The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches

Abstract

The aim of this study was to quantify the population impact of rheumatic and musculoskeletal diseases (RMDs) with other non-communicable diseases (NCDs), using two complementary strategies: standard multivariate models based on global burden of disease (GBD)-defined groups vs. empirical mutually exclusive patterns of NCDs. We used cross-sectional data from the Portuguese Fourth National Health Survey (n = 23,752). Six GBD-defined groups were included: RMDs, chronic obstructive pulmonary disease or asthma, cancer, depression, diabetes or renal failure, and stroke or myocardial infarction. The empirical approach comprised the patterns "low disease probability", "cardiometabolic conditions", "respiratory conditions" and "RMDs and depression". As recommended by the outcome measures in rheumatology (OMERACT) initiative, health outcomes included life impact, pathophysiological manifestations, and resource use indicators. Population attributable fractions (PAF) were computed for each outcome and bootstrap confidence intervals (95% CI) were estimated. Among GBDdefined groups, RMDs had the highest impact across all the adverse health outcomes, from frequent healthcare utilization (PAF 7.8%, 95% CI 6.2-9.3) to negative self-rated health (PAF 18.1%,). In the empirical approach, patterns "cardiometabolic conditions" and "RMDs and depression" had similar PAF estimates across all adverse health outcomes, but "RMDs and depression" showed significantly higher impact on chronic pain (PAF 8.9%, 95% CI 7.6-10.3) than the remaining multimorbidity patterns. RMDs revealed the greatest population impact across all adverse health outcomes tested, using both approaches. Empirical patterns are particularly interesting to evaluate the impact of RMDs in the context of their co-occurrence with other NCDs.

Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study

“…Rheumatic and musculoskeletal Open access diseases have been reported to have the strongest association with poor SRH among the chronic conditions. 44 SRH in older people with multimorbidity is exacerbated by vision impairment, hearing impairment, depression and anxiety. 45 Mental disorders and/or musculoskeletal diseases have been reported as combinations of chronic conditions associated with poor SRH.…”

Exploring the Role of Rheumatic and Musculoskeletal Diseases in Multimorbidity

“…Additionally, people living with multimorbidity have greater self-care needs [18] and are especially likely to rely on a caregiver for health management [19]. At the healthcare level, it implies increased risk of receiving less than best practice care [20], more frequent postoperative complications [21], longer hospitalization, higher likelihood of readmission [22], more frequent healthcare utilization, higher direct costs [23,24], and increased use of polypharmacy with the potential for adverse drug effects [25]. With all these adverse health outcomes, the ramifications of suffering from multimorbidity affect the individual within social, educational, cultural, behavioral, economic, and environmental circumstances, which in turn affect disease management.…”

Classification of patients with osteoarthritis through clusters of comorbidities using 633,330 individuals from Spain

“…Clustering of comorbidities among individuals with OA has only recently started to be explored. Studies examining general multimorbidity have shown that musculoskeletal problems including OA are very common among people with multimorbidity 15 , and often cluster with cardiovascular disease 16,17 . OA is a particularly common contributor to multimorbidity among the elderly 17 .…”