Journal of multimorbidity and comorbidity最新文献

Background: 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).

Methods: 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.

Results: 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).

Conclusion: 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.

Background & objective: 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.

Study design & setting: This study was a retrospective case-control study using patient records from a vestibular outpatient rehabilitation clinic in Florida, USA.

Patients & outcomes: 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).

Results: 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.

Conclusion: 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.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Protocol registration: This systematic review and meta-analysis study was registered under the registration number CRD42023493170.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Purpose: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Background: Inflammatory bowel disease (IBD) may be burdened by other comorbid conditions. We herein sought to assess comorbidity in hospitalized and non-hospitalized IBD patients.

Methods: This was part of the San MAtteo Complexity (SMAC) study (2017-2019). Data of hospitalized IBD patients were compared to gender- and age-matched IBD outpatients in a 2:1 fashion. The association of comorbidity in relation to hospitalization and clinical and socioeconomic factors was assessed.

Results: We included 104 patients, 27 hospitalized (median age 49 years, IQR 32-70) and 77 outpatients (median age 54 years, IQR 37-68). Comorbidity was reported in 63/104 patients (60.6%), of whom 45 (58.5%) non-hospitalized and 18 (66.6%) hospitalized. Patients with comorbidity were older (median 60 years, IQR 44-61 vs median 40 years, IQR 28-50 vs; p<0.001), had a higher Cumulative Illness Rating Scale severity index (median 1.85, IQR 1.5-2.5 vs median 1.31, IQR 1.2-2.5; p=0.002), were more commonly female (37, 60.7% vs 14, 35.0%; p=0.01), frailer (14, 22.2% vs 1, 2.4%; p=0.004), and had a lower educational level (13, 20.6% vs 2, 4.9%; p=0.04). In a bivariable analysis, factors associated to comorbidity were age >65 years (OR 5.30, 95% CI 1.81-15.55; p=0.002), female sex (OR 2.92, 95% CI 1-27-6.71; p=0.012), income <1000€ (OR 3.04, 95% CI 1.09-8.44; p=0.033), schooling <8 years (OR 5.09, 95% CI 1.08-23.96; p=0.039), frailty (OR 12.56, 95% CI 1.48-106.45; p=0.020), and polypharmacy (OR 10.41, 95% CI 1.85-59.38; p=0.008).

Conclusion: A high prevalence of comorbidity was found in IBD, possibly related to low socioeconomic status and poor educational level.

Background: Multimorbidity, defined as the coexistence of two or more chronic diseases in a single individual, is a growing public health challenge globally and particularly in Saudi Arabia.

Aims: This narrative review aims to synthesize existing literature on multimorbidity in Saudi Arabia by examining its prevalence, identifying gender-based differences, and highlighting the most commonly associated chronic diseases.

Methods: A structured search was conducted using PubMed, Google Scholar, and institutional databases, including Scopus and Web of Science, for English-language studies on multimorbidity in Saudi Arabia published between 2015 and 2025. Boolean operators were applied, and reference lists were screened to ensure comprehensive coverage while minimizing duplication. A total of 17 studies were included, and data were extracted on study design, population, sample size, multimorbidity prevalence, and gender-specific findings. These were analyzed thematically to identify patterns, disparities in gender, and disease clusters.

Results: Multimorbidity prevalence in Saudi Arabia ranged from 7.1% to 77.6%, with notably higher rates among women, especially in older age groups. Among the five studies that reported disease-specific patterns, diabetes mellitus was the most frequently cited chronic condition, ranking first in three studies. Other frequently reported conditions included hypertension and dyslipidemia, though their ranking varied across studies.

Conclusion: This review highlights the evolving landscape of multimorbidity in Saudi Arabia. Findings call for gender-sensitive, integrated care models that address the clustering of chronic conditions. To address persistent gaps, future research should prioritize mental health integration, early-onset multimorbidity, and ensuring better representation of rural populations. Policymakers should invest in national screening programs, strengthen data systems, and embed equity into care delivery in line with Vision 2030 reforms.

Background: Older adults with multimorbidity experience fragmentation of care. Ensuring optimal use of healthcare services requires stratifying their need for integrated care. We aimed to map existing stratification tools for assessing older adults with multimorbidity in an integrated care context.

Methods: We searched MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL, and extracted definitions of population, concept, and context following the JBI Framework for Scoping Reviews.

Results: We identified 17,689 articles of which 11 articles were included. Few stratification tools for this population exist and differ on scoring methods, domains and settings of use. Stratification is used for identifying older adults with multimorbidity to multidisciplinary teams or to case managers. Future research should develop stratification tools across sectors focused on the common risk factors of multimorbidity in older adults.

Background: Cardiometabolic multimorbidity (CM), two or more of stroke, diabetes, and heart disease is increasing in prevalence and associated with a multiplicative mortality risk. Sex differences exist in disability outcomes for those with stroke, diabetes, and heart disease, and thus are likely for those with CM.

Objectives: To assess 1) sex differences in the prevalence of CM, 2) sex differences in disability variables amongst those with CM, and 3) the predicted probabilities of disability among people with and without CM by sex.

Methods: A secondary analysis using data from the Canadian Longitudinal Study on Aging (CLSA). The CLSA included a stratified, random sample of approximately 51,000 participants aged 45 to 85 at recruitment. Independent variables include depressive symptoms, pain, high blood pressure, eyesight, limitations with activities of daily living (ADL), and social participation.

Results: A weighted population of 13,204,82 participants were included, 659,621 had CM. Males had a higher prevalence of CM than females, accounting for 62% of those with CM. Females with CM had a higher probability than males of reporting high depressive symptoms (females: 29% [95%CI:27%-31%], males: 21% [95%CI:19%-23%]), pain (females: 49% [95%CI:47%-52%], males: 41% [95%CI:39%-43%]), and limitations with ADL (females: 27% [95%CI:25%-29%], males: 11% [95%CI:10%-13%]) Males with CM had a higher probability than females of reporting infrequent social participation (females: 18% [95%CI:16%-20%], males: 23% [95%CI:21%-25%]).

Conclusion: This study provides evidence on sex differences in the likelihood of reporting disability variables in individuals with CM. These insights into sex differences can inform targeted interventions and improve patient outcomes.

Objectives: Demographic and epidemiological shifts have led to people living with coexisting health issues, known as 'multimorbidity'. Given India's aging population, rising noncommunicable disease burden, chronic infections, fragmented healthcare, and reliance on specialist care, a scoping review is needed to understand the extent and nature of research on multimorbidity in India.

Methods: A comprehensive search was conducted across PubMed, Cochrane, and Embase for studies focused on multimorbidity, with information specifically from India. Two reviewers independently screened the results and extracted information on definitions, including use of cut-offs or a minimum number of conditions, data and methods, patterns, risk factors and outcomes. Results were synthesized using descriptive statistics and narrative synthesis.

Results: Of 9954 identified studies, 100 were included in the final synthesis. Of these, 62 were secondary analyses, 35 collected primary data, and 3 used administrative data. Most studies defined multimorbidity as two or more chronic or long-term conditions but did not specify whether long-term infections or mental health conditions were included. The number of conditions varied between 4 and 22. Circulatory, endocrine-nutritional-metabolic, and respiratory diseases were most frequently included. Beyond simple disease counts, combinations were reported in 15 studies. Healthcare utilization, out-of-pocket expenditure, and quality of life were commonly studied, mostly using cross-sectional designs.

Conclusion: A standardised panel of conditions with clear definitions is needed for measuring multimorbidity. Conditions should be ascertained through a combination of self-report, physical examinations, and laboratory investigations. Additionally, longitudinal studies focused on multimorbidity, and its outcomes are needed to strengthen evidence base in India.