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Patterns of multimorbidity and demographic profile of latent classes in a Danish population-A register-based study.

ABSTRACT: BACKGROUND:Multimorbidity is an increasing public health concern and is associated with a range of further adverse outcomes. Identification of disease patterns as well as characteristics of populations affected by multimorbidity is important for prevention strategies to identify those at risk. AIM:The aim of the study was to identify and describe demographic characteristics of multimorbidity classes in three age groups (16-44 years, 45-64 years, and 65+ years). METHODS:Based on register information on 47 chronic diseases and conditions, we used latent class analysis to identify multimorbidity classes in a random sample of the Danish population (n = 470,794). Information on sociodemographic characteristics (age, sex, region of origin, educational level, employment status, and marital status) was obtained from registers and linked to the study population. Age- and sex-adjusted multinomial logistic regression models were used to examine associations between multimorbidity classes and sociodemographic characteristics. RESULTS:We identified seven classes among individuals in the age groups 45-64 years and 65+ years and five classes in the age group 16-44 years. Overall, the classes were similar in the three age groups, but varied in size, i.e. the class 'No or few diseases' was larger in the younger age group. The class 'Many diseases' (a class with both somatic diseases and mental illnesses) was only seen in individuals aged 45-64 years and 65+ years. There were social inequalities in odds of belonging to the multimorbidity classes compared to the healthier class. These social inequalities varied but were especially strong in the classes named 'Many diseases' and 'Mental illness, epilepsy'. CONCLUSION:The results of the study suggest that there are social inequalities in multimorbidity but that these inequalities are not universal to all types of multimorbidity. This supports that multimorbidity is diverse and should be prevented and treated accordingly.

SUBMITTER: Moller SP

PROVIDER: S-EPMC7418992 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Patterns of multimorbidity and demographic profile of latent classes in a Danish population-A register-based study.

Møller Sanne Pagh SP Laursen Bjarne B Johannesen Caroline Klint CK Tolstrup Janne S JS Schramm Stine S

PloS one 20200811 8

<h4>Background</h4>Multimorbidity is an increasing public health concern and is associated with a range of further adverse outcomes. Identification of disease patterns as well as characteristics of populations affected by multimorbidity is important for prevention strategies to identify those at risk.<h4>Aim</h4>The aim of the study was to identify and describe demographic characteristics of multimorbidity classes in three age groups (16-44 years, 45-64 years, and 65+ years).<h4>Methods</h4>Base ...[more]

PMID: 32780781

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Project description:IntroductionAs the flows of immigrant populations increase worldwide, their heterogeneity becomes apparent with respect to the differences in the prevalence of chronic physical and mental disease. Multimorbidity provides a new framework in understanding chronic diseases holistically as the consequence of environmental, social, and personal risks that contribute to increased vulnerability to a wide variety of illnesses. There is a lack of studies on multimorbidity among immigrants compared to native-born populations.MethodologyThis nationwide multi-register study in Norway enabled us i) to study the associations between multimorbidity and immigrant origin, accounting for other known risk factors for multimorbidity such as gender, age and socioeconomic levels using logistic regression analyses, and ii) to identify patterns of multimorbidity in Norway for immigrants and Norwegian-born by means of exploratory factor analysis technique.ResultsMultimorbidity rates were lower for immigrants compared to Norwegian-born individuals, with unadjusted odds ratios (OR) and 95% confidence intervals 0.38 (0.37-0.39) for Eastern Europe, 0.58 (0.57-0.59) for Asia, Africa and Latin America, and 0.67 (0.66-0.68) for Western Europe and North America. Results remained significant after adjusting for socioeconomic factors. Similar multimorbidity disease patterns were observed among Norwegian-born and immigrants, in particular between Norwegian-born and those from Western European and North American countries. However, the complexity of patterns that emerged for the other immigrant groups was greater. Despite differences observed in the development of patterns with age, such as ischemic heart disease among immigrant women, we were unable to detect the systematic development of the multimorbidity patterns among immigrants at younger ages.ConclusionsOur study confirms that migrants have lower multimorbidity levels compared to Norwegian-born. The greater complexity of multimorbidity patterns for some immigrant groups requires further investigation. Health care policies and practice will require a holistic approach for specific population groups in order to meet their health needs and to curb and prevent diseases.

Project description:BACKGROUND:Evidence suggests that the single-disease paradigm does not accurately reflect the individual experience, with increasing prevalence of chronic disease multimorbidity, and subtle yet important differences in types of co-occurring diseases. Knowledge of multimorbidity patterns can aid clarification of individual-level burden and needs, to inform prevention and treatment strategies. This study aimed to estimate the prevalence of multimorbidity in Jamaica, identify population subgroups with similar and distinct disease profiles, and examine consistency in patterns identified across statistical techniques. METHODS:Latent class analysis (LCA) was used to examine multimorbidity patterns in a sample of 2,551 respondents aged 15-74 years, based on data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 and self-reported presence/absence of 11 chronic conditions. Secondary analyses compared results with patterns identified using exploratory factor analysis (EFA). RESULTS:Nearly one-quarter of the sample (24.1%) were multimorbid (i.e. had ?2 diseases), with significantly higher burden in females compared to males (31.6% vs. 16.1%; p<0.001). LCA revealed four distinct classes, including a predominant Relatively Healthy class, comprising 52.7% of the sample, with little to no morbidity. The remaining three classes were characterized by varying degrees and patterns of multimorbidity and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Four diseases determined using physical assessments (obesity, hypertension, diabetes, hypercholesterolemia) were primary contributors to multimorbidity patterns overall. EFA identified three patterns described as "Vascular" (hypertension, obesity, hypercholesterolemia, diabetes, stroke); "Respiratory" (asthma, COPD); and "Cardio-Mental-Articular" (cardiovascular disease, arthritis, mental disorders). CONCLUSION:This first study of multimorbidity in the Caribbean has revealed a high burden of co-existing conditions in the Jamaican population, that is predominantly borne by females. Consistency across methods supports the validity of patterns identified. Future research into the causes and consequences of multimorbidity patterns can guide development of clinical and public health strategies that allow for targeted prevention and intervention.

Project description:BackgroundPopulation ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries.MethodsWe analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity.ResultsOverall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression).ConclusionsA high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.

Project description:OBJECTIVES:Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity. DESIGN:Population-based cohort study. SETTING:Primary healthcare in Denmark. PARTICIPANTS:118?410 participants from the Danish National Health Survey 2010 followed for 1?year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers. OUTCOME MEASURES:General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers. RESULTS:Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95%?CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95%?CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95%?CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95%?CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95%?CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services. CONCLUSION:Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.

Project description:ObjectivesThis study aims to estimate the association between pregnancy-associated maternal cancers, diagnosed both prenatally and postnatally, and birth outcomes.DesignPopulation-based register study.SettingNational registers of Denmark and Sweden.ParticipantsA total of 5 523 365 children born in Denmark (1977-2008) and Sweden (1973-2006).Primary and secondary outcome measures: gestational age, birth weight, size for gestational age, Apgar score, caesarean section and sex were the outcomes of interest. ORs and relative risk ratios (RRR) with 95% CIs were estimated using logistic regression and multinomial logistic regression, respectively.ResultsIn this study, 2% of children were born to mothers with a diagnosis of cancer. Children whose mothers received a prenatal cancer diagnosis had higher risk of being born preterm (RRR: 1.77, 95%?CI 1.64 to 1.90); low birth weight (RRR 1.84, 95%?CI 1.69 to 2.01); low Apgar score (OR 1.36, 95%?CI 1.20 to 1.56); and by caesarean section (OR: 1.69, 95%?CI 1.59 to 1.80). Associations moved towards the null for analyses using postnatal diagnoses, but preterm birth (RRR: 1.13, 95%?CI 1.09 to 1.17) and low birth weight (RRR: 1.14, 95%?CI 1.09 to 1.18) remained statistically significant, while risk of caesarean section became so (OR: 0.95, 95%?CI 0.91 to 0.98). Additionally, statistical significance was reached for large for gestational age (RRR: 1.06, 95%?CI 1.01 to 1.11), high birth weight (RRR: 1.04, 95%?CI 1.01 to 1.06) and caesarean section (OR: 0.95, 95%?CI 0.91 to 0.98).ConclusionsResults suggest an association between pregnancy-associated cancers and adverse birth outcomes in the offspring. While this is strongest for prenatally diagnosed cancers, some smaller associations exist for postnatally diagnosed cancers, indicating that cancer itself could affect fetal development, or that cancer and adverse birth outcomes share risk factors. Future studies on maternal cancer during pregnancy should consider including some postnatal years in their exposure window.

Project description:Exacerbation frequency is central in treatment strategies for chronic obstructive pulmonary disease. However, whether chronic obstructive pulmonary disease patients from the general population with frequent exacerbations continue to have frequent exacerbations over an extended period of time is currently unknown. In this study, we aimed to investigate the stability of the frequent exacerbator in a population-based setting. To this end, we conducted a nationwide register-based descriptive study with a 10-year follow-up period of chronic obstructive pulmonary disease patients with at least one medically treated exacerbation in 2003. Each subsequent year, we divided the population into frequent, infrequent and non-exacerbators and quantified the flow between categories. Further, we estimated the percentage of frequent exacerbators at baseline who stayed in this category each year during a 5-year follow-up. We identified 19,752 patients with chronic obstructive pulmonary disease and an exacerbation in 2003. Thirty percent were frequent exacerbators. Overall, the majority of exacerbators in 2003 were non-exacerbators in the following years (60% in 2004 increasing to 68% in 2012). Approximately half of frequent exacerbators in one year experienced a decrease in exacerbation frequency and had either zero or one exacerbation in the subsequent year. This pattern was stable throughout follow-up. During a 5-year follow-up period, a substantial proportion (42%) of frequent exacerbators in 2003 had no additional years as frequent exacerbators, while the minority (6%) remained in this category each year. In conclusion, the rate of exacerbations shows considerable variation over time among chronic obstructive pulmonary disease patients in the general population. This might hold implications for chronic obstructive pulmonary disease treatment guidelines and their practical application.Chronic obstructive lung diseaseVARIATIONS IN DISEASE PROGRESSION: Patients with chronic obstructive pulmonary disease (COPD) who suffer from frequent exacerbations do not necessarily persist with such severity over time. Exacerbations in COPD are defined by worsening respiratory symptoms that result in changes to treatment, hospitalization and, at worst, death. However, clarity is needed on whether frequent exacerbations is a stable feature of some patients' disease. Mette Reilev at the University of Southern Denmark and co-workers followed, over 10 years, 19,752 COPD patients living in Denmark who suffered at least one exacerbation in 2003. By 2004, 60% of patients were classed as infrequent or non-exacerbators, rising to 68% by 2012. Very few patients remained "frequent exacerbators", suggesting the rate of exacerbations changes considerably over time. This could hold implications for COPD treatment and challenge assumptions made about disease progression.

Dataset Information

Patterns of multimorbidity and demographic profile of latent classes in a Danish population-A register-based study.

Publications

Patterns of multimorbidity and demographic profile of latent classes in a Danish population-A register-based study.

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