Journal of multimorbidity and comorbidity最新文献

{"title":"The effect of disease onset chronology on mortality among patients with multimorbidity: A Danish nationwide register study.","authors":"Tora G Willadsen,&nbsp;Volkert Siersma,&nbsp;Dagny R Nicolaisdóttir,&nbsp;Rasmus Køster-Rasmussen,&nbsp;Susanne Reventlow,&nbsp;Maarten Rozing","doi":"10.1177/26335565221122025","DOIUrl":"https://doi.org/10.1177/26335565221122025","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is associated with increased mortality. Certain combinations of diseases are known to be more lethal than others, but the limited knowledge of how the chronology in which diseases develop impacts mortality may impair the development of effective clinical interventions for patients with multimorbidity.</p><p><strong>Objective: </strong>To explore if in multimorbidity the chronology of disease onset is associated with mortality. Design: A prospective nationwide cohort study, including 3,986,209 people aged ≥18 years on 1 January 2000, was performed. We included ten diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. We defined multimorbidity as the presence of at least two diagnoses from two diagnosis groups (out of ten). To determine mortality, logistic regression models were used to calculate odds ratios (OR) and ratio of ORs (RORs).</p><p><strong>Results: </strong>For most combinations of multimorbidity, the chronology of disease onset does not change mortality. However, when multimorbidity included mental health diagnoses, mortality was in general higher if the mental health diagnosis appeared first. If multimorbidity included heart and sensory diagnoses, mortality was higher if these developed second. For the majority of multimorbidity combinations, there was excess mortality if multimorbidity was diagnosed simultaneously, rather than consecutively, for example, heart and kidney (3.58 ROR; CI 2.39-5.36), or mental health and musculoskeletal diagnoses (2.38 ROR; CI 1.70-3.32).</p><p><strong>Conclusions: </strong>Overall, in multimorbidity, the chronology in which diseases develop is not associated with mortality, with few exceptions. For almost all combinations of multimorbidity, diagnoses act synergistically in relation to mortality if diagnosed simultaneously.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":"26335565221122025"},"PeriodicalIF":0.0,"publicationDate":"2022-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/7d/10.1177_26335565221122025.PMC9400403.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33442169","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":"Cultivating informatics capacity for multimorbidity: A learning health systems use case.","authors":"Tremaine B Williams, Maryam Garza, Riley Lipchitz, Thomas Powell, Ahmad Baghal, Taren Swindle, Kevin Wayne Sexton","doi":"10.1177/26335565221122017","DOIUrl":"10.1177/26335565221122017","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to characterize patterns of multimorbidity across patients and identify opportunities to strengthen the informatics capacity of learning health systems that are used to characterize multimorbidity across patients.</p><p><strong>Methods: </strong>Electronic health record (EHR) data on 225,710 multimorbidity patients were extracted from the Arkansas Clinical Data Repository as a use case. Hierarchical cluster analysis identified the most frequently occurring combinations of chronic conditions within the learning health system's captured data.</p><p><strong>Results: </strong>Results revealed multimorbidity was highest among patients ages 60 to 74, Caucasians, females, and Medicare payors. The largest numbers of chronic conditions occurred in the smallest numbers of patients (i.e., 70,262 (31%) patients with two conditions, two (<1%) patients with 22 chronic conditions). The results revealed urgent needs to improve EHR systems and processes that collect and manage multimorbidity data (e.g., creating new, multimorbidity-centric data elements in EHR systems, detailed longitudinal tracking of compounding disease diagnoses).</p><p><strong>Conclusions: </strong>Without additional capacity to collect and aggregate large-scale data, multimorbidity patients cannot benefit from the recent advancements in informatics (i.e., clinical data registries, emerging data standards) that are abundantly working to improve the outcomes of patients with single chronic conditions. Additionally, robust socio-technical system studies of clinical workflows are needed to assess the feasibility of integrating the collection of risk factor data elements (i.e., psycho-social, cultural, ethnic, and socioeconomic attributes of populations) into primary care encounters. These approaches to advancing learning health systems for multimorbidity could substantially reduce the constraints of current technologies, data, and data-capturing processes.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":"26335565221122017"},"PeriodicalIF":0.0,"publicationDate":"2022-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/37/10.1177_26335565221122017.PMC9389034.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712750","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":"Multimorbidity matters in low and middle-income countries.","authors":"Ana Basto-Abreu, Tonatiuh Barrientos-Gutierrez, Alisha N Wade, Daniela Oliveira de Melo, Ana S Semeão de Souza, Bruno P Nunes, Arokiasamy Perianayagam, Maoyi Tian, Lijing L Yan, Arpita Ghosh, J Jaime Miranda","doi":"10.1177/26335565221106074","DOIUrl":"10.1177/26335565221106074","url":null,"abstract":"<p><p>Multimorbidity is a complex challenge affecting individuals, families, caregivers, and health systems worldwide. The burden of multimorbidity is remarkable in low- and middle-income countries (LMICs) given the many existing challenges in these settings. Investigating multimorbidity in LMICs poses many challenges including the different conditions studied, and the restriction of data sources to relatively few countries, limiting comparability and representativeness. This has led to a paucity of evidence on multimorbidity prevalence and trends, disease clusters, and health outcomes, particularly longitudinal outcomes. In this paper, based on our experience of investigating multimorbidity in LMICs contexts, we discuss how the structure of the health system does not favor addressing multimorbidity, and how this is amplified by social and economic disparities and, more recently, by the COVID-19 pandemic. We argue that generating epidemiologic data around multimorbidity with similar methods and definition is essential to improve comparability, guide clinical decision-making and inform policies, research priorities, and local responses. We call for action on policy to refinance and prioritize primary care and integrated care as the center of multimorbidity.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":"26335565221106074"},"PeriodicalIF":0.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/08/10.1177_26335565221106074.PMC9208045.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40237086","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":"Research policy for people with multiple long-term conditions and their carers.","authors":"Natalie Owen,&nbsp;Leanne Dew,&nbsp;Stuart Logan,&nbsp;Simon Denegri,&nbsp;Lucy C Chappell","doi":"10.1177/26335565221104407","DOIUrl":"https://doi.org/10.1177/26335565221104407","url":null,"abstract":"<p><p>People with multiple long-term conditions (MLTC) are a growing population, not only in the United Kingdom but internationally. Health and care systems need to adapt to rise to this challenge. Policymakers need to better understand how medical education and training, and service configuration and delivery should change to meet the needs of people with MLTC and their carers. A series of workshops with people with MLTC and carers across the life-course identified areas of unmet need including the impact of stigma; poorly coordinated care designed around single conditions; inadequate communication and consultations that focus on clinical outcomes rather than patient-oriented goals and imperfectly integrate mental and physical wellbeing. Research which embeds the patient voice at its centre, from inception to implementation, can provide the evidence to drive the change to patient-centred, coordinated care. This should not only improve the lives of people living with MLTC and their carers but also create a health and care system which is more effective and efficient. The challenge of MLTC needs to be bought to the fore and it will require joint effort by policymakers, practitioners, systems leaders, educators, the third sector and those living with MLTC to design a health and care system from the perspective of patients and carers, and provide practitioners with the skills and tools needed to provide the highest quality care.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":"26335565221104407"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40041675","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":"Multi-morbidity and patient-reported functional limitations: a population-based cohort study.","authors":"Alanna M Chamberlain, Jennifer L St Sauver, Cynthia M Boyd, Lila J Finney Rutten, Chun Fan, Debra J Jacobson, Walter A Rocca","doi":"10.1177/26335565221105448","DOIUrl":"10.1177/26335565221105448","url":null,"abstract":"<p><strong>Background: </strong>Persons who accumulate chronic conditions at a rate faster than their peers may experience accelerated aging and poor health outcomes, including functional limitations.</p><p><strong>Methods: </strong>Adults aged ≥40 years who resided in Olmsted County, Minnesota on 1 January 2006 were identified. The prevalence of 21 chronic conditions was ascertained, and age-specific quartiles of the number of chronic conditions was estimated within 4 age groups: 40-54, 55-64, 65-74, and ≥75 years. Difficulty with nine patient-reported functional limitations (including basic and instrumental activities of daily living and mobility activities) were ascertained through 31 October 2018. Cox regression was used to model associations of chronic condition quartiles with new-onset functional limitations considered separately. We estimated absolute risk differences and hazard ratios stratified by age group, and adjusted for sex, race, ethnicity, marital status, education, and the residual effect of age.</p><p><strong>Results: </strong>Among 39,624 persons (44.5% men, 93.2% white), the most common reported new functional limitations were difficulty with climbing stairs, walking, and housekeeping. For all functional limitations, the absolute risk differences were largest among the oldest age group (≥75 years). Approximately twofold increased hazard ratios were observed among those in the highest vs. lowest quartile for the three oldest age groups, and approximately threefold or higher hazard ratios were observed for persons aged 40-54 years.</p><p><strong>Conclusion: </strong>Persons with increased accumulation of chronic conditions experience increased risks of developing functional limitations compared to their peers. These findings underscore the importance of assessing health status and of employing interventions to prevent and effectively manage multi-morbidity at all ages.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":"26335565221105448"},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9158431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45281303","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":"Frequency and types of clusters of major chronic diseases in 0.5 million adults in urban and rural China.","authors":"Parisa Hariri, Robert Clarke, Fiona Bragg, Yiping Chen, Yu Guo, Ling Yang, Jun Lv, Canqing Yu, Liming Li, Zhengming Chen, Derrick A Bennett","doi":"10.1177/26335565221098327","DOIUrl":"10.1177/26335565221098327","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the frequency and types of disease clusters involving major chronic diseases that contribute to multimorbidity in China. We examined the frequency of disease clusters involving major chronic diseases and their relationship with age and socioeconomic status in 0.5 million Chinese adults.</p><p><strong>Methods: </strong>Multimorbidity was defined as the presence of at least two or more of five major chronic diseases: stroke, ischaemic heart disease (IHD), diabetes, chronic obstructive pulmonary disease (COPD) and cancer. Multimorbid disease clusters were estimated using both self-reported doctor-diagnosed diseases at enrolment and incident cases during 10-year follow-up. Frequency of multimorbidity was assessed overall and by age, sex, region, education and income. Association rule mining (ARM) and latent class analysis (LCA) were used to assess clusters of the five major diseases.</p><p><strong>Results: </strong>Overall, 11% of Chinese adults had two or more major chronic diseases, and the frequency increased with age (11%, 24% and 33% at age 50-59, 60-69 and 70-79 years, respectively). Multimorbidity was more common in men than women (12% vs 11%) and in those living in urban than in rural areas (12% vs 10%), and was inversely related to levels of education. Stroke and IHD were the most frequent combinations, followed by diabetes and stroke. The patterns of self-reported disease clusters at baseline were similar to those that were recorded during the first 10 years of follow-up.</p><p><strong>Conclusions: </strong>Cardiometabolic and cardiorespiratory diseases were most common disease clusters. Understanding the nature of such clusters could have implications for future prevention strategies.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221098327"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9125108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9150462","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 condition clusters and associated disability over time.","authors":"Tara C Klinedinst, Lauren Terhorst, Juleen Rodakowski","doi":"10.1177/26335565221093569","DOIUrl":"10.1177/26335565221093569","url":null,"abstract":"<p><strong>Objectives: </strong>Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (activities of daily living (ADL) and functional mobility (FM)) over time; the aim of this study was to investigate this relationship.</p><p><strong>Methods: </strong>This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) (<i>n</i> = 6179). Using latent class analysis (LCA), we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years.</p><p><strong>Results: </strong>We identified six chronic condition clusters: Minimal Disease, Cognitive/Affective, Multiple Morbidity, Osteoporosis, Vascular, and Cancer. Chronic condition cluster was related to ADL and FM outcomes, indicating that groups experienced differential disability over time. At time point 4, all chronic condition groups had worse FM than Minimal Disease.</p><p><strong>Discussion: </strong>The clusters of conditions identified here are plausible when considered clinically and in the context of previous research. All groups with chronic conditions carry risk for disability in FM and ADL; increased screening for disability in primary care could identify early disability and prevent decline.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":"26335565221093569"},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9106307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42522283","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":"Patient centred care in an evidence based world? A meta-ethnography of multimorbidity interventions","authors":"Marianne McCallum, F. Mair, Oscar Ponce, N. Corcoran, Tiffany Keep, Guy Rughani","doi":"10.1370/afm.20.s1.2803","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2803","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"151 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78436240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of multimorbidity in sub-saharan africa: Preliminary findings from three community studies","authors":"B. Jani, F. Mair, M. Jobe, J. Seeley, I. Sekitoleko, A. Price, A. Prentice","doi":"10.1370/afm.20.s1.2740","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2740","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"61 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77654154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of people living with multi morbidity in urban and rural Malawi","authors":"Edith F Chikumbu, Christopher Bunn, F. Mair, J. Seeley, B. Jani, S. Wyke","doi":"10.1370/afm.20.s1.2702","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2702","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82365140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}