The effect of multimorbidity patterns, and the impact of comorbid anxiety and depression, on primary health service use: the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study

Abstract

Background: Multimorbidity has been identified as a serious challenge on global health system, closely associated with lower quality of life, poorer health outcomes, and higher utilisation of health services. However, there are major gaps in our knowledge around multimorbidity, especially its effect on primary care services and the burden of comorbid mental health conditions on multimorbidity patterns. This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men. Methods: This was a prospective cohort study with Australian population. The study population consisted of 2,039 men aged ≥40, who were enrolled either in the Florey Adelaide Male Ageing Study (FAMAS) Stage 2 between 2007-2010 or in the North-West Adelaide Health Study (NWAHS) Stage 3 between 2008-2010. Data have been collected on the prevalence of 8 chronic conditions and linked Medicare data about individual health service utilization information on annual GP visits. Multinomial logistic regression was adopted to quantify the impact of anxiety and depression on the frequencies of GP visits, with adjustment for participant’s demographic and lifestyle characteristics. Results: Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two non-random multimorbidity “clusters” emerged: (CVD, Obesity, Diabetes) and (CVD, Obesity, Osteoarthritis). Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. Comparing to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI: 2.8-4.8). When CVD was comorbid with anxiety and depression having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI: 1.2-2.5). Conclusions: In Australian, community-dwelling men, multimorbidity is associated with a high use of GP services; especially for multimorbidity that includes CVD with comorbid anxiety and depression. Multimorbidity patterns involving CVD should be considered in developing clinical trials to better inform medical decision making and care for patients with CVD and comorbid conditions.

Exploring multimorbidity clusters in relation to healthcare use and its impact on self-rated health among older people in India

“…Thirdly, the number of latent classes and clusters/patterns may not be comparable due to the result of variations in the characteristics of the study sample as well as the number and type of chronic diseases that were examined. Beyond the statistical technique, our investigation found some clusters that were expected and corroborated by the results of other studies carried out in India and other nations [34,58,59]. Fourthly, we also include participants without chronic disease or multimorbidity for comparison purposes in the context of healthcare use, which may explain the contrasting findings.…”