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Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting
OBJECTIVE: To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity. DESIGN: Longitudinal study based on anonymised primary care data. SETTING: General practices in an urban multiethnic borough in London, UK. PARTICIPANTS: 332...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008443/ https://www.ncbi.nlm.nih.gov/pubmed/31874873 http://dx.doi.org/10.1136/bmjopen-2019-031649 |
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author | Ashworth, Mark Durbaba, Stevo Whitney, David Crompton, James Wright, Michael Dodhia, Hiten |
author_facet | Ashworth, Mark Durbaba, Stevo Whitney, David Crompton, James Wright, Michael Dodhia, Hiten |
author_sort | Ashworth, Mark |
collection | PubMed |
description | OBJECTIVE: To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity. DESIGN: Longitudinal study based on anonymised primary care data. SETTING: General practices in an urban multiethnic borough in London, UK. PARTICIPANTS: 332 353 patients aged ≥18 years. MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients with multimorbidity, defined as ≥3 of 12 long-term conditions (LTCs) selected according to high predicted healthcare use. Multilevel logistic regression was used to model social determinants and cardiovascular risk factors. Alluvial plots were constructed to illustrate multimorbidity acquisition sequences according to age, ethnicity and social deprivation. RESULTS: 5597 (1.7%) patients had ≥3 selected LTCs, the ‘multimorbidity cohort’. The the most common LTCs were diabetes (63.0%) and chronic pain (CP) (42.8%). Social deprivation and ethnicity were independent determinants of multimorbidity: most compared with the least deprived quintile (adjusted OR (AOR) 1.56 (95% CI 1.41 to 1.72)); South Asian compared with white ethnicity (AOR 1.44 (95% CI 1.29 to 1.61)); and black compared with white ethnicity (AOR 0.86 (95% CI 0.80 to 0.92)). The included cardiovascular risk factors were relatively strong determinants of multimorbidity: hypertension (AOR 5.05 (95% CI 4.69 to 5.44)), moderate obesity (AOR 3.41 (95% CI 3.21 to 3.63)) and smoking (AOR 2.30 (95% CI 2.16 to 2.45)). The most common initial onset conditions were diabetes and depression; diabetes particularly in older and black ethnic groups; and depression particularly in younger, more deprived and white ethnicity groups. CP was less common as an initial condition. CONCLUSION: Our findings confirm the importance of age, social deprivation and ethnicity as determinants of multimorbidity. Smoking, obesity and hypertension as cardiovascular risk factors were stronger determinants of multimorbidity than deprivation or ethnicity. The acquisition sequence of multimorbidity is patterned by sociodemographic determinants. Understanding onset conditions of multimorbidity and cardiovascular cardiovascular risk factors may lead to the development of interventions to slow the progression of multimorbidity. |
format | Online Article Text |
id | pubmed-7008443 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-70084432020-02-24 Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting Ashworth, Mark Durbaba, Stevo Whitney, David Crompton, James Wright, Michael Dodhia, Hiten BMJ Open General practice / Family practice OBJECTIVE: To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity. DESIGN: Longitudinal study based on anonymised primary care data. SETTING: General practices in an urban multiethnic borough in London, UK. PARTICIPANTS: 332 353 patients aged ≥18 years. MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients with multimorbidity, defined as ≥3 of 12 long-term conditions (LTCs) selected according to high predicted healthcare use. Multilevel logistic regression was used to model social determinants and cardiovascular risk factors. Alluvial plots were constructed to illustrate multimorbidity acquisition sequences according to age, ethnicity and social deprivation. RESULTS: 5597 (1.7%) patients had ≥3 selected LTCs, the ‘multimorbidity cohort’. The the most common LTCs were diabetes (63.0%) and chronic pain (CP) (42.8%). Social deprivation and ethnicity were independent determinants of multimorbidity: most compared with the least deprived quintile (adjusted OR (AOR) 1.56 (95% CI 1.41 to 1.72)); South Asian compared with white ethnicity (AOR 1.44 (95% CI 1.29 to 1.61)); and black compared with white ethnicity (AOR 0.86 (95% CI 0.80 to 0.92)). The included cardiovascular risk factors were relatively strong determinants of multimorbidity: hypertension (AOR 5.05 (95% CI 4.69 to 5.44)), moderate obesity (AOR 3.41 (95% CI 3.21 to 3.63)) and smoking (AOR 2.30 (95% CI 2.16 to 2.45)). The most common initial onset conditions were diabetes and depression; diabetes particularly in older and black ethnic groups; and depression particularly in younger, more deprived and white ethnicity groups. CP was less common as an initial condition. CONCLUSION: Our findings confirm the importance of age, social deprivation and ethnicity as determinants of multimorbidity. Smoking, obesity and hypertension as cardiovascular risk factors were stronger determinants of multimorbidity than deprivation or ethnicity. The acquisition sequence of multimorbidity is patterned by sociodemographic determinants. Understanding onset conditions of multimorbidity and cardiovascular cardiovascular risk factors may lead to the development of interventions to slow the progression of multimorbidity. BMJ Publishing Group 2019-12-23 /pmc/articles/PMC7008443/ /pubmed/31874873 http://dx.doi.org/10.1136/bmjopen-2019-031649 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | General practice / Family practice Ashworth, Mark Durbaba, Stevo Whitney, David Crompton, James Wright, Michael Dodhia, Hiten Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting |
title | Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting |
title_full | Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting |
title_fullStr | Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting |
title_full_unstemmed | Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting |
title_short | Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting |
title_sort | journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting |
topic | General practice / Family practice |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008443/ https://www.ncbi.nlm.nih.gov/pubmed/31874873 http://dx.doi.org/10.1136/bmjopen-2019-031649 |
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