Journal of multimorbidity and comorbidity最新文献

Purpose: Frailty is closely related to multimorbidity and unfavorable outcomes. The Tilburg Frailty Indicator (TFI) is a self-reported assessment comprising 15 questions across three domains. We assessed whether the TFI predicts 180-day mortality, 30-day readmission and healthcare contacts among adults with multimorbidity across a broad age range.

Methods: Single-center prospective cohort study including adults with multimorbidity. Follow-up was 180 days. Cox regression analyses estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for death and readmission. Poisson regression estimated incidence rate ratios (IRR) of any health care contact. Exposure was TFI as both a dichotomous and a 0-15 points integer variable. Analyses were adjusted for age and sex.

Results: We included 471 participants, median age 70 years (IQR 60-76 years) with an average of 6.0 chronic diseases. In adjusted analyses, frailty (TFI score > 5) was associated with HR 4.6 (CI 2.2, 9.7) for death and HR 2.6 (CI 1.7, 4.1) for readmission. Frailty was associated with an IRR of 1.5 (CI 1.3, 1.7) of any health care contact. A one-point increase in TFI score conferred increments in relative estimates across all outcomes.

Conclusions: Our findings extend prior TFI research from older community-dwelling cohorts to multimorbid adults across clinical settings; TFI was both dichotomously and point-by point associated with adverse outcomes. TFI is a self-reported tool that offers a practical and efficient alternative to traditional frailty scoring systems, requiring neither clinical metrics nor expert evaluation, reducing time and resource demands. TFI may be a relevant multidomain risk assessment tool for care pathways in multimorbidity.

Background: The Multimorbidity Questionnaire (MMQ1) is a patient-reported outcome measure assessing quality of life (QoL) in people with multimorbidity. An English-language version was recently validated for use in the United Kingdom. This study examines: (1) Whether MMQ1 detects expected variations in QoL according to individual characteristics; (2) How MMQ1 compares with EQ-5D-5L in detecting such variations, and in discriminating between different levels of QoL.

Methods: A postal survey was distributed to 2753 patients with multimorbidity. Relationships between MMQ1 and EQ-5D-5L with six independent variables (long-term condition count, mental-physical multimorbidity, deprivation, self-rated QoL, age and sex) were examined using linear regression analyses. Discriminative ability was assessed using Receiver Operating Characteristic curves and sample size calculations with respect to consecutive classes of self-rated QoL.

Results: 597 responses were received (22%). Respondents had a mean age of 69.5 years and 48% were men. Higher long-term condition count, the presence of mental-physical multimorbidity and increasing deprivation were associated with poorer QoL on both measures. In addition, three MMQ1 domains demonstrated age-related variations in QoL that were not detected using EQ-5D-5L. MMQ1 exhibited superior discriminative ability to EQ-5D-5L, especially in distinguishing between individuals with 'Poor' vs 'Very Poor' self-rated QoL, where EQ-5D-5L was particularly weak.

Conclusion: MMQ1 detected expected variations in QoL according to individual characteristics, supporting known-groups validity. It was superior to EQ-5D-5L in its ability to detect age-related variations in QoL and to discriminate between different levels of self-rated QoL. MMQ1 has the potential to improve the measurement of QoL in people with multimorbidity.

Introduction: Preterm birth (PTB) is a leading global cause of neonatal morbidity and mortality. While individual maternal chronic conditions are established risk factors, the role of maternal multimorbidity remains underexplored. This study aimed to examine the association between maternal multimorbidity and PTB, and to identify chronic conditions associated with the occurrence and severity of PTB.

Methods: A retrospective matched case-control study was conducted at Archbishop Makarios III Hospital in Nicosia, Cyprus. The sample included 978 singleton live births, consisting of 489 preterm cases (<37 weeks) matched 1:1 with 489 term controls (≥37 weeks) by maternal age and country of origin. Data were extracted from patient's medical records. Multimorbidity was defined as the presence of two or more chronic conditions. Conditional logistic regression assessed associations with PTB, and binary logistic regression examined predictors of extreme/very PTB (<32 weeks) versus moderate/late PTB (32 to <37 weeks).

Results: Maternal multimorbidity was associated with increased odds of PTB (aOR = 1.80; 95% CI: 1.16-2.79; p=0.009). Hypertension (aOR=4.26; 95% CI: 1.84-9.86), kidney disease (aOR=3.67; 95% CI: 1.01-13.30), thrombophilia (aOR=3.53; 95% CI: 1.14-10.88), thyroid disorders (aOR = 1.77; 95% CI: 1.05-2.98), and allergies (aOR=1.82; 95% CI: 1.12-2.99) were independently associated with PTB. Diabetes was inversely associated with extreme PTB (aOR=0.19; 95% CI: 0.10-0.92).

Conclusions: Maternal multimorbidity and several chronic conditions are significant and independent predictors of PTB. These findings underscore the importance of comprehensive antenatal screening and integrated care for women with multiple health conditions. Tailored risk assessment strategies may help reduce the burden of PTB, particularly in populations with rising rates of chronic disease.

Background: Multidisciplinary diabetes management has been designed to reduce the risk of diabetes-associated complications. Nevertheless, it remains underexplored whether multidisciplinary management may provide the added benefits of lowering cancer risk. This study aims to compare differences in clinical profiles and cancer incidence between patients receiving multidisciplinary and standard management in primary care.

Methods: This retrospective cohort study identified patients who attended general outpatient clinics between year 1997 and 2021 without cancer history using territory-wide electronic health records of Hong Kong. Patients were followed up until December 31st, 2021. Cox regression weighted with inverse probability of treatment was applied to compare the risk of site-specific cancers (colon and rectum, liver, pancreas, stomach, bladder, kidney, and lung) between patients with usual diabetes care (n=25,301), multidisciplinary diabetes management (n=66,382), and those without diabetes (n=54,376).

Results: The risk of developing liver and pancreatic cancers appeared to be attenuated in patients who received multidisciplinary diabetes care, when compared to those with usual care alone (aHRs for liver: 1.90, 95%CI 1.26-2.86 vs 2.26, 95%CI 1.47-3.46; pancreas: 3.47, 95%CI 1.41-8.53 vs 5.57, 95%CI 2.15-14.45), with reference to non-diabetes. Patients with usual diabetes care showed a higher risk of gastric cancer in unweighted model, but the association disappeared in weighted model. Overall, patients who received multidisciplinary diabetes management tended to be younger with less comorbidities.

Conclusion: The risk of liver and pancreatic cancers appeared to be mitigated in patients receiving multidisciplinary diabetes care. Further studies are warranted to evaluate whether multidisciplinary management may provide additional benefits of cancer prevention.

Purposes: We explored the experience of older adults living with multimorbidity during the COVID-19 pandemic. Methods: Using a phenomenological approach, we conducted semi-structured interviews with 17 participants aged 50 years and older living with multimorbidity. Data collection and analysis were iterative using a thematic approach. We explored participants' overall pandemic experience as well as querying specifically about pandemic experiences of social isolation, coping and resilience. Results: We describe our findings according to four main themes: (1) Lives disrupted; (2) Diverse social isolation experiences; (3) Coping through seeking solitary and group activities; and (4) Individual ways of enacting resilience and the role of health care to build resilience. Conclusion: We found the experiences of older adults living with multimorbidity during the COVID-19 pandemic were characterized by disruption. When queried social isolation was shared as a prominent concern. We identified the creativity with which participants coped with social isolation and the resilience they marshaled. This study will be used to inform interventions to mitigate social isolation and its effects in a post-pandemic world.

Purpose: 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.

Methods: 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.

Major findings: Compared to urban residents, rural residents reported significantly higher rates of nearly all chronic conditions, multimorbidity (3+ chronic conditions: 26.7% vs 18.3%, P<.001), problems paying medical bills (13.7% vs 11.0%, P=.004), and inability to pay medical bills (9.6% vs 6.8%, P<.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.

Conclusions: 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.

Objective: 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.

Rationale: 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.

Inclusion/exclusion criteria: 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.

Methods: 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.

Discussion: 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.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.