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      The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study

      research-article
      , PhD , FRACGP DRANZCOG, PhD , PhD, FRCGP (Hon) , MB, BChir, PhD , MD, FRCGP , MBChB, MPH , PhD, FRCGP
      The British Journal of General Practice
      Royal College of General Practitioners
      chronic disease, mental health, multimorbidity, primary health care, socioeconomic status

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          Abstract

          Background

          Multimorbidity occurs at a younger age in individuals in areas of high socioeconomic deprivation but little is known about the ‘typology’ of multimorbidity in different age groups and its association with socioeconomic status.

          Aim

          To characterise multimorbidity type and most common conditions in a large nationally representative primary care dataset in terms of age and deprivation.

          Design and setting

          Cross-sectional analysis of 1 272 685 adults in Scotland.

          Method

          Multimorbidity type of participants (physical-only, mental-only, mixed physical, and mental) and most common conditions were analysed according to age and deprivation.

          Results

          Multimorbidity increased with age, ranging from 8.1% in those aged 25–34 to 76.1% for those aged ≥75 years. Physical-only (56% of all multimorbidity) was the most common type of multimorbidity in those aged ≥55 years, and did not vary substantially with deprivation. Mental-only was uncommon (4% of all multimorbidity), whereas mixed physical and mental (40% of all multimorbidity) was the most common type of multimorbidity in those aged <55 years and was two- to threefold more common in the most deprived compared with the least deprived in most age groups. Ten conditions (seven physical and three mental) accounted for the top five most common conditions in people with multimorbidity in all age groups. Depression and pain featured in the top five conditions across all age groups. Deprivation was associated with a higher prevalence of depression, drugs misuse, anxiety, dyspepsia, pain, coronary heart disease, and diabetes in multimorbid patients at different ages.

          Conclusion

          Mixed physical and mental multimorbidity is common across the life-span and is exacerbated by deprivation from early adulthood onwards.

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          Most cited references32

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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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            Multimorbidity Patterns in the Elderly: A New Approach of Disease Clustering Identifies Complex Interrelations between Chronic Conditions

            Objective Multimorbidity is a common problem in the elderly that is significantly associated with higher mortality, increased disability and functional decline. Information about interactions of chronic diseases can help to facilitate diagnosis, amend prevention and enhance the patients' quality of life. The aim of this study was to increase the knowledge of specific processes of multimorbidity in an unselected elderly population by identifying patterns of statistically significantly associated comorbidity. Methods Multimorbidity patterns were identified by exploratory tetrachoric factor analysis based on claims data of 63,104 males and 86,176 females in the age group 65+. Analyses were based on 46 diagnosis groups incorporating all ICD-10 diagnoses of chronic diseases with a prevalence ≥ 1%. Both genders were analyzed separately. Persons were assigned to multimorbidity patterns if they had at least three diagnosis groups with a factor loading of 0.25 on the corresponding pattern. Results Three multimorbidity patterns were found: 1) cardiovascular/metabolic disorders [prevalence female: 30%; male: 39%], 2) anxiety/depression/somatoform disorders and pain [34%; 22%], and 3) neuropsychiatric disorders [6%; 0.8%]. The sampling adequacy was meritorious (Kaiser-Meyer-Olkin measure: 0.85 and 0.84, respectively) and the factors explained a large part of the variance (cumulative percent: 78% and 75%, respectively). The patterns were largely age-dependent and overlapped in a sizeable part of the population. Altogether 50% of female and 48% of male persons were assigned to at least one of the three multimorbidity patterns. Conclusion This study shows that statistically significant co-occurrence of chronic diseases can be subsumed in three prevalent multimorbidity patterns if accounting for the fact that different multimorbidity patterns share some diagnosis groups, influence each other and overlap in a large part of the population. In recognizing the full complexity of multimorbidity we might improve our ability to predict needs and achieve possible benefits for elderly patients who suffer from multimorbidity.
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              The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland.

              The inverse care law states that the availability of good medical care tends to vary inversely with the need for it in the population served, but there is little research on how the inverse care law actually operates. A questionnaire study was carried out on 3,044 National Health Service (NHS) patients attending 26 general practitioners (GPs); 16 in poor areas (most deprived) and 10 in affluent areas (least deprived) in the west of Scotland. Data were collected on demographic and socioeconomic factors, health variables, and a range of factors relating to quality of care. Compared with patients in least deprived areas, patients in the most deprived areas had a greater number of psychological problems, more long-term illness, more multimorbidity, and more chronic health problems. Access to care generally took longer, and satisfaction with access was significantly lower in the most deprived areas. Patients in the most deprived areas had more problems to discuss (especially psychosocial), yet clinical encounter length was generally shorter. GP stress was higher and patient enablement was lower in encounters dealing with psychosocial problems in the most deprived areas. Variation in patient enablement between GPs was related to both GP empathy and severity of deprivation. The increased burden of ill health and multimorbidity in poor communities results in high demands on clinical encounters in primary care. Poorer access, less time, higher GP stress, and lower patient enablement are some of the ways that the inverse care law continues to operate within the NHS and confounds attempts to narrow health inequalities.
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                Author and article information

                Contributors
                Role: Research associate
                Role: Chair of primary care research, head of general practice and primary health care academic centre
                Role: Professor of health and wellbeing
                Role: Professor of primary care medicine
                Role: Norie Miller professor of general practice
                Role: Academic clinical fellow
                Role: Professor of primary care research
                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
                July 2014
                30 June 2014
                30 June 2014
                : 64
                : 624
                : e440-e447
                Affiliations
                Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
                Primary Care Research Unit, University of Melbourne, Melbourne, Australia.
                Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
                Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK.
                Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
                Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
                Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
                Author notes
                Address for correspondence Stewart W Mercer, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK. E-mail: stewart.mercer@ 123456gla.ac.uk
                Article
                10.3399/bjgp14X680545
                4073730
                24982497
                f680ad8c-3dd6-4c68-855e-8aba9c6d0db1
                © British Journal of General Practice 2014

                This is an OpenAccess article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 January 2014
                : 23 February 2014
                : 08 April 2014
                Categories
                Research

                chronic disease,mental health,multimorbidity,primary health care,socioeconomic status

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