Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study

Yajing Zhu*, Duncan Edwards, Jonathan Mant, Rupert A Payne, Steven Kiddle

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background
Multimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects. Additionally, multimorbidity is often negatively associated with participation in research cohorts. Therefore, we set out to identify clusters of multimorbidity patients and how they are differentially associated with mortality and service use across age groups in a population representative sample.

Methods
Linked primary and secondary care electronic health records contributed by 382 general practices in England to the Clinical Practice Research Datalink (CPRD) were used. The study included a representative set of multimorbid adults (18 years old or more, N=113,211) with two or more long-term conditions (a total of 38 conditions were included). A random set of 80% of the multimorbid patients (N=90,571) were stratified by age groups and clustered using latent class analysis. Consistency between obtained multimorbidity phenotypes, classification quality and associations with demographic characteristics and primary outcomes (GP consultations, hospitalisations, regular medications and mortality) was validated in the remaining 20% of multimorbid patients (N=22,640).

Results
We identified twenty patient clusters across four age strata. The clusters with the highest mortality comprised psychoactive substance and alcohol misuse (aged 18-64), coronary heart disease, depression and pain (aged 65-84) and coronary heart disease, heart failure and atrial fibrillation (aged 85+). The clusters with the highest service use coincided with those with highest mortality for people aged over 65. For people aged 18-64, the cluster with the highest service use comprised depression, anxiety and pain. The majority of 85+ year olds multimorbid patients belonged to the cluster with the lowest service use and mortality for that age range. Pain featured in thirteen clusters.

Conclusions
This work has highlighted patterns of multimorbidity that have implications for health services. These include the importance of psychoactive substance and alcohol misuse in people under the age of 65; of co-morbid depression and coronary heart disease in people aged 65-84, and of cardiovascular disease in people aged 85+.
Original languageEnglish
Article number78 (2020)
Number of pages11
JournalBMC Medicine
Volume18
DOIs
Publication statusPublished - 10 Apr 2020

Keywords

  • Multimorbidity phenotype
  • chronic conditions
  • latent class analysis
  • pattern recognition
  • validation
  • age-stratification

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