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Comorbidity and healthcare use for individuals with CVD in the Ireland: a cross-sectional, population-based study.

ABSTRACT: OBJECTIVE:This study explores the factors associated with health service use for individuals with cardiovascular disease (CVD) and comorbidity in the Ireland. DESIGN:Population-based cross-sectional survey. SETTING:Nationally representative health and health service use survey from the 2010 Quarterly National Household Survey was analysed. PRIMARY OUTCOME MEASURES:Four outcome variables were examined: no CVD, CVD only, CVD with CVD-related comorbidities and CVD with non-CVD-related comorbidity. RESULTS:Of the 791 individuals reporting doctor-diagnosed CVD, 77% had a second morbidity. Using type of healthcare coverage as a proxy for socioeconomic status, both CVD-related and non CVD-related comorbidity increases the use of health service usage substantially for individuals with CVD, particularly general practitioner services (8.47, CI 4.49 to 15.96 and 5.20, CI 2.10 to 12.84) and inpatient public hospital care (3.64, CI 2.93 to 4.51 and 3.00, CI 2.11 to 4.26). CONCLUSION:This study indicated that even when demographic and socioeconomic factors are controlled for, comorbidity significantly increases the risk of accessing health services for individuals with CVD.

SUBMITTER: Morrissey K

PROVIDER: S-EPMC6340414 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Comorbidity and healthcare use for individuals with CVD in the Ireland: a cross-sectional, population-based study.

Morrissey Karyn K

BMJ open 20190115 1

<h4>Objective</h4>This study explores the factors associated with health service use for individuals with cardiovascular disease (CVD) and comorbidity in the Ireland.<h4>Design</h4>Population-based cross-sectional survey.<h4>Setting</h4>Nationally representative health and health service use survey from the 2010 Quarterly National Household Survey was analysed.<h4>Primary outcome measures</h4>Four outcome variables were examined: no CVD, CVD only, CVD with CVD-related comorbidities and CVD with ...[more]

PMID: 30647048

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Project description:BackgroundMultimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population.MethodsIn this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex.ResultsHalf of the individuals (49.1% (95% CI 49.0-49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1-8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1-6.2) of the study population, and 13.1% (13.0-13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse.ConclusionsThe burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.

Project description:ObjectivesTo analyse how comorbidity among patients with back pain, depression and osteoarthritis influences healthcare costs per patient. A special focus was made on the distribution of costs for primary healthcare compared with specialist care, hospital care and drugs.DesignPopulation-based cross-sectional study.SettingThe County of Östergötland, Sweden.PatientsData on diagnoses and healthcare costs for all 266 354 individuals between 20 and 75 years of age, who were residents of the County of Östergötland, Sweden, in the year 2006, were extracted from the local healthcare register and the national register of drug prescriptions.Main outcome measuresThe effects of comorbidity on healthcare costs were estimated as interactions in regression models that also included age, sex, number of other health conditions and education.ResultsThe largest diagnosed group was back pain (11 178 patients) followed by depression (7412 patients) and osteoarthritis (5174 patients). The largest comorbidity subgroup was the combination of back pain and depression (772 patients), followed by the combination of back pain and osteoarthritis (527 patients) and the combination of depression and osteoarthritis (206 patients). For patients having both a depression diagnosis and a back pain diagnosis, there was a significant negative interaction effect on total healthcare costs. The average healthcare costs among patients with depression and back pain was SEK 11 806 lower for a patient with both diagnoses. In this comorbidity group, there were tendencies of a positive interaction for general practitioner visits and negative interactions for all other visits and hospital days. Small or no interactions at all were seen between depression diagnoses and osteoarthritis diagnoses.ConclusionsA small increase in primary healthcare visits in comorbid back pain and depression patients was accompanied with a substantial reduction in total healthcare costs and in hospital costs. Our results can be of value in analysing the cost effects of comorbidity and how the coordination of primary and secondary care may have an impact on healthcare costs.

Project description:Background: The EQ-5D descriptive system has become a widely used generic instrument to measure population health. In this study we use the EQ-5D-5L system to describe the health of residents in Ireland in 2015/16 and examine relationships between health and a range of socio-demographic characteristics. Methods: A representative sample of residents in Ireland was established in a two-stage random sampling exercise in 2015/16. Self-reported health, together with a range of socio-demographic characteristics, were collected using a computer-assisted-personal-interview survey. Self-reported health was captured using the EQ-5D-5L descriptive system including a visual analogue scale. Data were presented as descriptive statistics and analysed using a general linear regression model and ordered logistic regression models in the case of specific health domains. Socio-economic gradients in health were also examined using concentration curves and indices. Results: A usable sample of 1,131 individuals provided responses to all questions in the survey. The population in general reported good health across the five domains with roughly 78%, 94%, 81%, 60% and 78% reporting no problems with mobility, self-care, usual activities, pain/discomfort and anxiety/depression respectively. Differences in health with respect to age, and socio-economic status were evident; those who were older, less well-educated of lower income and without private health insurance reported poorer health. Differences in health between groups differentiated by socio-economic status varied across domains of health, and were dependent on the measure of socio-economic status used. Conclusion: Residents of Ireland appear to rate their health as relatively good across the various domains captured by the EQ-5D-5L system. A pro-affluent gradient in self-reported health is evident though the sharpness of that gradient varies between domains of health and the measures of socio-economic status used. The study provides baseline data against which the health of the population can be measured in the future as demography and economic conditions change.

Project description:ObjectivesThis study reports the prevalence of persistent amblyopia (post-traditional treatment age) in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive and genetic profiles but different eye-care systems.DesignThis is a population-based observational study of amblyopia and refractive error.SettingRecruitment and testing in primary and post-primary schools in Ireland and NI.ParticipantsTwo groups identified through random cluster sampling to represent the underlying population; Ireland 898 participants (12-13?years old) and NI 723 participants (295 aged 9-10?years old, 428 aged 15-16?years old).Main outcome measuresMonocular logMAR visual acuity (presenting and pinhole), refractive error (cycloplegic autorefraction), ocular alignment (cover test) and history of previous eye care. These metrics were used to determine prevalence and type of amblyopia and treatment histories.ResultsChildren examined in NI between 2009 and 2011 had a significantly lower amblyopia prevalence than children examined in Ireland between 2016 and 2018 (two-sample test of proportions, p<0.001). Using a criteria of pinhole acuity 0.2logMAR (6/9.5 Snellen) plus an amblyogenic factor, 4 of 295 participants aged 9-10?years old (1.3%, 95% CIs 0.4 to 3.6) and 3 of 428 participants aged 15-16?years old (0.7%, 95%CIs 0.2 to 2.2) were identified in NI. The corresponding numbers in Ireland were 40 of 898 participants aged 12-13?years old (4.5%, 95%?CI 3.2 to 6.1). In NI strabismic amblyopia was the most prevalent type of persistent amblyopia, whereas anisometropic was predominant in Ireland. In Ireland, amblyopia was associated with socioeconomic disadvantage (OR=2.2, 95%CIs 1.4 to 3.6, p=0.002) and poor spectacle compliance (OR 2.5, 95% CIs 2.0 to 3.2, p<0.001).ConclusionsAmblyopia prevalence persisting beyond traditional treatment ages was significantly lower among NI children compared with Ireland. Uncorrected anisometropia, compliance with spectacle wear and socioeconomic disadvantage were contributing factors in Ireland. Children without obvious visible eye defects were less likely to access eye care in Ireland, resulting in missed opportunities for intervention where necessary.

Dataset Information

Comorbidity and healthcare use for individuals with CVD in the Ireland: a cross-sectional, population-based study.

Publications

Comorbidity and healthcare use for individuals with CVD in the Ireland: a cross-sectional, population-based study.

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