Impact of co-morbidities on self-rated health in self-reported COPD: An analysis of NHANES 2001–2008

Abstract

Chronic Obstructive Pulmonary Disease (COPD) coexists with co-morbidities. While co-morbidity has been associated with poorer health status, it is unclear which conditions have the greatest impact on self-rated health. We sought to determine which, and how much, specific co-morbid conditions impact on self-rated health in current and former smokers with self-reported COPD. Using the 2001–2008 National Health and Nutrition Examination Survey we characterized the association between thirteen co-morbidities and health status among individuals self-reporting COPD. Adjusted odds ratios (ORs) were generated using ordinal logistic regression. Additionally we evaluated the impact of increasing number of co-morbidities with self-rated health. Eight illnesses had significant associations with worse self-rated health, however after mutually adjusting for these conditions, congestive heart failure (OR 3.07, 95% CI 1.69–5.58), arthritis (OR 1.69, 95% CI 1.13–2.52), diabetes (OR 1.63, 95% CI 1.01–2.64), and incontinence/prostate disease (OR 1.63, 95% CI 1.01–2.62) remained independent predictors of self-rated health. Each increase in co-morbidities was associated with a 43% higher chance of worse self-rated health (95% CI 1.27-1.62). Individuals with COPD have a substantial burden of co-morbidity, which is associated with worse self-rated health. CHF, arthritis, diabetes and incontinence/prostate disease have the most impact on self-rated health. Targeting these co-morbidities in COPD may result in improved self-rated health.     

Predicting cardiovascular disease from handgrip strength: the potential clinical implications

The measurement of handgrip strength has proven prognostic value for all-cause and cardiovascular death, and for cardiovascular disease. It is also an important indicator of frailty and vulnerability. The measurement of handgrip strength may be most useful in the context of multi-morbidity, where it may be a simple tool to identify the individual at particularly high risk of adverse outcomes, who may benefit from closer clinical attention. Research into dietary, exercise, and pharmacologic strategies to increase muscle strength is ongoing. Important issues will be the feasibility and sustainability of increases in muscle strength, and whether these increases translate into clinical benefit.     

The Sustainable Development Agenda Needs to Include Long-term Care

The rapid ageing of populations around the world and the associated shift in the burden of disease from infectious to chronic conditions are creating complex challenges for national governments. Addressing the needs of these older populations in a sustainable and equitable way, will be a fundamental pillar of socioeconomic development in the 21^st Century.The World Health Organization (WHO) Global strategy and action plan on ageing and health, which was adopted by all the Organization’s 194 Member states in 2016, provides a clear framework for global action. One critical priority is to establish sustainable and equitable long-term care systems in every country. WHO defines long-term care as “the activities undertaken by others to ensure that people with, or at risk of, a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity”. These activities include both social care and health care, as well as contributions from other sectors, such as education or transport. And these activities need to be effectively coordinated if they are to efficiently, equitably and sustainably meet the needs of older people. This requires the stewardship of governments to ensure that: care is accessible and affordable; the rights of older people to lives of meaning and dignity are upheld regardless of their physical or mental capacity; services are oriented around the individual’s specific needs; caregivers are supported; the workforce (both paid and unpaid) are treated fairly; and older people’s intrinsic capacity is maintained for as long as possible.WHO has proposed three inter-related strategies to establish and sustain long-term care systems. System infrastructure needs to be developed and continually improved. The capacity of the workforce needs to be strengthened and families and communities must be supported. And the care and support provided needs to be more person-centred and integrated, underpinned by minimum standards and accreditation for care providers. This paper outlines some of the critical issues confronting governments in countries at all levels of development if this ambitious vision is to be achieved.     

Age-independent rise of inflammatory scores may contribute to accelerated aging in multi-morbidity

Aging is associated with an increase in a chronic, low-grade inflammation. This phenomenon, termed “inflammaging” is also a risk factor for both morbidity and mortality in the elderly. Frequent co-occurrence of chronic diseases, known as multi-morbidity, may be explained by interconnected pathophysiology of these conditions, most of which depend on its inflammatory component. Here we present an analysis of the U.S. National Health and Nutrition Examination Survey data collected between 1999 and 2008, for the presence, and the number, of chronic diseases along with HDL-cholesterol, C-reactive protein, white blood cell count, lymphocyte percent, monocyte percent, segmented neutrophils percent, eosinophils percent, basophils percent, and glycohemoglobin levels. Importantly, even after adjustment for age and BMI, many inflammatory markers continued to be associated to multi-morbidity. C-reactive protein (CRP) levels and Glasgow Prognostic Score (GPS) were most dramatically increased in parallel with an accumulation of chronic diseases, and may be utilized as multi-morbidity predictors. These observations point at background inflammation as direct, age-independent contributor to an accumulation of the disease burden. Our findings also suggest a possibility that systemic inflammation associated with chronic diseases may explain accelerated aging phenomenon previously observed among the patients with heavy disease burden.     

住院老年共病患者5 505例疾病分布特点分析

目的：了解老年共病患者的患病数量、患病种类及不同年龄组老年共病患者所患疾病的分布特点,为加强老年共病管理及防治提供参考数据。方法对2008年至2013年住院的5505例老年共病患者进行数据收集,记录所患疾病及一般特征。按年龄分为3组,低龄组65～74岁,中龄组75～84岁,高龄组≥85岁。结果5505例老年共病患者,年龄65～104（80.70±6.41）岁,其中男性3772例,女性1733例。所患共病数量2～23种,其中患病数量在5～9种之间的患者人数为3125例,占56.76%。老年共病患者患病种类统计分析显示脑血管病占首位（58.31%）,此后依次是高血压（52.97%）、感染性疾病（51.57%）、冠心病（41.11%）、糖尿病（30.55%）、心功能不全（28.45%）、肾脏病（23.67%）、骨关节病（21.91%）、肿瘤（17.31%）、胃肠道疾病（16.17%）。按各年龄组进行分析,不同年龄组患病种类有所不同,感染性疾病在≥85岁的老年共病患者中所占比例较＜85岁的显著性增高（78.89%vs 27.15%,P＜0.05）。结论老年共病患者患病数量多集中在5～9种,以脑血管病、高血压、感染性疾病、冠心病、糖尿病为高发疾病,不同年龄老年共病患者所患疾病有所不同,感染性疾病在高龄老年患者中增多。     

多重用药对老年冠心病合并心房颤动患者远期预后的影响

目的 探讨多重用药对老年冠心病合并心房颤动患者远期预后的影响.方法 选取2013年1月1日至2015年3月31日期间本院收治的65岁及以上冠心病合并房颤患者,并进行回顾性病例调查,结合电话、门诊及住院病例查询等方式随访至少5年,评价不同用药种类的患者出现肝肾功能变化、药品不良反应(ADR)及主要不良心脑血管事件(MAC...     

Improving primary care through information. A Wonca keynote paper

Information from health care encounters across the entire health care spectrum, when consistently collected, analysed and applied can provide a clearer picture of patients’ history as well as current and future needs through a better understanding of their morbidity burden and health care experiences. It can facilitate clinical activity to target limited resources to those patients most in need through risk adjustment mechanisms that consider the morbidity burden of populations, and it can help target quality improvement and cost saving activities in the right places. It can also open the door to a new chapter of evidence-based medicine around multi-morbidity. In summary, it can support a better integrated health system where primary care can provide continuous, coordinated, and comprehensive person-centred care to those who could benefit most. This paper explores the potential uses of information collected in electronic health records (EHRs) to inform case-mix and predictive modelling, as well as the associated challenges, with a particular focus on their application to primary care.     

Time pressured deprioritization of COPD in primary care: a qualitative study

Objective: To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden. Setting: Primary health care centres (PHCCs) in Stockholm, Sweden. Subjects: A total of 59 PCPs. Design: Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM). Results: Time-pressured patient–doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: “Not becoming aware of COPD”, “Not becoming concerned due to clinical features”, “Insufficient local routines for COPD care”, “Negative personal attitudes and views about COPD”, “Managing diagnoses one at a time”, and “Perceiving a patient’s motivation as low’’. Conclusions: De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines.

• Key points

• Under-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient–doctor consultation offers a key opportunity to identify and provide COPD care.

  • Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation.

  • Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation.

  • Better local routines, extended consultation time, and a holistic approach are needed when managing multi-morbid patients with COPD.