Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study
Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study
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DOI：
10.1186/s12916-020-01543-8
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发表时间：
2020-04-10
期刊：
影响因子：
9.3
通讯作者：
Kiddle, Steven
中科院分区：
文献类型：
--
作者：
Zhu, Yajing;Edwards, Duncan;Kiddle, Steven
多重疾病与死亡率和服务使用有关，特定类型的多重疾病有不同的影响。此外，多发病往往与参与研究队列负相关。因此，我们开始在一个具有人口代表性的样本中确定多病患者群，以及它们与不同年龄组的死亡率和服务使用之间的差异。方法将英国382家全科医生提供的初级和二级医疗电子健康记录链接到临床实践研究数据链（CPRD）。该研究纳入了一组具有代表性的多病成年人（18岁或以上，N = 113,211），他们患有两种或两种以上的长期疾病（共包括38种疾病）。随机抽取80%的多病患者（N = 90,571）按年龄组分层，并使用潜在分类分析进行聚类。在剩余20%的多病患者（N = 22,640）中验证了所获得的多病表型、分类质量以及与人口学特征和主要结局（全科医生咨询、住院、常规用药和死亡率）的关联之间的一致性。结果我们确定了4个年龄层的20个患者群。死亡率最高的类别包括精神活性物质和酒精滥用（18-64岁）；冠心病、抑郁和疼痛（65-84岁）；冠心病、心力衰竭、房颤（85岁以上）。服务使用率最高的群体与65岁以上人群死亡率最高的群体相吻合。对于18-64岁的人来说，服务使用率最高的群体包括抑郁、焦虑和疼痛。大多数85岁以上的多病患者属于该年龄范围内服务使用率和死亡率最低的群集。疼痛有13个特点。这项工作突出了对卫生服务有影响的多病模式。其中包括65岁以下人群中精神活性物质和酒精滥用的重要性，65-84岁人群中抑郁症和冠心病的合并症以及85岁以上人群中心血管疾病的重要性。
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 20 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 the 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-old multimorbid patients belonged to the cluster with the lowest service use and mortality for that age range. Pain featured in 13 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+.