Dataset Information

Distinct trajectories of multimorbidity in primary care were identified using latent class growth analysis.

ABSTRACT:

Objectives

To investigate the use of latent class growth analysis (LCGA) in understanding onset and changes in multimorbidity over time in older adults.

Study design and setting

This study used primary care consultations for 42 consensus-defined chronic morbidities over 3 years (2003-2005) by 24,615 people aged >50 years at 10 UK general practices, which contribute to the Consultations in Primary Care Archive database. Distinct groups of people who had similar progression of multimorbidity over time were identified using LCGA. These derived trajectories were tested in another primary care consultation data set with linked self-reported health status.

Results

Five clusters of people representing different trajectories were identified: those who had no recorded chronic problems (40%), those who developed a first chronic morbidity over 3 years (10%), a developing multimorbidity group (37%), a group with increasing number of chronic morbidities (12%), and a multi-chronic group with many chronic morbidities (1%). These trajectories were also identified using another consultation database and associated with self-reported physical and mental health.

Conclusion

There are distinct trajectories in the development of multimorbidity in primary care populations, which are associated with poor health. Future research needs to incorporate such trajectories when assessing progression of disease and deterioration of health.

SUBMITTER: Strauss VY

PROVIDER: S-EPMC4165436 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Publications

Distinct trajectories of multimorbidity in primary care were identified using latent class growth analysis.

Strauss Vicky Y VY Jones Peter W PW Kadam Umesh T UT Jordan Kelvin P KP

Journal of clinical epidemiology 20140723 10

<h4>Objectives</h4>To investigate the use of latent class growth analysis (LCGA) in understanding onset and changes in multimorbidity over time in older adults.<h4>Study design and setting</h4>This study used primary care consultations for 42 consensus-defined chronic morbidities over 3 years (2003-2005) by 24,615 people aged >50 years at 10 UK general practices, which contribute to the Consultations in Primary Care Archive database. Distinct groups of people who had similar progression of multi ...[more]

PMID: 25063556

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Project description:BACKGROUND:Acute organophosphorus (OP) poisoning is one of the major causes of mortality among patients presenting to emergency departments in developing countries. Although various predictors of mortality among OP poisoning patients have been identified, the role of repeated measurements of vital signs in determining the risk of mortality is not yet clear. Therefore, the present study examined the relationship between trajectories of vital signs and mortality among OP poisoning patients using latent class growth analysis (LCGA). METHODS:This was a retrospective cohort study using data for 449 OP poisoning patients admitted to Civil-Hospital Karachi from Aug'10 to Sep'16. Demographic data and vital signs, including body temperature, blood pressure, heart rate, respiratory rate, and partial-oxygen pressure, were retrieved from medical records. The trajectories of vital signs were formed using LCGA, and these trajectories were applied as independent variables to determine the risk of mortality using Cox-proportional hazards models. P-values of <?0.05 were considered statistically significant. RESULTS:Data for 449 patients, with a mean age of 25.4?years (range 13-85?years), were included. Overall mortality was 13.4%(n?=?60). In trajectory analysis, a low-declining systolic blood pressure, high-declining heart rate trajectory, high-remitting respiratory rate trajectory and normal-remitting partial-oxygen pressure trajectory resulted in the greatest mortality, i.e. 38.9,40.0,50.0, and 60.0%, respectively, compared with other trajectories of the same parameters. Based on multivariable analysis, patients with low-declining systolic blood pressure were three times [HR:3.0,95%CI:1.2-7.1] more likely to die compared with those who had a normal-stable systolic blood pressure. Moreover, patients with a high-declining heart rate were three times [HR:3.0,95%CI:1.5-6.2] more likely to die compared with those who had a high-stable heart rate. Patients with a high-remitting respiratory rate were six times [HR:5.7,95%CI:1.3-23.8] more likely to die than those with a high-stable respiratory rate. Patients with normal-remitting partial oxygen pressure were five times [HR:4.7,95%CI:1.4-15.1] more likely to die compared with those who had a normal-stable partial-oxygen pressure. CONCLUSION:The trajectories of systolic blood pressure, heart rate, respiratory rate and partial-oxygen pressure were significantly associated with an increased risk of mortality among OP poisoning patients.

Project description:ObjectiveIn the absence of adequate nationally-representative empirical evidence on multimorbidity, the existing healthcare delivery system is not adequately oriented to cater to the growing needs of the older adult population. Therefore, the present study identifies frequently occurring multimorbidity patterns among older adults in India. Further, the study examines the linkages between the identified patterns and socioeconomic, demographic, lifestyle and anthropometric correlates.DesignThe present findings rest on a large nationally-representative sample from a cross-sectional study.Setting and participantsThe study used data on 58 975 older adults (45 years and older) from the Longitudinal Ageing Study in India, 2017-2018.Primary and secondary outcome measuresThe study incorporated a list of 16 non-communicable diseases to identify commonly occurring patterns using latent class analysis. The study employed multinomial logistic regression models to assess the association between identified disease patterns with unit-level socioeconomic, demographic, lifestyle and anthropometric characteristics.ResultsThe present study demonstrates that older adults in the country can be segmented into six patterns: 'relatively healthy', 'hypertension', 'gastrointestinal disorders-hypertension-musculoskeletal disorders', 'musculoskeletal disorders-hypertension-asthma', 'metabolic disorders' and 'complex cardiometabolic disorders'. Additionally, socioeconomic, demographic, lifestyle and anthropometric factors are significantly associated with one or more identified disease patterns.ConclusionsThe identified classes 'hypertension', 'metabolic disorders' and 'complex cardiometabolic disorders' reflect three stages of cardiometabolic morbidity with hypertension as the first and 'complex cardiometabolic disorders' as the last stage of disease progression. This underscores the need for effective prevention strategies for high-risk hypertension group. Also, targeted interventions are essential to reduce the burden on the high-risk population and provide equitable health services at the community level.

Dataset Information

Distinct trajectories of multimorbidity in primary care were identified using latent class growth analysis.

Objectives

Study design and setting

Results

Conclusion

Publications

Distinct trajectories of multimorbidity in primary care were identified using latent class growth analysis.

Similar Datasets

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