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      The epidemiology of multimorbidity in primary care: a retrospective cohort study

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          Abstract

          Background

          Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.

          Aim

          To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation.

          Design and setting

          Retrospective cohort study, undertaken in England.

          Method

          The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified.

          Results

          In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions.

          Conclusion

          Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

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          Most cited references10

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          Causes and consequences of comorbidity: a review.

          A literature search was carried out to identify and summarize the existing information on causes and consequences of comorbidity of chronic somatic diseases. A selection of 82 articles met our inclusion criteria. Very little work has been done on the causes of comorbidity. On the other hand, much work has been done on consequences of comorbidity, although comorbidity is seldom the main subject of study. We found comorbidity in general to be associated with mortality, quality of life, and health care. The consequences of specific disease combinations, however, depended on many factors. We recommend more etiological studies on shared risk factors, especially for those comorbidities that occur at a higher rate than expected. New insights in this field can lead to better prevention strategies. Health care workers need to take comorbid diseases into account in monitoring and treating patients. Future studies on consequences of comorbidity should investigate specific disease combinations.
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            Managing patients with multimorbidity in primary care.

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              Multimorbidity - not just an older person's issue. Results from an Australian biomedical study

              Background Multimorbidity, the simultaneous occurrence of two or more chronic conditions, is usually associated with older persons. This research assessed multimorbidity across a range of ages so that planners are informed and appropriate prevention programs, management strategies and health service/health care planning can be implemented. Methods Multimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling. Results Overall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status. Conclusions Multimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies.
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                Author and article information

                Contributors
                Role: Medical student
                Role: Research fellow
                Role: Research associate
                Role: Research statistician
                Role: Data manager
                Role: Consultant senior lecturer
                Role: Professor of general practice
                Journal
                Br J Gen Pract
                Br J Gen Pract
                bjgp
                The British Journal of General Practice
                Royal College of General Practitioners
                0960-1643
                1478-5242
                April 2018
                13 March 2018
                13 March 2018
                : 68
                : 669
                : e245-e251
                Affiliations
                School of Medicine, University of Utah, Salt Lake City, US.
                Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
                Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
                MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
                Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
                Centre for Academic Primary Care, University of Bristol, Bristol, UK.
                Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
                Author notes
                Address for correspondence Anna Cassell, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, US. Email: anna.cassell@ 123456utah.edu
                Article
                10.3399/bjgp18X695465
                5863678
                29530918
                504c63aa-d92e-438f-8afa-cd836f957202
                © British Journal of General Practice 2018

                This article is Open Access: CC BY-NC 4.0 licence ( http://creativecommons.org/licences/by-nc/4.0/).

                History
                : 30 October 2017
                : 28 November 2017
                : 09 January 2018
                Categories
                Research

                comorbidity,health service utilisation,multimorbidity,primary health care

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