Journal of multimorbidity and comorbidity最新文献

{"title":"Multimorbidity frameworks impact the composition of patterns and their associations with patient-reported outcomes among people with HIV.","authors":"Luxsena Sukumaran, Alan Winston, Jane Anderson, Marta Boffito, Frank A Post, Memory Sachikonye, Patrick W G Mallon, Laura Waters, Jaime Vera, Fiona Burns, Caroline A Sabin","doi":"10.1177/26335565251331732","DOIUrl":"10.1177/26335565251331732","url":null,"abstract":"<p><p><b>Objectives:</b> There is no consensus definition for multimorbidity. We explored how different frameworks affect multimorbidity patterns and their associations with patient-reported outcomes using the prospective, observational Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) Study. <b>Methods:</b> Sixty-four conditions were classified into three frameworks: Framework-D (diseases), Framework-DCI (diseases and clinical indicators) and Framework-DCIS (diseases, clinical indicators and symptoms). Principal component analysis (PCA) identified five comparable patterns: <i>Cardiovascular disease (CVD)</i>, <i>Sexually transmitted diseases</i>, <i>Metabolic/AIDS-related</i>, <i>Mental health/Other</i>, and <i>Cancer</i>. A sixth pattern was identified using Framework-D (<i>Infections/Skin)</i> and Framework-DCI/DCIS (<i>Cardiometabolic)</i>. Using PCA loadings, burden z-scores were calculated for each individual/pattern, and their associations with functional impairment (Lawton Instrumental Activities of Daily Living <8), hospitalisation and SF-36 physical and mental health scores were assessed using logistic or linear regression. <b>Results:</b> The analyses included 1073 people with HIV (median [interquartile range; IQR] age 52 [47 - 59] years; 85% male; 97% on ART). Clinical indicators and symptoms were correlated with the <i>CVD</i>, <i>Cardiometabolic</i> and <i>Mental health/Other</i> patterns. While differences were marginal, Framework-DCI showed slightly stronger relationships between <i>CVD</i> and functional impairment, hospitalisation and physical health compared to Framework-D. Similarly, Framework-DCIS demonstrated somewhat stronger associations between <i>Metabolic/AIDS-related</i> and <i>Mental health/Other</i> patterns with certain outcomes. <b>Conclusions:</b> The inclusion of clinical indicators and symptoms were associated with some changes in the strength of associations between certain multimorbidity patterns and outcomes. Our findings suggest that their inclusion in multimorbidity frameworks should be guided by the specific research context and question, rather than solely by effect size on patient-important outcomes.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251331732"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capturing the human impact of living with multiple long-term conditions in routine electronic health records - lost in translation?","authors":"Simon D S Fraser, Emilia Holland, Lynn Laidlaw, Nick A Francis, Sara Macdonald, Frances S Mair, Nisreen A Alwan, Michael Boniface, Rebecca B Hoyle, Nic Fair, Jakub J Dylag, Mozhdeh Shiranirad, Roberta Chiovoloni, Sebastian Stannard, Robin Poole, Ashley Akbari, Mark Ashworth, Alex Dregan","doi":"10.1177/26335565251329869","DOIUrl":"10.1177/26335565251329869","url":null,"abstract":"<p><strong>Background: </strong>Living with multiple long-term conditions (MLTCs) involves 'work'. A recent qualitative synthesis identified eight patient-centred work themes: 'learning and adapting', 'accumulation and complexity', 'investigation and monitoring', 'health service and administration' and 'symptom', 'emotional', 'medication' and 'financial' work. These themes may be underrepresented in electronic health records (EHRs). This study aimed to evaluate the representation of these themes and their constituent concepts in EHR data in a general population and among individuals with history of a mental health condition.</p><p><strong>Methods: </strong>Using the OpenCodelists builder from OpenSAFELY, clinical code lists corresponding to work concepts were developed using Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) and validated by two clinicians. Additional concepts were engineered within the Clinical Practice Research Datalink (CPRD) and the Secure Anonymised Information Linkage (SAIL) Databank. We analysed trends in recording rates over 20 years across a SAIL general population cohort (n=5,180,602) and a CPRD cohort comprising individuals with a mental health diagnosis (n=3,616,776) and matched controls (n=4,457,225).</p><p><strong>Results: </strong>55 code lists and seven engineered concepts were developed across the themes. The proportion of patients with codes related to 'investigation and monitoring' exceeded 40%, while 'accumulation and complexity' and 'financial work' were poorly represented (<2% and <1% of the study population respectively). Recording was generally higher among individuals with a mental health diagnosis history.</p><p><strong>Conclusion: </strong>While EHR data captures some aspects of MLTC work, patient-centred concepts are under-represented. Future research should explore reasons behind variability in coding practices, and innovative methods for enriching structured records with patient-centred data.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251329869"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Trust, humor, and the balance of involvement -</i> Patients with musculoskeletal conditions and comorbidities and their expectations towards physiotherapists.","authors":"Anna Bernhardt Lyhnebeck, John Sahl Andersen, Søren T Skou, Mette Bech Risør, Ann Dorrit Guassora","doi":"10.1177/26335565251321919","DOIUrl":"10.1177/26335565251321919","url":null,"abstract":"<p><strong>Background: </strong>Understanding patients' expectations of health care is central to providing patient-centered care and improving patient satisfaction. However, the current literature is primarily focused on single disease-specific patient expectations.</p><p><strong>Aim: </strong>To develop an in-depth understanding of the expectations patients with musculoskeletal conditions and comorbidities have towards physiotherapists working in private physiotherapy practice.</p><p><strong>Methods: </strong>35 observations with patients with musculoskeletal conditions and comorbidities receiving treatment in a Danish private physiotherapy setting were conducted. Of these, nine patients participated in interviews. A Grounded Theory analysis was undertaken, and categories were formed and agreed upon through an inductive approach grounded in the data.</p><p><strong>Results: </strong>Three major themes emerged from the data 1) Professional expertise is needed but will not be enough if enthusiasm fades in a long treatment course 2) Being able to laugh about life when you have many health problems 3) The balance of involvement and the sharing of power and responsibility. Patients express a desire for a strong bond with their physiotherapists, fostering intimacy and mutual understanding. They seek light-hearted interactions and wish to share personal aspects like family dynamics and hobbies. The study also underscores their expectations for sharing power and care tailored to their specific needs.</p><p><strong>Conclusion: </strong>Our findings reveal that patients with musculoskeletal conditions and comorbidities have clear expectations of treatment and collaboration with their physiotherapists in private physiotherapy practice. Underscoring personal relationships over physical results and demonstrating that this patient group has resources to support treatment and is clear about levels of involvement and collaboration.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251321919"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic morbidity levels and associated factors among older adults in western Nepal: A cross-sectional study.","authors":"Aman Shrestha, Krishna Prasad Sapkota, Isha Karmacharya, Lirisha Tuladhar, Preeti Bhattarai, Pratik Bhattarai, Bharat Kafle","doi":"10.1177/26335565251325920","DOIUrl":"10.1177/26335565251325920","url":null,"abstract":"<p><strong>Objective: </strong>The growing prevalence of chronic morbidity among Nepali older adults reflects the need for studies exploring the patterns and determinants for evidence-based public health strategies. This study evaluated chronic morbidity levels and the associated factors.</p><p><strong>Methods: </strong>A cross-sectional study recruited 612 participants (≥ 60 years) from all three ecological regions in Gandaki province, Nepal. Chronic morbidity level was derived as the cumulated presence of eight chronic conditions: coronary heart disease, hypertension, stroke, diabetes, cancer, respiratory issues, musculoskeletal conditions, and depression, and then creating three groups: no morbidity, single morbidity and multimorbidity. Ordinal logistic regression analyzed factors associated with morbidity levels, and findings are presented in adjusted odds ratio (OR) and 95% confidence interval (CI). All ethical standards were properly followed.</p><p><strong>Findings: </strong>About 40% of total participants reported having single morbidity, while 25% had multimorbidity. Participants above 70 years (OR: 1.68, CI: 1.18-2.38) and older women (OR: 2.34, CI: 1.53-3.58) reported odds of being in a higher morbidity category than their counterparts. Older adults without healthcare visits within a year had 90% lower odds (OR: 0.10, CI: 0.06-0.15) of being in a higher morbidity category.</p><p><strong>Interpretation: </strong>This study underlines the importance of regular healthcare visits, recommending that older adults undergo timely screenings for early diagnosis and effective management. It also emphasizes the need for increased public awareness and health promotion initiatives focused on chronic disease prevention activities within the older population. Additionally, investigating gender-specific factors may provide deeper insight into effective public health interventions.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251325920"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descriptions of advanced multimorbidity: A scoping review with content analysis.","authors":"Sarah P Bowers, Polly Black, Lewis McCheyne, Darcy Wilson, Rose S Penfold, Liam Stapleton, Pam Channer, Sarah E E Mills, Linda Williams, Frances Quirk, Jo Bowden","doi":"10.1177/26335565251326309","DOIUrl":"10.1177/26335565251326309","url":null,"abstract":"<p><strong>Introduction: </strong>Multimorbidity is associated with adverse clinical outcomes, including increased symptom burden and healthcare utilisation, particularly towards the end of life. Despite this, there is no accepted method to identify the point at which individuals with deteriorating health due to long-term conditions are nearing the end of life or might benefit from a palliative care approach - conceptualised as 'Advanced Multimorbidity'. This scoping review explored how Advanced Multimorbidity is described and operationalised within the literature.</p><p><strong>Methods: </strong>Multiple electronic databases and Grey Literature sources were searched following scoping review frameworks. Two reviewers independently performed screening and data extraction. Content analysis was used to examine the different descriptions of Advanced Multimorbidity. Stakeholder consultations were undertaken with clinicians, academics and public participants. Patient and public involvement was separately integrated throughout this review from conceptualisation, design and reporting.</p><p><strong>Results: </strong>Forty-four different descriptions of Advanced Multimorbidity were identified from 38 publications. These varied in terms of the clinical conditions and descriptors used. Eighteen descriptions relied on a single indicator to identify Advanced Multimorbidity; 24 used a multidimensional approach. Stakeholder consultations highlighted the need for descriptions that are user-friendly and actionable.</p><p><strong>Conclusion: </strong>The lack of a standardised definition of Advanced Multimorbidity risks variance in clinical and research practice, potentially affecting patient care. A consensus on defining Advanced Multimorbidity would enable better identification of patients who could benefit from a palliative care approach, ensuring more consistent and person-centred care, as well as supporting research and policy development.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251326309"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the virtual transitional care stroke intervention for older adults with stroke and multimorbidity: A qualitative descriptive study.","authors":"Maureen Markle-Reid, Kathryn Fisher, Kimberly M Walker, Jill I Cameron, David Dayler, Rebecca Fleck, Amiram Gafni, Rebecca Ganann, Ken Hajas, Barbara Koetsier, Robert Mahony, Chris Pollard, Jim Prescott, Tammy Rooke, Carly Whitmore","doi":"10.1177/26335565251323748","DOIUrl":"10.1177/26335565251323748","url":null,"abstract":"<p><strong>Background: </strong>Older adults with stroke and multimorbidity experience frequent care transitions, which are often poorly coordinated and fragmented. We conducted a pragmatic randomized controlled trial (RCT) to test the implementation and effectiveness of the Transitional Care Stroke Intervention (TCSI), a 6-month, multi-component, evidence-informed intervention to support older adults with stroke and multimorbidity using outpatient stroke rehabilitation services. The TCSI was designed to support self-management, improve health outcomes, and enhance the quality and experience of care transitions.</p><p><strong>Objective: </strong>To explore the facilitators and challenges to implementing the TCSI, from the perspective of healthcare providers (HCPs) (n = 12) and Managers (n = 3).</p><p><strong>Methods: </strong>Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected from study documents, individual and group interviews conducted with HCPs and a Care Coordinator, and surveys from managers. Data were analyzed using thematic analysis.</p><p><strong>Results: </strong>Intervention implementation was facilitated by: a) strong collaborative and interdependent HCP team relationships, b) dedicated resources (funding, staffing) to support intervention delivery, c) training and ongoing support, customized to individual HCP needs, d) organizational readiness, strong leadership, and effective champions, e) structures to facilitate virtual information-sharing, and f) regular monitoring of intervention implementation. Implementation challenges included: a) COVID-19 related challenges (staff turnover, community service disruptions), b) poor communication with community service providers, c) documentation burden (intervention-related), and d) virtual care delivery.</p><p><strong>Conclusions: </strong>This research enhances understanding of the diversity of factors influencing implementation of the TCSI, and the conditions under which implementation is more likely to succeed.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251323748"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prof Martin Fortin, An appreciation.","authors":"Susan M Smith, Frances S Mair, Marjan van den Akker","doi":"10.1177/26335565251323250","DOIUrl":"https://doi.org/10.1177/26335565251323250","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251323250"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building ADMISSION - A research collaborative to transform understanding of multiple long-term conditions for people admitted to hospital.","authors":"Miles D Witham, Victoria Bartle, Sue Bellass, Jonathan G Bunn, Duncan Cartner, Heather J Cordell, Rominique Doal, Felicity Evison, Suzy Gallier, Steve Harris, Susan J Hillman, Ray Holding, Peta Leroux, Tom Marshall, Fiona E Matthews, Paolo Missier, Anand Nair, Mo Osman, Ewan R Pearson, Chris Plummer, Sara Pretorius, Sarah J Richardson, Sian M Robinson, Elizabeth Sapey, Thomas Scharf, Rupal Shah, Marzieh Shahmandi, Mervyn Singer, Jana Suklan, James Ms Wason, Rachel Cooper, Avan A Sayer","doi":"10.1177/26335565251317940","DOIUrl":"10.1177/26335565251317940","url":null,"abstract":"<p><strong>Background: </strong>Multiple long-term conditions (MLTCs; commonly referred to as multimorbidity) are highly prevalent among people admitted to hospital and are therefore of critical importance to hospital-based healthcare systems. To date, most research on MLTCs has been conducted in primary care or the general population with comparatively little work undertaken in the hospital setting.</p><p><strong>Purpose: </strong>To describe the rationale and content of ADMISSION: a four-year UK Research and Innovation and National Institute of Health and Care Research funded interdisciplinary programme that seeks, in partnership with public contributors, to transform care for people living with MLTCs admitted to hospital.</p><p><strong>Research design: </strong>Based across five UK academic centres, ADMISSION combines expertise in clinical medicine, epidemiology, informatics, computing, biostatistics, social science, genetics and care pathway mapping to examine patterns of conditions, mechanisms, consequences and pathways of care for people with MLTCs admitted to hospital.</p><p><strong>Data collection: </strong>The programme uses routinely collected electronic health record data from large UK teaching hospitals, population-based cohort data from UK Biobank and routinely collected blood samples from The Scottish Health Research Register and Biobank (SHARE). These approaches are complemented by focused qualitative work exploring the perspectives of healthcare professionals and the lived experience of people with MLTCs admitted to hospital.</p><p><strong>Conclusion: </strong>ADMISSION will provide the necessary foundations to develop novel ways to prevent and treat MLTCs and their consequences in people admitted to hospital and to improve care systems and the quality of care for this underserved group.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251317940"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The usefulness of Charlson Comorbidity Index (CCI) scoring in predicting all-cause mortality in Outpatients with Clinical Diagnoses of COPD.","authors":"Kevin Ly, Dorothy Wakefield, Richard ZuWallack","doi":"10.1177/26335565251315876","DOIUrl":"10.1177/26335565251315876","url":null,"abstract":"<p><strong>Background: </strong>Since comorbid conditions are frequently present in chronic obstructive pulmonary disease (COPD) and affect outcome, a composite scoring system to quantify comorbidity might be helpful in assessing mortality risk.</p><p><strong>Methods: </strong>We tested the hypothesis that the Charlson Comorbidity Index (CCI) score at the time of an outpatient medical clinic encounter for COPD predicts all-cause mortality. Cox Proportional Hazards analyses were used in 200 randomly selected patients to relate CCI scores to all-cause mortality out to 5 years.</p><p><strong>Results: </strong>Mean age was 62 ± 10 years, 56% were female, FEV1 was 62%, CCI was 3.08 ± 2.30, and 30% had a CCI ≥ 4, indicating 3 or more comorbid conditions. All-cause mortality was 8.5% and 20% at 3 and 5 years, respectively. In univariate testing, the CCI score and hospitalizations predicted mortality, but FEV1 did not. In multivariable testing, which included covariates of age, sex, socioeconomic status, race, FEV1 percent-predicted, and all-cause hospitalizations in the preceding year, CCI expressed as a continuous variable strongly predicted mortality: hazard ratio (HR) 1.38 for each unit increase in the score (p < 0.0001). While 1 or 2 comorbid conditions were not significantly related to mortality, 3 or more comorbid conditions (compared to none) strongly predicted mortality: HR 9.80, 95% CI 3.80 to 25.00.</p><p><strong>Conclusion: </strong>Comorbidity, assessed with the CCI, is strongly predictive of mortality in outpatients with a clinical diagnosis of COPD, and this relationship appears to be non-linear. This instrument may be useful in determining prognosis in this population.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251315876"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic and clinical characteristics of older people with multimorbidity accessing primary healthcare in Malawi: A cross-sectional study.","authors":"Duncan Kwaitana, James Jafali, Maya Jane Bates, Dorothee van Breevoort, Thomas Mildestvedt, Eivind Meland, Eric Umar","doi":"10.1177/26335565251317380","DOIUrl":"10.1177/26335565251317380","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is a growing global concern, affecting patient outcomes and healthcare costs. In low- and middle-income countries, data on multimorbidity in primary care beyond prevalence is limited. Our study explored the demographic and clinical characteristics of multimorbidity among older people attending primary health care in Malawi.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis on medical records from 15,009 older patients aged ≥50 years across three hospitals in Malawi (one tertiary, two district). Data from 2019-2021 was analyzed using R statistical software to examine patterns of multimorbidity (two or more chronic conditions). Outcome estimates were adjusted for sex, age, location, and year of clinic visit.</p><p><strong>Results: </strong>The overall prevalence of multimorbidity, defined across 17 recorded chronic conditions, was 19.6%. Among the 2,941 cases of multimorbidity, 2,708 (92.0%) involved two chronic conditions, while 233 (8.0%) involved three. While most conditions increased steadily in prevalence with age, diabetes followed a different pattern, with higher prevalence among individuals aged 50-59 years (53.9%) and 60-69 years (52.4%) compared to those 70 years and older (40.3%). After adjusting for clinic visit year, gender, and study location, individuals aged 70 years and older were significantly less likely to have multimorbidity compared to those aged 50-59 years (AOR = 0.57, 95% CI: 0.52-0.62, p < 0.001).</p><p><strong>Conclusion: </strong>The study revealed a wide range of multimorbidity combinations among older people attending primary health care. Strategies to address multimorbidity in older people should include efforts to identify other, less common clusters of chronic conditions.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251317380"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}