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Multimorbidity and Comorbidity of Chronic Diseases among the Senior Australians: Prevalence and Patterns  [PDF]
M. Mofizul Islam, Jose M. Valderas, Laurann Yen, Paresh Dawda, Tanisha Jowsey, Ian S. McRae
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0083783
Abstract: Understanding patterns and identifying common clusters of chronic diseases may help policymakers, researchers, and clinicians to understand the needs of the care process better and potentially save both provider and patient time and cost. However, only limited research has been conducted in this area, and ambiguity remains as those limited previous studies used different approaches to identify common clusters and findings may vary with approaches. This study estimates the prevalence of common chronic diseases and examines co-occurrence of diseases using four approaches: (i) identification of the most occurring pairs and triplets of comorbid diseases; performing (ii) cluster analysis of diseases, (iii) principal component analysis, and (iv) latent class analysis. Data were collected using a questionnaire mailed to a cross-sectional sample of senior Australians, with 4574 responses. Eighty-two percent of respondents reported having at least one chronic disease and over 52% reported having at least two chronic diseases. Respondents suffering from any chronic diseases had an average of 2.4 comorbid diseases. Three defined groups of chronic diseases were identified: (i) asthma, bronchitis, arthritis, osteoporosis and depression; (ii) high blood pressure and diabetes; and (iii) cancer, with heart disease and stroke either making a separate group or “attaching” themselves to different groups in different analyses. The groups were largely consistent across the approaches. Stability and sensitivity analyses also supported the consistency of the groups. The consistency of the findings suggests there is co-occurrence of diseases beyond chance, and patterns of co-occurrence are important for clinicians, patients, policymakers and researchers. Further studies are needed to provide a strong evidence base to identify comorbid groups which would benefit from appropriate guidelines for the care and management of patients with particular disease clusters.
Use of hospitalisation history (lookback) to determine prevalence of chronic diseases: impact on modelling of risk factors for haemorrhage in pregnancy
Jian Sheng Chen, Christine L Roberts, Judy M Simpson, Jane B Ford
BMC Medical Research Methodology , 2011, DOI: 10.1186/1471-2288-11-68
Abstract: A range of chronic disease prevalence for 53,438 women who had their first birth in New South Wales (NSW), Australia, 2005-2006, were ascertained for up to five years prior to the birth admission (for pregnancy, 2-, 3-, 4- and 5-year periods) and obstetric haemorrhage was identified from maternal hospital records for 2005 and 2006.The ascertainment of chronic disease prevalence increased with increasing length of lookback. However, the rate of the increase was slower after 2 to 3 years than for the more recent periods. The effect size of chronic diseases on obstetric haemorrhage risk decreased with the increased case ascertainment associated with longer lookback. Furthermore, longer lookback did not improve the predictive capacity (C-statistic: 0.624) of a model that was based only on the birth admission records.Longer ascertainment periods resulted in improved identification of chronic disease history among pregnant women, but the additional information from prior admissions did little to improve the modelling of risk factors for obstetric haemorrhage.The use of population health data for health and health outcomes research is increasing. These routinely collected data may be administrative, surveillance, registry or vital statistics collections and have the common feature of including information on an entire population. However, concerns about the completeness of comorbidity information in the admission of interest (index record) have been raised as a limitation of using hospital discharge data for research [1]. One reason that comorbidity information is under-ascertained from hospital records is that only diagnoses affecting the current admission are required to be coded in the discharge summary, so unrelated chronic illnesses may not be recorded [2]. However, through record linkage it is possible to evaluate a patient's hospitalisation history in detail. Records belonging to the same individual can increasingly be longitudinally linked. The term that refers to
Prevalence and incidence density rates of chronic comorbidity in type 2 diabetes patients: an exploratory cohort study  [cached]
Luijks Hilde,Schermer Tjard,Bor Hans,van Weel Chris
BMC Medicine , 2012, DOI: 10.1186/1741-7015-10-128
Abstract: Background Evidence-based diabetes guidelines generally neglect comorbidity, which may interfere with diabetes management. The prevalence of comorbidity described in patients with type 2 diabetes (T2D) shows a wide range depending on the population selected and the comorbid diseases studied. This exploratory study aimed to establish comorbidity rates in an unselected primary-care population of patients with T2D. Methods This was a cohort study of 714 adult patients with newly diagnosed T2D within the study period (1985-2007) in a practice-based research network in the Netherlands. The main outcome measures were prevalence and incidence density rates of chronic comorbid diseases and disease clusters. All chronic disease episodes registered in the practice-based research network were considered as comorbidities. We categorised comorbidity into 'concordant' (that is, shared aetiology, risk factors, and management plans with diabetes) and 'discordant' comorbidity. Prevalence and incidence density were assessed for both categories of comorbidity. Results The mean observation period was 17.3 years. At the time of diabetes diagnosis, 84.6% of the patients had one or more chronic comorbid disease of 'any type', 70.6% had one or more discordant comorbid disease, and 48.6% and 27.2% had three or more chronic comorbid diseases of 'any type' or of 'discordant only', respectively. A quarter of those without any comorbid disease at the time of their diabetes diagnosis developed at least one comorbid disease in the first year afterwards. Cardiovascular diseases (considered concordant comorbidity) were the most common, but there were also high rates of musculoskeletal and mental disease. Discordant comorbid diseases outnumbered concordant diseases. Conclusions We found high prevalence and incidence density rates for both concordant and discordant comorbidity. The latter may interfere with diabetes management, thus future research and clinical practice should take discordant comorbidity in patients with T2D into account.
Prevalence of Chronic Conditions in Australia  [PDF]
Christopher Harrison, Helena Britt, Graeme Miller, Joan Henderson
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0067494
Abstract: Objectives To estimate prevalence of chronic conditions among patients seeing a general practitioner (GP), patients attending general practice at least once in a year, and the Australian population. Design, setting and participants A sub-study of the BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice activity conducted between July 2008 and May 2009. Each of 290 GPs provided data for about 30 consecutive patients (total 8,707) indicating diagnosed chronic conditions, using their knowledge of the patient, patient self-report, and patient's health record. Main outcome measures Estimates of prevalence of chronic conditions among patients surveyed, adjusted prevalence in patients who attended general practice at least once that year, and national population prevalence. Results Two-thirds (66.3%) of patients surveyed had at least one chronic condition: most prevalent being hypertension (26.6%), hyperlipidaemia (18.5%), osteoarthritis (17.8%), depression (13.7%), gastro-oesophageal reflux disease (11.6%), asthma (9.5%) and Type 2 diabetes (8.3%). For patients who attended general practice at least once, we estimated 58.8% had at least one chronic condition. After further adjustment we estimated 50.8% of the Australian population had at least one chronic condition: hypertension (17.4%), hyperlipidaemia (12.7%), osteoarthritis (11.1%), depression (10.5%) and asthma (8.0%) being most prevalent. Conclusions This study used GPs to gather information from their knowledge, the patient, and health records, to provide prevalence estimates that overcome weaknesses of studies using patient self-report or health record audit alone. Our results facilitate examination of primary care resource use in management of chronic conditions and measurement of prevalence of multimorbidity in Australia.
Comorbidity Patterns in Patients with Chronic Diseases in General Practice  [PDF]
Luis García-Olmos, Carlos H. Salvador, ángel Alberquilla, David Lora, Montserrat Carmona, Pilar García-Sagredo, Mario Pascual, Adolfo Mu?oz, José Luis Monteagudo, Fernando García-López
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0032141
Abstract: Introduction Healthcare management is oriented toward single diseases, yet multimorbidity is nevertheless the rule and there is a tendency for certain diseases to occur in clusters. This study sought to identify comorbidity patterns in patients with chronic diseases, by reference to number of comorbidities, age and sex, in a population receiving medical care from 129 general practitioners in Spain, in 2007. Methods A cross-sectional study was conducted in a health-area setting of the Madrid Autonomous Region (Comunidad Autónoma), covering a population of 198,670 individuals aged over 14 years. Multiple correspondences were analyzed to identify the clustering patterns of the conditions targeted. Results Forty-two percent (95% confidence interval [CI]: 41.8–42.2) of the registered population had at least one chronic condition. In all, 24.5% (95% CI: 24.3–24.6) of the population presented with multimorbidity. In the correspondence analysis, 98.3% of the total information was accounted for by three dimensions. The following four, age- and sex-related comorbidity patterns were identified: pattern B, showing a high comorbidity rate; pattern C, showing a low comorbidity rate; and two patterns, A and D, showing intermediate comorbidity rates. Conclusions Four comorbidity patterns could be identified which grouped diseases as follows: one showing diseases with a high comorbidity burden; one showing diseases with a low comorbidity burden; and two showing diseases with an intermediate comorbidity burden.
Informing Evidence-Based Decision-Making for Patients with Comorbidity: Availability of Necessary Information in Clinical Trials for Chronic Diseases  [PDF]
Cynthia M. Boyd, Daniela Vollenweider, Milo A. Puhan
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0041601
Abstract: Background The population with multiple chronic conditions is growing. Prior studies indicate that patients with comorbidities are frequently excluded from trials but do not address whether information is available in trials to draw conclusions about treatment effects for these patients. Methods and Findings We conducted a literature survey of trials from 11 Cochrane Reviews for four chronic diseases (diabetes, heart failure, chronic obstructive pulmonary disease, and stroke). The Cochrane Reviews systematically identified and summarized trials on the effectiveness of diuretics, metformin, anticoagulants, longacting beta-agonists alone or in combination with inhaled corticosteroids, lipid lowering agents, exercise and diet. Eligible studies were reports of trials included in the Cochrane reviews and additional papers that described the methods of these trials. We assessed the exclusion and inclusion of people with comorbidities, the reporting of comorbidities, and whether comorbidities were considered as potential modifiers of treatment effects. Overall, the replicability of both the inclusion criteria (mean [standard deviation (SD)]: 6.0 (2.1), range (min-max): 1–9.5) and exclusion criteria(mean(SD): 5.3 (2.1), range: 1–9.5) was only moderate. Trials excluded patients with many common comorbidities. The proportion of exclusions for comorbidities ranged from 0–42 percent for heart failure, 0–55 percent for COPD, 0–44 percent for diabetes, and 0–39 percent for stroke. Seventy of the 161 trials (43.5%) described the prevalence of any comorbidity among participants with the index disease. The reporting of comorbidities in trials was very limited, in terms of reporting an operational definition and method of ascertainment for the presence of comorbidity and treatments for the comorbidity. It was even less common that the trials assessed whether comorbidities were potential modifiers of treatment effects. Conclusions Comorbidities receive little attention in chronic disease trials. Given the public health importance of people with multiple chronic conditions, trials should better report on comorbidities and assess the effect comorbidities have on treatment outcomes.
Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases
Sherine E Gabriel, Kaleb Michaud
Arthritis Research & Therapy , 2009, DOI: 10.1186/ar2669
Abstract: Epidemiology has taken an important role in improving our understanding of the outcomes of rheumatoid arthritis (RA) and other rheumatic diseases. Epidemiology is the study of the distribution and determinants of disease in human populations. This definition is based on two fundamental assumptions. First, human disease does not occur at random; and second, human disease has causal and preventive factors that can be identified through systematic investigation of different populations or subgroups of individuals within a population in different places or at different times. Thus, epidemiologic studies include simple descriptions of the manner in which disease appears in a population (levels of disease frequency: incidence and prevalence, comorbidity, mortality, trends over time, geographic distributions, and clinical characteristics) and studies that attempt to quantify the roles played by putative risk factors for disease occurrence. Over the past decade considerable progress has been made in both types of epidemiologic studies. The latter studies are the topic of Professor Silman's review in this special issue of Arthritis Research & Therapy [1]. In this review we examine a decade of progress on the descriptive epidemiology (incidence, prevalence, and survival) associated with the major rheumatic diseases. We then discuss the influence of comorbidity on the epidemiology of rheumatic diseases, using RA as an example.The most reliable estimates of incidence, prevalence, and mortality in RA are those derived from population-based studies [2-6]. Several of these, primarily from the past decade, have been conducted in a variety of geographically and ethnically diverse populations [7]. Indeed, a recent systematic review of the incidence and prevalence of RA [8] revealed substantial variation in incidence and prevalence across the various studies and across time periods within the studies. These data emphasize the dynamic nature of the epidemiology of RA. A substantial dec
Prevalence of aspergillosis in chronic lung diseases  [cached]
Shahid M,Malik A,Bhargava R
Indian Journal of Medical Microbiology , 2001,
Abstract: Eighty eight patients of chronic lung diseases (CLD) attending TB and Chest department of J.N. Medical college Hospital were studied to find out the prevalence of Aspergillus in Broncho-alveolar Lavage (BAL) and anti- aspergillus antibodies in their sera. Direct microscopy and fungal culture of BAL was done. Antibodies were studied by immunodiffusion (ID) and Enzyme linked immunosorbent assay (ELISA). Dot blot assay for anti-aspergillus antibodies was also performed in sera of patients which were either positive by ID or by ELISA. Aspergillus was isolated in culture from 13(14.7%) cases of CLD, while, 30.6% cases showed anti-aspergillus antibodies by serological methods. Aspergillus fumigatus was the predominant species isolated. 17(19.3%) cases of CLD showed antibody against Aspergillus by ID, 22(25%) by ELISA, while 19 of 27 seropositive cases also showed positive results by Dot Blot assay. In cases of bronchogenic carcinoma and pulmonary tuberculosis, anti-aspergillus antibodies were detected equally by ID and ELISA in 21.42% and 21.05% cases respectively. In bronchial asthma, the antibodies could be detected in 60% cases by ELISA, while, in only 10% cases by ID. ELISA was found more sensitive than ID for detection of anti-aspergillus antibodies. The sensitivity of Dot Blot lies some what between ID and ELISA. It is concluded that prevalence of Aspergillosis is quite high in chronic lung diseases, culture and serological test should be performed in conjunction and more than one type of serological tests should be performed to establish the diagnosis.
Population Based Study of 12 Autoimmune Diseases in Sardinia, Italy: Prevalence and Comorbidity  [PDF]
Claudia Sardu,Eleonora Cocco,Alessandra Mereu,Roberta Massa,Alessandro Cuccu,Maria Giovanna Marrosu,Paolo Contu
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0032487
Abstract: The limited availability of prevalence data based on a representative sample of the general population, and the limited number of diseases considered in studies about co-morbidity are the critical factors in study of autoimmune diseases. This paper describes the prevalence of 12 autoimmune diseases in a representative sample of the general population in the South of Sardinia, Italy, and tests the hypothesis of an overall association among these diseases.
The Prevalence of Disease Clusters in Older Adults with Multiple Chronic Diseases – A Systematic Literature Review  [PDF]
Judith Sinnige, Jozé Braspenning, Fran?ois Schellevis, Irina Stirbu-Wagner, Gert Westert, Joke Korevaar
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079641
Abstract: Background Since most clinical guidelines address single diseases, treatment of patients with multimorbidity, the co-occurrence of multiple (chronic) diseases within one person, can become complicated. Information on highly prevalent combinations of diseases can set the agenda for guideline development on multimorbidity. With this systematic review we aim to describe the prevalence of disease combinations (i.e. disease clusters) in older patients with multimorbidity, as assessed in available studies. In addition, we intend to acquire information that can be supportive in the process of multimorbidity guideline development. Methods We searched MEDLINE, Embase and the Cochrane Library for all types of studies published between January 2000 and September 2012. We included empirical studies focused on multimorbidity or comorbidity that reported prevalence rates of combinations of two or more diseases. Results Our search yielded 3070 potentially eligible articles, of which 19 articles, representing 23 observational studies, turned out to meet all our quality and inclusion criteria after full text review. These studies provided prevalence rates of 165 combinations of two diseases (i.e. disease pairs). Twenty disease pairs, concerning 12 different diseases, were described in at least 3 studies. Depression was found to be the disease that was most commonly clustered, and was paired with 8 different diseases, in the available studies. Hypertension and diabetes mellitus were found to be the second most clustered diseases, both with 6 different diseases. Prevalence rates for each disease combination varied considerably per study, but were highest for the pairs that included hypertension, coronary artery disease, and diabetes mellitus. Conclusions Twenty disease pairs were assessed most frequently in patients with multimorbidity. 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.
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