Journal of multimorbidity and comorbidity最新文献

[This corrects the article DOI: 10.1177/26335565231212336.].

Background: Social restrictions and their possible impact on lifestyle make people with multimorbidity (≥2 co-existing chronic conditions) more vulnerable to poor perceived mental health and health behaviours modifications during the COVID-19 pandemic.

Objective: To understand the mental health status and health behaviour modifications among individuals with multimorbidity during different levels of COVID-19 social restrictions.

Methods: Longitudinal multinational cohort study consisting of two online questionnaires with its first wave taken place while social restrictions were imposed (May 2020), and its second wave with less social restrictions in place (November 2020). Including 559 participants (wave 1) and 147 participants from wave 1 (wave 2) with an average age of 34.30±12.35 and 36.21±13.07 years old. Mostly females living in Canada, France, India and Lebanon.

Results: The prevalence of multimorbidity was 27.68% (wave 1) and 35.37% (wave 2). While social restrictions were imposed, people with multimorbidity were 2 to 3 times more likely to experience psychological distress, depressive symptoms, increased stress or isolation than those without multimorbidity. Health behaviours were also modified during this period with people with multimorbidity being more likely to reduce their physical activity and increased their fruit and vegetable consumption. In wave 2, regardless of multimorbidity status, sexual desire continuously decreased while stress and psychological distress increased.

Conclusion: Mental health and health behaviours modifications occurred while social restrictions were imposed and people with multimorbidity were more severely impacted than those without multimorbidity, indicating a need for a more adapted approach of care during socially restrictive periods for this population.

Background: Multimorbidity has emerged as a major challenge facing health services globally, which will place a substantial burden on health systems going forward. This paper seeks to estimate the association between multimorbidity and direct healthcare costs among older people in Ireland from a healthcare system perspective.

Methods: Cross-sectional analysis of data on 8,447 community-dwelling adults aged 50 and over collected between 2009 and 2011 as part of the Irish Longitudinal Study on Ageing. Multivariable generalised linear model regression, employing a log-link and Poisson family distribution, is used to assess the association between self-reported multimorbidity status and direct healthcare costs.

Results: For the full sample, 21.20% reported having no chronic conditions, 27.39% had one chronic condition, and 51.40% had multimorbidity. After controlling for a range of socio-demographic and health status variables, we found that relative to those reporting no chronic conditions, one chronic condition was associated with additional average annual costs of €513 (95% CIs: 245, 781), increasing to €1277 (95% CIs: 942, 1612) for those with 6 or more chronic conditions. Relative to those reporting 2 chronic conditions, 4 chronic conditions were associated with additional costs of €411 (95% CIs: 106, 716), 5 chronic conditions with €591 (95% CIs: 214, 969), and 6 or more chronic conditions with additional average costs of €1006 (95% CIs: 641, 1371).

Conclusion: This study finds positive and significant associations between the number of chronic conditions and direct healthcare costs and further highlights the potential economic benefits from preventing the onset and progression of multimorbidity.

Purpose: Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts.

Methods: Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity.

Results: Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes.

Conclusion: Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM.

Background: Mental ill-health and obesity are increasingly prevalent in childhood with both conditions likely to co-occur. Less is known about associations between adverse childhood experiences (ACEs) and mental ill-health and obesity (MH-OB) comorbidity in adolescence. The aim of this study was to examine associations between ACEs and MH-OB comorbidity in adolescents from a national cohort study.

Methods: Participants; 10,734 adolescents (males = 50.3%) from the Millennium Cohort Study with 6 ACEs (for e.g., parental MH, drug/alcohol misuse, physical punishment) collected prospectively between ages 3-11 years. MH-OB comorbidity (binary indicator) was based on objectively measured BMI (for overweight/obesity) and self-reported depression/anxiety at ages 14 and 17. Associations between: 1.total ACE scores (0, 1, 2 or ≥3) and additionally each individual ACE, and MH-OB, were analysed used logistic regression, separately at 14 and 17 years.

Results: At age 14, ACE scores were associated with higher odds for MH-OB comorbidity, with a gradient of increasing odds ratios (OR) with increasing ACEs. Individuals with 1 (OR:1.22[95%CI: 1.1-1.6]), 2 (OR:1.7[1.3-2.3]), or ≥3ACEs (OR:2[1.5-2.6]) had increased odds for MH-OB comorbidity compared to those with 0 ACEs. At age 17, associations between ACE scores and MH-OB were attenuated and observed in individuals with ≥3ACEs (OR:1.54, 1.1-2.3). Parental MH (OR:1.5, 1.2-1.9), intimate-partner violence (OR:1.2, 1.1-1.6), physical punishment (OR:1.3, 1.1-1.6), bullying (OR:2, 1.6-2.5) were associated with MH-OB comorbidity age 14. However, only parental MH (OR:1.5, 1.1-2.1) and bullying (OR:1.6, 1.2-2.1) were associated with MH-OB comorbidity at age 17.

Conclusion: ACEs are associated with increased risk of MH-OB comorbidity in between ages 14 and 17. These findings provide timely opportunity for interventions to reduce risk and are pertinent given that MH and obesity contribute significantly to global burden of disease and track across the lifecourse.

Background: Given current health system trends, clinicians increasingly care for patients with complex care needs. There is a recognized lack of evidence to support clinician decision-making in these situations, as complex or multimorbid patients have been historically excluded from the types of research that inform clinical practice guidelines. However, expert clinicians at sites of excellence (e.g., Stroke Distinction sites) provide measurably excellent care. We sought to review profession-specific competency frameworks to locate information that may be supporting the development of clinician expertise when managing the care of patients with complex care needs.

Methods: We conducted a review of the professional competency frameworks for core members of the inpatient stroke rehabilitation team, to determine the degree of guidance and/or preparation for the management of patients with complex care needs. We developed and applied an assessment rubric to locate references to patient complexity, multimorbidity and complexity theory.

Results: Across the professional competency frameworks, there are some references to complexity at patient- and team-levels; there are fewer references to system-level complexity. We noted a lack of clear guidance for clinicians regarding the management of patients with complex care needs.

Conclusion: Further research is needed to explore how clinicians develop expertise in the management of patients with complex care needs, as we noted minimal guidance in the professional competency frameworks. However, we suggest that integrating complexity-related language into professional competency frameworks could better prime novice clinicians for new learning in the workplace and ease their transition into working in a complex context.

Background: People with comorbidities are under-represented in randomised controlled trials, and it is unknown whether patterns of comorbidity are similar in trials and the community.

Methods: Individual-level participant data were obtained for 83 clinical trials (54,688 participants) for 16 index conditions from two trial repositories: Yale University Open Data Access (YODA) and the Centre for Global Clinical Research Data (Vivli). Community data (860,177 individuals) were extracted from the Secure Anonymised Information Linkage (SAIL) databank for the same index conditions. Comorbidities were defined using concomitant medications. For each index condition, we estimated correlations between comorbidities separately in trials and community data. For the six commonest comorbidities we estimated all pairwise correlations using Bayesian multivariate probit models, conditioning on age and sex. Correlation estimates from trials with the same index condition were combined into a single estimate. We then compared the trial and community estimates for each index condition.

Results: Despite a higher prevalence of comorbidities in the community than in trials, the correlations between comorbidities were mostly similar in both settings. On comparing correlations between the community and trials, 21% of correlations were stronger in the community, 10% were stronger in the trials and 68% were similar in both. In the community, 5% of correlations were negative, 21% were null, 56% were weakly positive and 18% were strongly positive. Equivalent results for the trials were 11%, 33%, 45% and 10% respectively.

Conclusions: Comorbidity correlations are generally similar in both the trials and community, providing some evidence for the reporting of comorbidity-specific findings from clinical trials.

Background: The generalizability of treatments examined in rehabilitation randomized controls trials (RCTs) partly depend on the similarity between trial subjects and a stroke rehabilitation inpatient population. The aim of this study was to determine the proportion of stroke rehabilitation inpatients that would have been eligible or ineligible to participate in published stroke RCTs.

Methods: This was a secondary analysis of chart review data collected as part of an independent quality improvement initiative. Data pertaining to the characteristics of stroke rehabilitation inpatients (e.g. age, cognitive impairment, previous stroke, comorbidities) were extracted from the medical charts of patients consecutively admitted to an inpatient stroke rehabilitation unit at a large urban rehabilitation hospital in Canada. Using the exclusion criteria categories of stroke RCTs identified from a systematic scoping review of 428 RCTs, we identified how many stroke rehabilitation inpatients would have been eligible or ineligible to participate in stroke RCTs based on their age, cognitive impairment, previous stroke and presence of comorbidities.

Results: In total, 110 stroke rehabilitation inpatients were included. Twenty-four percent of patients were 80 years of age or older, 84.5% had queries or concerns regarding patient cognitive abilities, 28.0% had a previous stroke, and 31.8% had a severe stroke. Stroke rehabilitation inpatients had six comorbidities on average. Based on these factors, most stroke rehabilitation inpatients could have been excluded from stroke RCTs, with cognitive impairment the most common RCT exclusion criteria.

Conclusions: Changes to the design of RCTs would support the development of clinical practice guidelines that reflect stroke rehabilitation inpatient characteristics, enhancing equity, diversity, and inclusion within samples and the generalizability of results.