–14 data from previously created cohort of Ontario, Canada residents classified according to whether or not they had multimorbidity, defined as having 3+ of 17 chronic conditions. Adjusted rate ratios were calculated to compare mortality rates for those with and without multimorbidity, comparing rates by material deprivation/rural location, and by age group. Results: There were 13,581,191 people in the cohort ages 0 to 105 years; 15.2% had multimorbidity. Median length of observation was 365 days. Adjusted mortality rate ratios did not vary by material deprivation/rural location; overall adjusted mortality rate ratio was 2.41 (95% CI 2.37–2.45). Adjusted mortality rate ratios varied by age with ratios decreasing as age increased. Overall rate ratio was 14.7 (95% CI 14.48–14.91). Children (0–17 years) had highest ratio, 40.06 (95% CI 26.21–61.22). Youngest adult age group (18–24 years) had rate ratio of 9.96 (95% CI 7.18–13.84); oldest age group (80+ years) had rate ratio of 1.97 (95% CI 1.94–2.04). Conclusion: Compared to people without multimorbidity, multimorbidity conferred higher risk of death in this study at all age groups. Risk was greater in early and middle adulthood than in older ages. Results reinforce the fact multimorbidity is not just a problem of aging, and multimorbidity leads not only to poorer health and higher health care utilization, but also to a higher risk of death at a younger age.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Multimorbidity and mortality in Ontario, Canada: A population-based retrospective cohort study

Ryan

Allen²,

Zwarenstein

et al. 2020

J Comorb

View full text Add to dashboard Cite

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“…Studies on multimorbidity have increased in recent years,11–20 and a clinical guideline on clinical assessment and management of multimorbidity was developed by the National Institute for Health and Care Excellence in the UK in 2016 21. However, studies are still needed for the epidemiology and profiles of patients with multimorbidity and their longitudinal outcomes to inform policy-making in different populations including Chinese primary care patients 3 11.…”

Section: Introductionmentioning

confidence: 99%

“…However, studies are still needed for the epidemiology and profiles of patients with multimorbidity and their longitudinal outcomes to inform policy-making in different populations including Chinese primary care patients 3 11. Most studies on primary care patients with multimorbidity are conducted in western countries such as UK, USA, Australia, Spain and Belgium,14 15 22–28 and limited research has been conducted on psychological and social problems accompanying with multimorbidity 3 11 21 29 30. Several longitudinal studies of multimorbidity have been conducted in Asian populations,31–33 but none of these are of primary care patients.…”

Section: Introductionmentioning

confidence: 99%

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Cohort profile: The prospective study on Chinese elderly with multimorbidity in primary care in Hong Kong

et al. 2020

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PurposeThis is an ongoing prospective cohort aiming to examine the biopsychosocial health profiles and predictors of health outcomes of older patients with multimorbidity in primary care in Hong Kong.ParticipantsFrom April 2016 to October 2017, 1077 patients aged 60+ years with at least two chronic diseases were recruited in four public primary care clinics in the New Territories East Region of Hong Kong.Findings to dateAfter weighting, the patients had 4.1 (1.8) chronic conditions and 2.5 (1.9) medications on average; 37% forgot taking medication sometimes; 71% rated their health as fair or poor; 17% were frail; 73% reported one (21%) or two or more (52%) body pain areas; 62% were overweight/obese; 23% reported chewing difficulty, 18% reported incontinence; 36% had current stage 1/2 hypertension; 38% had handgrip strength below the cut-off; 10% screened positive in sarcopenia; 17% had mild or severer cognitive impairment; 17% had mild to severe depression; 16% had mild to severe anxiety; 50% had subthreshold to severe insomnia; 28% indicated being lonely; 12% needed help in at least one out of the five daily functions and the EuroQoL-5-Dimensions-5-Level index score was 0.81 (0.20) and its Visual Analogue Scale (VAS) score was 67.6 (14.6). In the past 12 months, 17% were hospitalised, 92% attended general outpatient clinics, 70% attended specialist outpatient clinics and 10% used elderly daycare centre services, the median out-of-pocket health cost was HK$1000 (US$150). Female and male patients showed significant differences in many biopsychosocial health aspects.Future plansWith assessments and clinical data, the cohort can be used for understanding longitudinal trajectories of biopsychosocial health profiles of Chinese older patients with multimorbidity in primary care. We are also initially planning cohort studies on factors associated with various health outcomes, as well as quality of life and healthcare use.Cohort registration numberChiCTR-OIC-16008477

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Multimorbidity clusters among long‐term breast cancer survivors in Spain: Results of the SURBCAN study

Jansana

Poblador‐Plou

Gimeno‐Miguel

et al. 2021

Intl Journal of Cancer

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The disease management of long-term breast cancer survivors (BCS) is hampered by the scarce knowledge of multimorbidity patterns. The aim of our study was to identify multimorbidity clusters among long-term BCS and assess their impact on mortality and health services use. We conducted a retrospective study using electronic health records of 6512 BCS from Spain surviving at least 5 years. Hierarchical cluster analysis was used to identify groups of similar patients based on their chronic diagnoses, which were assessed using the Clinical Classifications Software. As a result, multimorbidity clusters were obtained, clinically defined and named according to the comorbidities with higher observed/expected prevalence ratios. Multivariable Cox and negative binomial regression models were fitted to estimate overall mortality risk and probability of contacting health services according to the clusters identified. 83.7% of BCS presented multimorbidity, essential hypertension (34.5%) and obesity and other metabolic disorders (27.4%) being the most prevalent chronic diseases at the beginning of follow-up. Five

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Survival in relation to multimorbidity patterns in older adults in primary care in Barcelona, Spain (2010–2014): a longitudinal study based on electronic health records

Abstract: Mortality and survival vary according to CMPs in older adults stratified by sex and age. Our findings are useful for guiding the design and implementation of clinical management strategies.

Cited by 25 publications

References 28 publications

Multimorbidity and mortality in Ontario, Canada: A population-based retrospective cohort study

Multimorbidity and mortality in Ontario, Canada: A population-based retrospective cohort study

Cohort profile: The prospective study on Chinese elderly with multimorbidity in primary care in Hong Kong

Multimorbidity clusters among long‐term breast cancer survivors in Spain: Results of the SURBCAN study

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