Multimorbidity Patterns, Hospital Uses and Mortality by Race and Ethnicity Among Oldest-Old Patients.

IF 3.2 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Journal of Racial and Ethnic Health Disparities Pub Date : 2025-04-01 Epub Date: 2024-02-21 DOI:10.1007/s40615-024-01929-x
Jinmyoung Cho, Heather Allore, Gelareh Rahimighazikalayeh, Ivana Vaughn
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Abstract

Backgrounds: Adults aged 85 years and older ("oldest-old") are perceived as survivors resilient to age-related risk factors. Although considerable heterogeneity has been often observed in this population, less is known about the unmet needs in health and healthcare service utilization for diverse patients in healthcare systems. We examined racial-ethnic variation in patterns of multimorbidity associated with emergency department (ED), clinic visits, and mortality among the oldest-old patients with multimorbidity.

Methods: Administrative and clinical data from an integrated healthcare system for five years included 25,801 oldest-old patients with two or more chronic conditions. Hierarchical cluster analysis identified patterns of multimorbidity by four racial-ethnic groups (White, Black, Hispanic, & Other). Clusters associated with ED and clinic visits, and mortality were analyzed using generalized estimation equations and proportional hazards survival model, respectively.

Results: Hypothyroidism, Alzheimer's disease and related dementia, bone & joint conditions, metabolism syndrome, and pulmonary-vascular clusters were commonly observed across the groups. While most clusters were significantly associated with ED and clinic visits among White patients, bone & joint conditions cluster was the most significantly associated with ED and clinic visits among Black (RR = 1.32, p <.01 for ED; RR = 1.67, p <.0001 for clinic) and Hispanic patients (RR = 1.36, p <.0001 for ED; RR = 1.39, p <.0001 for clinic). Similar patterns were observed in the relationship between multimorbidity clusters and mortality.

Conclusions: Patterns of multimorbidity and its significant association with the uses of ambulatory and emergency care varied by race-ethnicity. More studies are needed to explore barriers when minoritized patients are faced with the use of hospital services.

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按种族和民族划分的高龄患者多病模式、医院使用情况和死亡率。
背景:85 岁及以上的成年人("高龄老人")被认为是能够抵御与年龄有关的风险因素的幸存者。虽然在这一人群中经常观察到相当大的异质性,但对医疗系统中不同患者的健康和医疗服务利用方面未满足的需求却知之甚少。我们研究了在患有多种疾病的高龄患者中,与急诊科(ED)、诊所就诊和死亡率相关的多种疾病模式的种族-民族差异:一个综合医疗系统五年来的行政和临床数据包括 25,801 名患有两种或两种以上慢性病的高龄患者。层次聚类分析确定了四个种族-民族群体(白人、黑人、西班牙裔和其他)的多病模式。使用广义估计方程和比例危险生存模型分别分析了与急诊室和诊所就诊以及死亡率相关的聚类:结果:甲状腺功能减退症、阿尔茨海默病及相关痴呆症、骨关节疾病、新陈代谢综合征和肺血管疾病群在各组中很常见。在白人患者中,大多数疾病群与急诊室和门诊量有明显相关性,而在黑人患者中,骨关节疾病群与急诊室和门诊量的相关性最大(RR = 1.32,p 结论:多病共患的模式与患者的健康状况密切相关:多病模式及其与门诊和急诊使用的显著相关性因种族-民族而异。需要进行更多的研究来探讨少数族裔患者在使用医院服务时遇到的障碍。
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来源期刊
Journal of Racial and Ethnic Health Disparities
Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
7.30
自引率
5.10%
发文量
263
期刊介绍: Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.
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