Age and gender differences in the prevalence and patterns of multimorbidity in the older population
Tóm tắt
The coexistence of several chronic diseases in one same individual, known as multimorbidity, is an important challenge facing health care systems in developed countries. Recent studies have revealed the existence of multimorbidity patterns clustering systematically associated distinct clinical entities. We sought to describe age and gender differences in the prevalence and patterns of multimorbidity in men and women over 65 years. Observational retrospective multicentre study based on diagnostic information gathered from electronic medical records of 19 primary care centres in Aragon and Catalonia. Multimorbidity patterns were identified through exploratory factor analysis. We performed a descriptive analysis of previously obtained patterns (i.e. cardiometabolic (CM), mechanical (MEC) and psychogeriatric (PG)) and the diseases included in the patterns stratifying by sex and age group. 67.5% of the aged population suffered two or more chronic diseases. 32.2% of men and 45.3% of women were assigned to at least one specific pattern of multimorbidity, and 4.6% of men and 8% of women presented more than one pattern simultaneously. Among women over 65 years the most frequent pattern was the MEC pattern (33.3%), whereas among men it was the CM pattern (21.2%). While the prevalence of the CM and MEC patterns decreased with age, the PG pattern showed a higher prevalence in the older age groups. Significant gender differences were observed in the prevalence of multimorbidity patterns, women showing a higher prevalence of the MEC and PG patterns, as well as a higher degree of pattern overlapping, probably due to a higher life expectancy and/or worse health. Future studies on multimorbidity patterns should take into account these differences and, therefore, the study of multimorbidity and its impact should be stratified by age and sex.
Tài liệu tham khảo
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni F: Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011, 10: 430-439. 10.1016/j.arr.2011.03.003.
OECD: Health Reform: Meeting the Challenge of Ageing and Multiple Morbidities. 2011, Paris: OECD Publishing, Available at http://dx.doi.org/10.1787/9789264122314-en
Boyd CM, Fortin M: Future of multimorbidity research: How should understanding of multimorbidity inform health system design?. Public Health Rev. 2010, 32: 451-474.
Fortin M, Dionne J, Pinho G, Gignac J, Almirall J, Lapointe L: Randomized controlled trials: do they have external validity for patients with multiple comorbidities?. Ann Fam Med. 2006, 4: 104-108. 10.1370/afm.516.
van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA: Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998, 51: 367-375. 10.1016/S0895-4356(97)00306-5.
Starfield B, Lemke KW, Herbert R, Pavlovich WD, Anderson G: Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med. 2005, 3: 215-222. 10.1370/afm.307.
Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA: Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001, 54: 661-674. 10.1016/S0895-4356(00)00363-2.
Wolff J, Starfield B, Anderson G: Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002, 162: 2269-2276. 10.1001/archinte.162.20.2269.
Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T: Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012, 345: e5205-10.1136/bmj.e5205.
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity: Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc. 2012, 60: E1-E25.
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity: Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the american geriatrics society. J Am Geriatr Soc. 2012, 60: 1957-1968.
van den Akker M, Buntinx F, Knottnerus JA: Comorbidity or multimorbidity: what’s in a name? a review of literature. Eur J Gen Pract. 1996, 2: 65-70. 10.3109/13814789609162146.
Prados-Torres A, Poblador-Plou B, Calderon-Larranaga A, Gimeno-Feliu LA, Gonzalez-Rubio F, Poncel-Falco A, Sicras-Mainar A, Alcalá-Nalvaiz JT: Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis. PLoS One. 2012, 7: e32190-10.1371/journal.pone.0032190.
Schäfer I, von Leitner EC, Schön G, Koller D, Hansen H, Kolonko T, Kaduszkiewicz H, Wegscheider K, Glaeske G, van den Bussche H: Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010, 5: e15941-10.1371/journal.pone.0015941.
Cornell J, Pugh J, Williams J, Kazis L, Lee A, Parchman ML, Zeber J, Pederson T, Montgomery KA, Nokl PH: Multimorbidity clusters: clustering binary data from multimorbidity clusters: clustering binary data from a large administrative medical database. Applied Multivariate Research. 2007, 12: 163-182.
Newcomer SR, Steiner JF, Bayliss EA: Identifying subgroups of complex patients with cluster analysis. AmJ ManagCare. 2011, 17: e324-e332.
Kirchberger I, Meisinger C, Heier M, Zimmermann AK, Thorand B, Autenrieth CS, Peters A, Ladwig KH, Doring A: Patterns of multimorbidity in the aged population. Results from the KORA-Age study. PLoS One. 2012, 7: e30556-10.1371/journal.pone.0030556.
Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L: Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009, 57: 225-230. 10.1111/j.1532-5415.2008.02109.x.
Garcia-Olmos L, Salvador CH, Alberquilla A, Lora D, Carmona M, Garcia-Sagredo P, Pascual M, Munoz A, Monteagudo JL, Garcia-Lopez F: Comorbidity patterns in patients with chronic diseases in general practice. PLoS One. 2012, 7: e32141-10.1371/journal.pone.0032141.
Lamberts H WM. ICPC: International Classification of Primary Care. 1987, Oxford: Oxford University Press
The Johns Hopkins ACG® System: Reference Manual. 2008, Baltimore: The Johns Hopjins University, version 8.2
Información y Estadísticas Sanitarias, Ministerio de Sanidad: International Classification of Diseases 9th Revision Clinical Modification ICD-9-CM. 2008, Madrid: Ministerio de Sanidad, 6
Kernick D: A theoretical framework for multimorbidity: from complicated to chaotic. Br J Gen Pract. 2012, 62 (602): e659-e662. 10.3399/bjgp12X654740.
Mangin D, Heath I, Jamoulle M: Beyond diagnosis: rising to the multimorbidity challenges. BMJ. 2012, 344: e3526-10.1136/bmj.e3526.
Hemingway H, Croft P, Perel P, Hayden JA, Abrams K, Timmis A, Briggs A, Udumyan R, Moons KGM, Steyerberg EW, Roberts I, Schroter S, Altmann DG, Riley RD: Prognosis research strategy (PROGRESS 1): a framework for researching clinical outcomes. BMJ. 2013, 346: e5595-10.1136/bmj.e5595.
Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA: Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2011, 61 (582): e12-e21. 10.3399/bjgp11X548929.
Perelman J, Mateus C, Fernandes A: Gender equity in treatment for cardiac heart disease in Portugal. Soc Sci Med. 2010, 71: 25-29. 10.1016/j.socscimed.2010.03.026.
Bowling A, Bond M, McKee D, McClay M, Banning AP, Dudley N, Elder A, Martin A, Blackman I: Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications. Heart. 2001, 85: 680-686. 10.1136/heart.85.6.680.
National Health Survey: 2006, Available at [http://www.msssi.gob.es/estadEstudios/estadisticas/encuestaNacional/encuesta2006.htm]
Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TIL, Getz L: Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospectivbe data from the Norwegian HUNT 2 study. J Eval Clin Pract. 2012, 18: 159-168. 10.1111/j.1365-2753.2011.01767.x.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012, 380 (9836): 37-43. 10.1016/S0140-6736(12)60240-2.
Schafer I, Hansen H, Schon G, Hofels S, Altiner A, Dahlhaus A, Gensichen J, Riedel-Heller S, Weyerer S, Blank WA, König HH, von dem Knesebeck O, Wegscheider K, Scherer M, van den Bussche H, Wiese B: The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. First results from the MultiCare cohort study. BMC Health Serv Res. 2012, 12: 89-10.1186/1472-6963-12-89.
Sternberg SA, Wershof Schwartz A, Karunananthan S, Bergman H, Clarfield M: The identification of frailty: a systematic literature review. J Am Geriatr Soc. 2011, 59: 2129-2138. 10.1111/j.1532-5415.2011.03597.x.
Eom CS, Park SM, Myung SK, Yun JM, Ahn JS: Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Ann Fam Med. 2011, 9 (3): 257-267. 10.1370/afm.1243.
Foguet-Boreu Q, Violan C, Roso-Llorach A, Rodríguez-Blanco T, Pons-Vigués M, Muñoz-Pérez MA, Pujol-Ribera E, Valderas JM: Impact of multimorbidity: acute morbidity, area of residency and use of health services across the life span in a region of south Europe. BMC Fam Pract. 2014, 15: 55-10.1186/1471-2296-15-55.
Starfield B: Challenges to primary care from co- and multi-morbidity. Prim Health Care Res Dev. 2011, 12: 1-2.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2318/14/75/prepub