Open AccessDOI
Inequalities in developing multimorbidity over time: A population-based cohort study from an urban, multi-ethnic borough in the United Kingdom
Alessandra Bisquera,Alessandra Bisquera,Ellie Bragan Turner,Lesedi Ledwaba-Chapman,Lesedi Ledwaba-Chapman,Rupert Dunbar-Rees,Nasrin Hafezparast,Martin Gulliford,Martin Gulliford,Stevo Durbaba,Marina Soley-Bori,Julia Fox-Rushby,Julia Fox-Rushby,Hiten Dodhia,Mark Ashworth,Yanzhong Wang,Yanzhong Wang +16 more
- Vol. 12, pp 100247
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TLDR
In this article, the authors examined the association between health inequality, risk factors and accumulation or resolution of long-term conditions (LTCs), taking disease sequences into consideration, and found that substance use was the strongest risk factor for multimorbidity with an 85% probability of gaining LTC over the next year.Abstract:
Background Social and material deprivation accelerate the development of multimorbidity, yet the mechanisms which drive multimorbidity pathways and trajectories remain unclear. We aimed to examine the association between health inequality, risk factors and accumulation or resolution of LTCs, taking disease sequences into consideration. Methods We conducted a retrospective cohort of adults aged 18 years and over, registered between April 2005 and May 2020 in general practices in one inner London borough (n = 826,936). Thirty-two long term conditions (LTCs) were selected using a consensus process, based on a definition adapted to the demographic characteristics of the local population. sThe development and resolution of these LTCs were examined according to sociodemographic and clinical risk factors (hypertension; moderate obesity (BMI 30·0–39·9 kg/m2), high cholesterol (total cholesterol > 5 mmol/L), smoking, high alcohol consumption (>14 units per week), and psychoactive substance use), through the application of multistate Markov chain models. Findings Participants were followed up for a median of 4.2 years (IQR = 1·8 - 8·4); 631,760 (76%) entered the study with no LTCs, 121,424 (15%) with 1 LTC, 41,720 (5%) with 2 LTCs, and 31,966 (4%) with three or more LTCs. At the end of follow-up, 194,777 (24%) gained one or more LTCs, while 45,017 (5%) had resolved LTCs and 27,021 (3%) died. In multistate models, deprivation (hazard ratio [HR] between 1·30 to 1·64), female sex (HR 1·13 to 1·20), and Black ethnicity (HR 1·20 to 1·30; vs White) were independently associated with increased risk of transition from one to two LTCs, and shorter time spent in a healthy state. Substance use was the strongest risk factor for multimorbidity with an 85% probability of gaining LTCs over the next year. First order Markov chains identified consistent disease sequences including: chronic pain or osteoarthritis followed by anxiety and depression; alcohol and substance dependency followed by HIV, viral hepatitis, and liver disease; and morbid obesity followed by diabetes, hypertension, and chronic pain. Interpretation We examined the relations among 32 LTCs, taking the order of disease occurrence into consideration. Distinctive patterns for the development and accumulation of multimorbidity have emerged, with increased risk of transitioning from no conditions to multimorbidity and mortality related to ethnicity, deprivation and gender. Musculoskeletal disorders, morbid obesity and substance abuse represent common entry points to multimorbidity trajectories.read more
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Association of Multimorbidity, Disease Clusters, and Modification by Genetic Factors With Risk of Dementia
TL;DR: It is suggested that disease clusters might be important for dementia risk stratification and the development of targeted interventions to prevent or delay dementia.
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Air pollution associated with incidence and progression trajectory of chronic lung diseases: a population-based cohort study
Xiaojie Wang,Lanqi Chen,Miao Cai,Fei Tian,Hongtao Zou,Zhengmin Qian,Zilong Zhang,Haitao Li,Chongjian Wang,Steven W. Howard,Yang Peng,Li'e Zhang,Elizabeth Bingheim,Hualiang Lin,Yunfeng Zou +14 more
TL;DR: In this paper , the authors examined the effects of air pollution on the progression from healthy to chronic lung disease, subsequent chronic lung multimorbidity and further to death using data from the UK Biobank.
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Ethnic inequities in multimorbidity among people with psychosis: a retrospective cohort study
TL;DR: In this article , the authors investigated ethnic inequities in physical health multimorbidity in a cohort of people with schizophrenia and found that people of Chinese ethnicity had higher odds of having three or more physical health conditions compared with white British ethnicity.
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Continuity of care in diverse ethnic groups: a general practice record study in England
TL;DR: In this paper , the authors used multilevel regression models to describe continuity by ethnicity sequentially adjusted for: a) the number of consultations, follow-up time, age, sex, and practice-level random intercept; b) socioeconomic deprivation in the patient's residential area; and c) long-term conditions.
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Osteoarthritis is positively associated with self-reported sleep trouble in older adults
TL;DR: Osteoarthritis was positively associated with sleep trouble in older adults, with different odds ratio values among different subgroups, and the results suggest that older adults with OA should be aggressively screened for sleep problems.
References
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The Prevalence of Disease Clusters in Older Adults with Multiple Chronic Diseases – A Systematic Literature Review
Judith Sinnige,Jozé Braspenning,François G. Schellevis,Irina Stirbu-Wagner,Gert P. Westert,Joke C. Korevaar +5 more
TL;DR: These disease combinations could serve as a first priority setting towards the development of multimorbidity guidelines, starting with the diseases with the highest observed prevalence rates and those with potential interacting treatment plans.
Journal ArticleDOI
The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study
TL;DR: Mixed physical and mental multimorbidity is common across the life-span and is exacerbated by deprivation from early adulthood onwards, and was associated with a higher prevalence of depression, drugs misuse, anxiety, dyspepsia, pain, coronary heart disease, and diabetes in multimor bids at different ages.
Journal ArticleDOI
Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.
Heinz Freisling,Vivian Viallon,Hannah Lennon,Vincenzo Bagnardi,Cristian Ricci,Adam S. Butterworth,Michael J. Sweeting,David C. Muller,Isabelle Romieu,Pauline Bazelle,Marina Kvaskoff,Patrick Arveux,Gianluca Severi,Christina Bamia,Tilman Kühn,Rudolf Kaaks,Manuela M. Bergmann,Heiner Boeing,Anne Tjønneland,Anja Olsen,Kim Overvad,Christina C. Dahm,Virginia Menéndez,Antonio Agudo,María José Sánchez,Pilar Amiano,Carmen Santiuste,Aurelio Barricarte Gurrea,Tammy Y.N. Tong,Julie A. Schmidt,Ioanna Tzoulaki,Ioanna Tzoulaki,Konstantinos K. Tsilidis,Konstantinos K. Tsilidis,Heather Ward,Domenico Palli,Claudia Agnoli,Rosario Tumino,Fulvio Ricceri,Salvatore Panico,H. Susan J. Picavet,Marije F. Bakker,Evelyn M. Monninkhof,Peter Nilsson,Jonas Manjer,Olov Rolandsson,Elin Thysell,Elisabete Weiderpass,Mazda Jenab,Elio Riboli,Paolo Vineis,John Danesh,Nicholas J. Wareham,Marc J. Gunter,Pietro Ferrari +54 more
TL;DR: Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.
Journal ArticleDOI
Prevalence and outcomes of multimorbidity in South Asia: a systematic review.
Sanghamitra Pati,Subhashisa Swain,Mohammad Akhtar Hussain,Marjan van den Akker,Job F. M. Metsemakers,J. André Knottnerus,Chris Salisbury +6 more
TL;DR: The present study, a comprehensive mapping of multimorbidity research in South Asia, reveals the insufficient volume of work carried out in this domain and calls for greater methodological rigour while conducting epidemiological studies.
Journal ArticleDOI
Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study
Aline Dugravot,Aurore Fayosse,Julien Dumurgier,Kim Bouillon,Tesnim Ben Rayana,Alexis Schnitzler,Mika Kivimäki,Séverine Sabia,Archana Singh-Manoux,Archana Singh-Manoux +9 more
TL;DR: Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health and primary prevention is key to reducing social inequalities in mortality.