Grupos de morbilidad ajustados: características y comorbilidades de los pacientes crónicos según nivel de riesgo en Atención Primaria

AimsTo describe the characteristics of patients with chronic conditions according to their risk levels assigned by the adjusted morbidity groups (AMG). To analyse the factors associated with a high risk level and to study their effect.DesignObservational cross-sectional study with an analytical focus.LocationPrimary care (PC), Madrid Health Service.ParticipantsPopulation of 18,107 patients stratified by their risk levels with the AMG in the computerised clinical records of Madrid PC.Main measurementsThe variables studied were: socio-demographic, clinical-nursing care and use of services. Univariate, bivariate, and multivariate analysis were performed.ResultsOf the 18,107 patients, 9,866(54.4%) were identified as chronic patients, with 444 (4.5%) stratified as high risk, 1784 (18,1%) as medium risk, and 7,638 (77.4%) as low risk. The high risk patients, compared with medium and low risk, had an older mean age [77.8 (SD = 12.9), 72.1 (SD = 12.9), 50.6 (SD = 19.4)], lower percentage of women (52.3%, 65%, 61.1%), a higher number of chronic diseases [6.7 (SD = 2.4), 4.3 (SD = 1.5), 1.9 (SD = 1.1)], polymedication (79.1%, 43.3%, 6.2%), and contact with PC [33.9 (28), 21.4 (17.3), 7.9 (9.9)] (P <. 01). In the multivariate analysis, the high risk level was independently related to age > 65 [1.43 (1.03-1.99), male gender (OR = 3.46, 95% CI = 2.64-4.52), immobility (OR = 6.33, 95% CI = 4.40-9.11), number of chronic conditions (OR = 2.60, 95% CI = 2.41-2.81), and PC contact > 7 times (OR = 1.95, 95% CI = 1.36-2.80)] (P < .01).ConclusionsMore than half of the population is classified by the AMG as a chronic, and it is stratified into 3 risk levels that show differences in gender, age, functional impairment, need for care, morbidity, complexity, and use of Primary Care services. Age > 65, male gender, immobility, number of chronic conditions, and contact with PC > 7 times were the factors associated with high risk.     

新疆南山牧区老年农牧民慢性病共病的现状分析

目的 分析新疆乌鲁木齐南山牧区老年农牧民慢性病共病的现状,并比较不同特征人群共病的患病差异。方法 选取2018年1月-10月在南山接受体检的年龄≥60岁的农牧民共720名,通过新疆居民健康档案及体检表获得相关信息,采用SPSS 25.0软件进行分析。结果 慢性病患病率为80.69%,检查出患病率最高的是高血压为60.83%,最低的是COPD为4%;女性高血压、高脂血症、胆囊疾病、脂肪肝、骨关节疾病患病率高于男性（P<0.05）;共病患病率为46.25%;共病组合最多的为高血压+骨关节病,占共病二元组合患者的22.35%（38/170）;不同年龄组、性别、文化程度、BMI、体育锻炼情况、文化程度、吸烟情况、饮酒的老年农牧民共病患病率,差异有统计学意义（P<0.05）;结论 新疆乌鲁木齐南山牧区老年农牧民共病患病率高,应重视对该地区老年农牧民共病的防治。     

Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

ObjectiveThis study aimed to provide population-level data regarding trends in multimorbidity over 13 years.MethodsWe linked provincial health administrative data in Ontario, Canada, to create 3 cross-sectional panels of residents of any age in 2003, 2009, and 2016 to describe: (i) 13-year trends in multimorbidity prevalence and constellations among residents and across age, sex, and income; and (ii) chronic condition clusters. Multimorbidity was defined as having at least any 2 of 18 selected conditions, and further grouped into levels of 2, 3, 4, or 5 or more conditions. Age-sex standardized multimorbidity prevalence was estimated using the 2009 population as the standard. Clustering was defined using the observed combinations of conditions within levels of multimorbidity.ResultsStandardized prevalence of multimorbidity increased over time (26.5%, 28.8%, and 30.0% across sequential panels), across sex, age, and area-based income. Females, older adults and those living in lower income areas exhibited higher rates in all years. However, multimorbidity increased relatively more among males, younger adults, and those with 4 or 5 or more conditions. We observed numerous and increasing diversity in disease clusters, namely at higher levels of multimorbidity.ConclusionOur study provides relevant and needed population-based information on the growing burden of multimorbidity, and related socio-demographic risk factors. Multimorbidity is markedly increasing among younger age cohorts. Also, there is an increasing complexity and lack of common clustering patterns at higher multimorbidity levels.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00474-y.     

社区老年脑卒中人群共病现况分析

目的 分析天津市中北镇社区60岁及以上老年人群脑卒中共病现况,为脑卒中防治提供依据。方法 回顾性分析2017年1—12月于天津市中北镇社区卫生服务中心进行体检的60岁及以上人群的数据,分析脑卒中人群共病特点。结果 本研究调查11 574名老年人,脑卒中患病率为4.2%。脑卒中人群共病患病率为94.5%,女性共病患病率（97.1%）高于男性共病患病率（92.7%）,差异具有统计学意义（P＜0.001）。脑卒中人群2种共病患病率最高（34.3%）,其共病模式中高血压+肥胖最多（23.2%）,男性与女性最常见的共病模式分别是高血压+贫血（24.0%）、高血压+肥胖（23.5%）。2种共病间相关性分析显示,高血压与肥胖、贫血、脂肪肝相关,肥胖与糖尿病、贫血、脂肪肝相关,贫血与糖尿病相关（P均＜0.05）。结论 天津市中北镇社区老年脑卒中人群共病患病率高,应重视脑卒中共病的管理,并根据不同性别、年龄对脑卒中共病进行有针对性的干预与防治。     

Sarcopenic obesity using the ESPEN and EASO consensus statement criteria of 2022 – Results from the German KORA-Age study

ObjectiveThe recent consensus statement of ESPEN and EASO recommends reviewing existing datasets to assess the prevalence of sarcopenic obesity based on the new definition and diagnostic criteria. Therefore, this study aimed to determine the prevalence of sarcopenic obesity in a population-based study and to assess the association of this new definition with clinical traits.MethodsThe KORA (Cooperative Health Research in the Region of Augsburg)-Age baseline examination (2008/2009) comprised 1079 participants aged 65 years and older from southern Germany. Sarcopenic obesity was defined in 998 participants (mean age 75.6 years, 498 women) with complete data according to the 2022 ESPEN and EASO algorithm, which includes reduced handgrip strength, reduced skeletal muscle mass per weight, and elevated fat mass. Body composition was measured using bioelectrical impedance analysis. Associations between sarcopenic obesity and physical activity, disability, multimorbidity, and polypharmacy were assessed using logistic regression analysis.ResultsThe overall prevalence of sarcopenic obesity was 4.5 % (5.0 % in men, 4.0 % in women). Sarcopenic obesity was associated with disability (2.87 [CI 1.84–4.48]), multimorbidity (≥ 2 comorbidities; 2.59 [CI 1.23–5.46]), polypharmacy (≥ 5 drugs; 1.96 [CI 1.05–3.63]), cognitive impairment (3.03 [CI 1.51–6.06]) and arthritis (2.66 [CI 1.39–5.07]) after adjusting for age, sex and marital status.ConclusionSarcopenic obesity is prevalent in the older German population and is associated with several clinical traits. Future longitudinal studies are needed to further elucidate whether the observed associations could be causal.     

eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project

IntroductionCare for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+.MethodsWithin the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as ‘high potential’ for their innovative approach and studied in depth through site visits.ResultsOut of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients’ data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers.ConclusionFindings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity.     

Multimorbidity is associated with uptake of influenza vaccination

ObjectivePatients with chronic conditions have higher rates of severe influenza-related illness and mortality. However, influenza vaccination coverage in high-risk populations continues to be suboptimal. We describe the association between cumulative disease morbidity, measured by a previously validated multimorbidity index, and influenza vaccination among community-dwelling adults.MethodsWe obtained interview and medical record data for participants ≥18 years who sought outpatient care for influenza-like illness between 2011 and 2016 as part of an outpatient-based study of influenza vaccine effectiveness. We defined cumulative disease morbidity by using medical diagnosis codes to calculate a multimorbidity-weighted index (MWI) for each participant. MWI and influenza vaccination status was evaluated by logistic regression. Akaike information criterion was calculated for all models.ResultsOverall, 1458 (48%) of participants out of a total of 3033 received influenza vaccination. The median MWI was 0.9 (IQR 0.00–3.5) and was higher among vaccinated participants (median 1.6 versus 0.0; p < 0.001). We found a positive linear association between MWI and vaccination, and vaccination percentages were compared between categories of MWI. Compared to patients with no multimorbidity (MWI = 0), odds of vaccination were 17% higher in the second category (MWI 0.01–1.50; [OR: 1.17, 95% CI: 0.92–1.50]), 58% higher in the third category (MWI 1.51–3.00; [OR: 1.58, 95% CI: 1.26–1.99]), 130% higher in the fourth category (MWI 3.01–6.00; [OR: 2.30, 95% CI: 1.78–2.98]) and 214% higher in the fifth category (MWI 6.01–45.00;[OR: 3.14, 95% CI: 2.41–4.10]). Participants defined as high-risk had 86% greater odds of being vaccinated than non-high-risk individuals (OR: 1.86, 95% CI: 1.56–2.21). The AIC was lowest for MWI compared with high-risk conditions.ConclusionsOur results suggest a dose response relationship between level of multimorbidity and likelihood of influenza vaccination. Compared with high-risk condition designations, MWI provided improved precision and a better model fit for the measurement of chronic disease and influenza vaccination.     

Peeking through the cracks: An assessment of the prevalence, clinical characteristics and health-related quality of life (HRQoL) of people with polypathology in a hospital setting

Little is known about the prevalence of the recently defined polypathology notion in hospital populations. Patients admitted to medical wards were assessed using established criteria of polypathology. Prevalence of polypathology, interobserver reliability, clinical features, nutritional status, and HRQoL were assessed using clinical data and interview, mini-nutritional assessment (MNA), and the 12-item short-form health survey (SF-12) scales. Of a total of 812 patients studied, 196 (24%) met polypathology criteria (65% men, of mean age 71.3 ± 11.6 years, mean defining chronic diseases 2.4 ± 0.046, and other comorbidities 2.6 ± 0.094). Interobserver reliability for the detection of cases was good (κ = 0.628). Their mean Charlson index/prescribed drugs were 3.3/6, respectively. Severe dyspnea, delirium, or active neoplasia were present in 44, 15, and 11%. A bad nutritional status/risk of malnutrition was evident in 10.3/52.6%, and correlated with the number of previous hospitalizations (p = 0.041), and the presence of active neoplasia (p = 0.037). Mean physical/mental summaries of HRQoL were 33.9 ± 10, and 42 ± 13, and correlated with a better nutritional status (p = 0.011, and p = 0.001, respectively). Polypathology affects one quarter of inpatients in a hospital setting, and can be easily and reliably identified. The diversity and complexity of patient needs underscore the need for continuity of care between community and hospital, crossing sub-speciality lines and institutional boundaries.     

Maintaining autonomy despite multimorbidity: self-efficacy and the two faces of social support

Multimorbidity—the co-occurrence of multiple illnesses—is a frequent condition in older adults and poses serious threats to autonomy. In order to identify resources for autonomy despite multimorbidity, our longitudinal study tested main and interaction effects of personal and social resources (self-efficacy and social support) on maintaining autonomy. Three hundred and nine individuals (aged 65–85 years) with multiple illnesses completed measures of self-efficacy beliefs, received instrumental social support and perceptions of autonomy. Data were analyzed using structural equation modeling. Cross-sectionally, individuals with lower perceptions of autonomy received more support from their networks. Longitudinally, the relation of received support with autonomy was moderated by self-efficacy: Simple slopes analyses showed that social support compensated for lower levels of self-efficacy, whereas in individuals with higher self-efficacy the resources interfered. Receiving social support bolstered autonomy in lower self-efficacious individuals, but in highly self-efficacious individuals support threatened autonomy. This has implications for both theory and practice, as it suggests differential effects of social resources depending on personal resources.