Journal of multimorbidity and comorbidity最新文献

{"title":"Chronic health conditions and health care affordability issues among U.S. rural and urban adults.","authors":"Ingrid Jacobson, Alexis Swendener, Hannah MacDougall, Carrie Henning-Smith","doi":"10.1177/26335565251399365","DOIUrl":"10.1177/26335565251399365","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic health conditions and rurality are associated with each other and with higher risks of medical debt. Less is known about the intersection of chronic conditions and health care affordability issues as they relate to rurality. The objective of this study is to determine whether rural/urban differences exist in associations between chronic conditions and health care affordability issues.</p><p><strong>Methods: </strong>Using data from the 2022 National Health Interview Survey, we conducted survey-weighted bivariate analyses comparing rates of chronic conditions and multimorbidity by rurality, followed by adjusted multivariate logistic regression models examining associations between health care affordability issues, chronic conditions, and multimorbidity.</p><p><strong>Major findings: </strong>Compared to urban residents, rural residents reported significantly higher rates of nearly all chronic conditions, multimorbidity (3+ chronic conditions: 26.7% vs 18.3%, <i>P</i><.001), problems paying medical bills (13.7% vs 11.0%, <i>P</i>=.004), and inability to pay medical bills (9.6% vs 6.8%, <i>P</i><.001). After adjustment, certain chronic conditions and multimorbidity were associated differentially with health care affordability issues across the full, urban-only, and rural-only subsamples.</p><p><strong>Conclusions: </strong>Adults living in rural areas of the U.S. may have higher rates of chronic conditions and be more likely to experience health care affordability issues than their urban counterparts. Differing patterns by multimorbidity and rurality indicate that policy interventions addressing medical debt should be targeted to chronic condition types and tailored by rurality.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251399365"},"PeriodicalIF":3.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12623636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558549","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-reported quality of life (QoL) measurements in adults with multiple long-term conditions: A scoping review protocol.","authors":"Marta Santillo, Laura J Gray, Hannah M L Young, Jonathan A Batty, Claire Brockett, Vishal R Aggarwal, Thomas Beaney, Lihua Wu, Sivesh Kamarajah, Nathan Davies, Nia Roberts, Tanya MacKay, Megan A Kirk","doi":"10.1177/26335565251390804","DOIUrl":"10.1177/26335565251390804","url":null,"abstract":"<p><strong>Objective: </strong>This scoping review will systematically map the evidence on Patient Reported Outcome Measures (PROMS) used to assess quality of life (QoL) in adults with multiple long-term conditions (MLTC) across all healthcare and community settings.</p><p><strong>Rationale: </strong>Research on patient-reported QoL in adults with MLTC is limited. Existing measures are mostly generic and may lack sensitivity to the complexity and heterogeneity of MLTC. This review will examine PROMs used in MLTC research, and identify gaps in QoL measurement.</p><p><strong>Inclusion/exclusion criteria: </strong>Quantitative, qualitative, or mixed-methods studies, and pre-specified grey literature, reporting QoL tools for adults with any combination of physical and/or mental MLTC will be included. Single conditions, comorbidity, or non-adult populations will be excluded.</p><p><strong>Methods: </strong>Following established scoping review guidelines, a systematic search strategy, developed with a librarian, will cover fivedatabases (e.g., MEDLINE, Embase, PsychINFO, CINAHL), plus grey literature and citation tracking. English-language publications with no restrictions on geographic location or publication date will be considered. After de-duplication, two reviewers will independently screen citations based on predefined inclusion criteria. Discrepancies will be resolved with a third reviewer. A pre-specified data extraction form to capture qualitative and quantitative data will be pilot tested. An 11-member patient and public advisory group will be established and stakeholder consultation will be conducted. Findings will be summarised using tables, figures and narrative synthesis and disseminated widely for multiple audiences.</p><p><strong>Discussion: </strong>This review will highlight QoL measurement gaps, inform future development of tailored QoL PROMs for MLTC populations, and contribute to national or global MLTC research priorities.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251390804"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12580504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446475","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":"Using responsive evaluation to shape research: Engaging and collaborating with stakeholders in the international symposium on multimorbidity.","authors":"Nina Grede, Christiane Muth, Maria Hanf, Amaia Calderón-Larrañaga, José Maria Valderas, Svetlana Puzhko, Marjan van den Akker","doi":"10.1177/26335565251388513","DOIUrl":"10.1177/26335565251388513","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity (MM) is a growing global public health issue requiring interdisciplinary collaboration among researchers, healthcare professionals, policymakers, and patients. The third International Symposium on Multimorbidity, held in May 2024 in Bielefeld, Germany, provided a platform for knowledge exchange and stakeholder engagement to address key challenges in MM research and care.</p><p><strong>Methods: </strong>The symposium followed a structured responsive evaluation approach with continuous stakeholder involvement. A pre-symposium survey was distributed to 116 international experts in the potential target audience; 85 responded, identifying the most pressing topics in MM. The lack of direct patient and policy maker involvement may have influenced the prioritization of certain topics.</p><p><strong>Results: </strong>Key topics included medication management, coordinated and personalized care, methods for measuring MM, applications of artificial intelligence, and concerns regarding overdiagnosis and overtreatment. These results informed the symposium agenda, ensuring relevance to the professional community. Participants from 16 countries attended, reflecting widespread international interest. A post-symposium survey (response rate: 19%) indicated high satisfaction; 85.5% of respondents would recommend the event. Feedback highlighted the need for broader topic coverage, more practical applications, and enhanced networking opportunities. Limitations included the low response rate for the post-symposium survey and potential self-selection bias.</p><p><strong>Conclusion: </strong>The symposium effectively facilitated discussion and knowledge exchange through a structured, stakeholder-driven format. Recommendations for future events include expanding topic variety, integrating practical components, improving logistics, and incorporating real-time feedback tools. These insights support ongoing advancements in MM research, policy, and clinical practice, emphasizing the importance of interdisciplinary and participant-centered approaches in academic event planning.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251388513"},"PeriodicalIF":3.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12579111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432971","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 perceptions of quality of care rendered for HIV and non-communicable diseases at an urban district hospital in KwaZulu-Natal.","authors":"Althea Rajagopaul, Mergan Naidoo","doi":"10.1177/26335565251381986","DOIUrl":"10.1177/26335565251381986","url":null,"abstract":"<p><strong>Background: </strong>In sub-Saharan Africa, the rising burden of noncommunicable diseases (NCDs), such as diabetes mellitus (DM) and hypertension (HT), coexists with the ongoing challenge of HIV, a leading cause of death. People living with HIV (PLHIV) also have NCDs, which may affect their healthcare experiences. This study explored patient perceptions of the quality of care received by PLHIV, with and without NCDs, at an antiretroviral treatment (ART) clinic in an urban district hospital in KwaZulu-Natal, South Africa.</p><p><strong>Methods: </strong>A sequential mixed-methods design was employed, comprising quantitative and qualitative phases. A structured questionnaire was systematically administered to 301 patients, followed by semi-structured interviews with ten purposively selected persons living with HIV (PLHIV), either without comorbidities or diagnosed with HT, DM, or both. Quantitative data were analysed using factor analysis and Principal Component Analysis (PCA) to identify key themes, while qualitative data were analysed using thematic content analysis based on the Donabedian Framework.</p><p><strong>Results: </strong>Quantitative findings indicated that 86% of patients expressed overall satisfaction with their care. However, qualitative insights highlighted structural, procedural, and outcome-related challenges, including long waiting times, staff shortages, and varying perceptions of healthcare provider competence. Patients prioritised HIV treatment. While some instances of integrated care were reported, fragmented service delivery remained prevalent.</p><p><strong>Conclusion: </strong>Although most patients reported positive care experiences, long waiting times and inadequate staffing negatively impacted service delivery. Strengthening health education is essential to improve patient adherence. Expanding integrated care and addressing staffing shortages could enhance the overall quality of care for PLHIV, particularly those with comorbid NCDs.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251381986"},"PeriodicalIF":3.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12536158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350462","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":"Addressing methodological challenges in multiple long-term conditions research: A stakeholder workshop using a nominal group technique method.","authors":"Hajira Dambha-Miller, Glenn Simpson, Lucy Smith, James Finney, Salwa S Zghebi, Sarah E Hughes, Victoria L Keevil, Ge Yu, Clare MacRae, Kamlesh Khunti, Colin McCowan","doi":"10.1177/26335565251372222","DOIUrl":"10.1177/26335565251372222","url":null,"abstract":"<p><strong>Background: </strong>Multiple long-term conditions (MLTC) - which refer to the coexistence in an individual of two or more long-term conditions - are a growing global concern, causing significant strain on healthcare systems and increasing care costs. Research into MLTC is a strategic priority for healthcare services, policymakers and research funders.</p><p><strong>Methods: </strong>To address these complexities, the UK's National Institute for Health and Care Research (NIHR) established the MLTC Cross-NIHR Collaboration (MLTC CNC) programme, to foster interdisciplinary collaboration and address key gaps in MLTC research. As part of this initiative, the Methodologies Workstream organised a two-day stakeholder workshop in March 2024 aimed at identifying current methodological challenges in MLTC research, prioritising key areas for improvement, and developing strategies to enhance research methodologies. The workshop employed a participatory and iterative approach, using structured presentations, facilitated group work, and the Nominal Group Technique (NGT) to promote cross-disciplinary collaboration and achieve consensus on key research priorities for MLTC.</p><p><strong>Results: </strong>Twenty-three delegates attended the workshop from a range of institutions and sectors, including representatives from data science, epidemiology, clinical trials, quality improvement, social sciences, healthcare management, clinical practice, industry, patient advocacy groups, policymakers, patients, carers, and public representatives. The workshop identified critical knowledge gaps in MLTC research methodologies, including challenges with disease classification, data integration, analytical approaches, and the inclusion of diverse population subgroups.</p><p><strong>Conclusion: </strong>By addressing these methodological gaps and fostering collaboration across disciplines, the MLTC research community can generate more rigorous, inclusive, and impactful evidence, ultimately improving healthcare delivery and patient outcomes.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251372222"},"PeriodicalIF":3.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187683","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":"Co-design and development of a Personalised Exercise-based Rehabilitation and self-management programme FOR people with Multiple long-term conditions: The PERFORM intervention.","authors":"Paulina Daw, Colin J Greaves, Nikki Gardiner, Patrick Doherty, Thomas M Withers, Amy C Barradell, Paul O'Halloran, Zahira Ahmed, Shaun Barber, Gwen Barwell, Sophie E Brown, Sarah Dean, Carlos Echevarria, Rachael A Evans, Tracy Ibbotson, Bhautesh D Jani, Kate Jolly, James R Manifield, Frances S Mair, Emma McIntosh, Daniel Miller, Paula Ormandy, Susan M Smith, Sharon A Simpson, Ghazala Waheed, Rod S Taylor, Sally J Singh, On Behalf Of The Perform Research Team","doi":"10.1177/26335565251367326","DOIUrl":"10.1177/26335565251367326","url":null,"abstract":"<p><strong>Background: </strong>Exercise and self-management support may be clinically effective and cost-effective treatments for a range of individual long-term conditions (LTCs), as they activate multiple beneficial physiological and psychological mechanisms. We aimed to develop a complex intervention to deliver exercise and self-management support for people with multiple LTCs (MLTCs).</p><p><strong>Methods: </strong>Following the Person Based Approach to intervention development, we conducted ten co-development workshops with people with MLTCs, family and friends; healthcare providers; service commissioners and policymakers. The workshops iteratively identified the unmet needs of people with MLTCs and informed a programme theory outlining theoretical mechanisms of change and intervention strategies to change the targeted behaviours. They also identified ideas for efficient delivery and service providers' training needs. Mixed methods feedback from the Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM) feasibility study (reported elsewhere) informed intervention refinement.</p><p><strong>Results: </strong>A diverse group of stakeholders (26 people with MLTCs/supporters, 13 service providers, 16 experts in chronic illness and 14 service commissioners) helped to develop the PERFORM intervention. This included 16 supervised exercise sessions and 16 'Health and Wellbeing' self-management support sessions, delivered in hospital or community settings over eight weeks, plus check-in sessions at four and six months. The self-management sessions covered maintenance of exercise/physical activity, healthy eating and managing common symptoms (pain, fatigue, breathlessness, stress).</p><p><strong>Conclusion: </strong>The PERFORM intervention is a comprehensive, evidence-informed, theoretically driven self-management and exercise-based rehabilitation intervention, co-developed with people with MLTCs, service providers and service commissioners. PERFORM is now ready for evaluation regarding clinical effectiveness and cost-effectiveness.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251367326"},"PeriodicalIF":3.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115181","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":"Exploring the association between BPPV, hypothyroidism, and metabolic comorbidities: A retrospective case-control study.","authors":"Rachael Arabian, Antonio Vintimilla","doi":"10.1177/26335565251371254","DOIUrl":"10.1177/26335565251371254","url":null,"abstract":"<p><strong>Background & objective: </strong>Benign paroxysmal positional vertigo (BPPV) is a leading cause of vertigo and has been loosely associated with osteoporosis, vitamin D deficiency, and broader metabolic dysfunction. Emerging evidence suggests that BPPV may relate to systemic conditions beyond the vestibular system. However, limited research has explored whether individuals with BPPV have increased rates of hypothyroidism, diabetes mellitus (DM), hypertension (HTN), or osteoporosis. The objective of this study was to examine the association between BPPV and hypothyroidism, diabetes mellitus (DM), hypertension (HTN), and osteoporosis.</p><p><strong>Study design & setting: </strong>This study was a retrospective case-control study using patient records from a vestibular outpatient rehabilitation clinic in Florida, USA.</p><p><strong>Patients & outcomes: </strong>Adults diagnosed with BPPV over a six-month period were included in the study. Control data was derived from the National Center for Health Statistics (NCHS). Binomial logistic regression was performed to calculate odds ratios (ORs).</p><p><strong>Results: </strong>A total of 140 individuals diagnosed with BPPV (98 female, 42 male) were analyzed. Patients with BPPV demonstrated statistically significant higher odds of hypothyroidism (OR 2.635, 95% CI 1.260-5.51) and diabetes mellitus (OR 2.28, 95% CI 1.09-4.76) compared to national estimates. No significant associations were found for hypertension or osteoporosis.</p><p><strong>Conclusion: </strong>An association exists between BPPV and both hypothyroidism and diabetes mellitus. These findings support the role of systemic metabolic and endocrine dysfunction in the pathophysiology of BPPV and highlight the potential clinical value of screening for relevant comorbidities. Further research is warranted.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251371254"},"PeriodicalIF":3.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071343","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":"Prevalence of comorbidities and their association with disease severity and mortality in COVID-19 patients: A systematic review and meta-analysis.","authors":"Beyene Zewdu Nigatu, Nigatu Teju Dessie","doi":"10.1177/26335565251371256","DOIUrl":"10.1177/26335565251371256","url":null,"abstract":"<p><strong>Background: </strong>Comorbidity among coronavirus disease-19 (COVID-19) patients contributes to increasing their susceptibility to severe illness. The objectives of this systematic review and meta-analysis were to assess the prevalence of comorbidities and their association in increased severity of disease and mortality in COVID-19 patients.</p><p><strong>Methods: </strong>A thorough search of the literature was conducted using PubMed, Google Scholar, and other sources to include pertinent studies. Two independent authors extracted pertinent data using Microsoft Excel and exported it to Stata version 17 for meta-analysis. This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Heterogeneity was assessed through I² statistics, subgroup analysis for categorical variables, and meta-regression for continuous variables. Publication bias was assessed through funnel plot and Egger statistics. Furthermore, a meta-analysis was performed using a random-effects model to estimate the pooled odds ratio (OR) with 95% CI, which was used to assess the association between comorbidity and severity and/or mortality of COVID-19.</p><p><strong>Results: </strong>A total of 62 studies with 611,646 patients were included. The pooled prevalence of comorbidity among COVID-19 was 53.9% (95% CI: 48.4-59.3). Comorbidity was significantly associated with severity of COVID-19. Specifically, hypertension (OR: 1.09; 95% CI: 1.03-2.51), diabetes mellitus (OR: 1.29; 95% CI: 1.07-1.56), and obesity (OR: 1.61; 95% CI: 1.46-1.76) significantly increased the odds of severe COVID-19. Furthermore, hypertension (OR: 1.14; 95% CI: 1.02-1.57), diabetes mellitus (OR: 1.39; 95% CI: 1.17-1.65), obesity (OR: 1.24; 95% CI: 1.15-1.32), chronic kidney diseases (OR: 1.62; 95% CI: 1.25-2.09), and chronic obstructive pulmonary diseases (COPD) (OR: 1.23; 95% CI: 1.15-1.32) were significantly associated with mortality of COVID-19 patients.</p><p><strong>Conclusion: </strong>The pooled prevalence of comorbidity among COVID-19 was found slightly higher than that reported in previous systematic reviews, which ranged from 40.0% to 41.1%. Comorbidity increased the odds of severe COVID-19. Participants with hypertension, obesity, or diabetes mellitus had significantly increased odds of severe COVID-19. There is a need to have close follow-up of COVID-19 patients who have comorbidity.</p><p><strong>Protocol registration: </strong>This systematic review and meta-analysis study was registered under the registration number CRD42023493170.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251371256"},"PeriodicalIF":3.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981369","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":"Trends and disparities in heart failure and heart failure with obesity mortality among U.S. adults: A 1999-2020 analysis of geographic, gender, and racial variations using CDC WONDER data.","authors":"Faizan Ahmed, Tehmasp Rehman Mirza, Sherif Eltawansy, Zaima Afzaal, Areeba Ahsan, Hira Zahid, Kainat Aman, Mushood Ahmed, Hritvik Jain, Muhammad Abdullah Naveed, Omar Kamel, Aman Ullah, Nisar Asmi, Farman Ali, Adnan Bhat, Paweł Łajczak, Ogechukwu Obi, Naveen Baskaran, Mian Zahid Khan Kakakhel, Ayesha Samad, Haitham Dib","doi":"10.1177/26335565251370816","DOIUrl":"10.1177/26335565251370816","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a leading cause of hospitalization and mortality, and it poses a significant burden on healthcare systems globally. Obesity is a considerable risk factor for HF and contributes to increased cardiac stress and metabolic demands.</p><p><strong>Methods: </strong>Data from the CDC WONDER database were examined from 1999-2020 for HF and HF with obesity-related mortality in adults aged 25 years and older at the time of death, using ICD-10 codes. Age-adjusted mortality rates (AAMR) per million persons were calculated.</p><p><strong>Results: </strong>From 1999 to 2020, the overall AAMR for HF-related deaths in adults declined from 1627 to 1544 (AAPC: -0.49, 95% CI: -0.63 to -0.34), whereas AAMR for HF and obesity rose steadily from 10.7 in 1999 to 42.1 in 2020 (AAPC: 6.23, 95% CI: 5.50 to 6.82). The overall HF-related AAMR for both genders decreased from 1999 to 2020, with a more significant decline in women. In contrast, HF and obesity-related AAMRs significantly increased for both genders, with a more pronounced rise in men. HF-related AAMRs decreased for Whites, Hispanic or Latinos, and Asian/Pacific Islanders but increased statistically insignificantly for Black/African Americans and American Indian/Alaska Natives. HF and obesity-related AAMRs increased across all races from 1999 to 2020, with an overall AAPC of 6.23. The highest HF-associated mortality and HF and obesity-related rates were observed in the Midwest.</p><p><strong>Conclusion: </strong>Overall, a declining trend in HF-related mortality could be seen. However, the increasing HF-obesity mortality despite a general decrease in HF death is concerning.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251370816"},"PeriodicalIF":3.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981504","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":"Network of doctors for multimorbidity and diabetes: Development of the NOMAD intervention - a multidisciplinary team for patients with diabetes and multimorbidity.","authors":"Stine Jorstad Bugge, Jørgen Hangaard, Per Damkier, Per Bruno Jensen, Sofie Lock Johansson, Subagini Nagarajah, Vasiliki Panou, Marianne Kjær Poulsen, Martin Torp Rahbek, Mette Bøg Horup, Mette Juel Rothmann, Karoline Schousboe, Ida Ransby Schneider, Daniel Pilsgaard Henriksen, Ann-Dorthe Olsen Zwisler","doi":"10.1177/26335565251366466","DOIUrl":"10.1177/26335565251366466","url":null,"abstract":"<p><strong>Purpose: </strong>This article reports the development of the NOMAD intervention, a model of multidisciplinary team conferences designed to improve care coordination and treatment for patients with multimorbidity and diabetes. Managing multiple chronic conditions increases care complexity, and multidisciplinary approaches may enhance care coherence, optimise treatment, and improve quality of life.</p><p><strong>Method: </strong>Guided by the Medical Research Council framework for developing complex interventions, we established a working group, formulated a programme theory, and conducted a preliminary test with qualitative interviews of patients and physicians. The intervention targets patients with diabetes and concurrent chronic conditions affecting the heart, lungs, or kidneys.</p><p><strong>Results: </strong>The NOMAD intervention was developed as a structured model of regular, in-person multidisciplinary team conferences involving specialists in endocrinology, cardiology, respiratory medicine, nephrology, and pharmacology. A key component was the integration of patient-reported outcomes to enhance patient-centred care, highlighting the aspect of quality of life.</p><p><strong>Conclusion: </strong>This development process provides a foundation for feasibility testing and future evaluation of NOMAD's impact in a randomised trial. Our experiences may also inform researchers and healthcare providers developing similar multidisciplinary interventions for complex patient populations.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"15 ","pages":"26335565251366466"},"PeriodicalIF":3.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981389","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}