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Multimorbidity in middle age predicts more subsequent hospital admissions than in older age: A nine-year retrospective cohort study of 121,188 discharged in-patients

Published:December 20, 2018DOI:https://doi.org/10.1016/j.ejim.2018.12.001

      Highlights

      • Middle-aged multimorbid in-patients were admitted more often than older ones after discharge.
      • Given similar multimorbidity status, older patients spent more days in hospitals annually.
      • With three or more conditions, number of hospitalized days did not differ substantially by age.
      • Adjusted association of multimorbidity with hospitalization was weaker in younger patients.
      • Middle-aged multimorbid patients represent a vulnerable group with distinct chronic care needs.

      Abstract

      Background

      Previous research has suggested a differential short-term effect of multimorbidity on hospitalization by age, with younger groups affected more. This study compares the nine-year hospitalization pattern by age and multimorbidity status in a retrospective cohort of discharged in-patients, who represent a high-need portion of the population.

      Methods

      We examined routine clinical records of all patients aged 45+ years with chronic conditions discharged from public general hospitals in 2005 in Hong Kong. Patterns of annual frequencies of hospital admissions and number of hospitalized days over nine years (2005–2014) were compared by multimorbidity status (1, 2, 3+ conditions) and age group (45–64, 65–74, 75+).

      Results

      Among 121,188 included patients, 33.9% had 2+ conditions and 12.3% had 3+. Hospitalization patterns varied by age and multimorbidity status. For those having only 1 condition, annual number of admissions was similar by age, but older patients had more hospitalized days (4.40 days per person-year for the 45–64 group versus 10.29 for the 75+ group in the 5th year). For those with 3+ conditions, younger patients had more admissions (4.39 admissions per person-year for the 45–64 group versus 1.87 for the 75+ group in the 5th year) but similar number of hospitalized days with older patients. Interaction analysis showed effect of multimorbidity on hospitalization was stronger in younger groups (P < 0.05).

      Conclusion

      Middle-aged discharged in-patients with multimorbidity are admitted more often than their older counterparts and have similar total hospitalized days per year. Further research is needed to investigate chronic care needs of younger people with multimorbidity.

      Keywords

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      References

        • Starfield B.
        • Kinder K.
        Multimorbidity and its measurement.
        Health Policy. 2011; 103: 3-8https://doi.org/10.1016/j.healthpol.2011.09.004
        • Diederichs C.
        • Berger K.
        • Bartels D.B.
        The measurement of multiple chronic diseases--a systematic review on existing multimorbidity indices.
        J Gerontol A Biol Sci Med Sci. 2011; 66: 301-311https://doi.org/10.1093/gerona/glq208
        • Fortin M.
        • Hudon C.
        • Haggerty J.
        • van Den Akker M.
        • Almirall J.
        Prevalence estimates of multimorbidity: a comparative study of two sources.
        BMC Health Serv Res. 2010; 10: 111https://doi.org/10.1186/1472-6963-10-111
        • Fu S.
        • Huang N.
        • Chou Y.-J.
        Trends in the prevalence of multiple chronic conditions in Taiwan from 2000 to 2010: a population-based study.
        Prev Chronic Dis. 2014; 11: 140205https://doi.org/10.5888/pcd11.140205
        • Van Oostrom S.H.
        • Gijsen R.
        • Stirbu I.
        • Korevaar J.C.
        • Schellevis F.G.
        • Picavet H.S.J.
        • et al.
        Time trends in prevalence of chronic diseases and multimorbidity not only due to aging: Data from general practices and health surveys.
        PLoS One. 2016; 11https://doi.org/10.1371/journal.pone.0160264
        • Barnett K.
        • Mercer S.W.
        • Norbury M.
        • Watt G.
        • Wyke S.
        • Guthrie B.
        Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.
        Lancet (London, England). 2012; 380 ([doi:10.1016/S0140-6736(12)60240-2]): 37-43
        • Chung R.Y.
        • Mercer S.
        • Lai F.T.T.
        • Yip B.H.K.
        • Wong M.C.S.
        • Wong S.Y.S.
        Socioeconomic determinants of multimorbidity: a population-based household survey of Hong Kong Chinese.
        PLoS One. 2015; 10 ([doi:10.1371/journal.pone.0140040])e0140040
        • Wang H.H.X.
        • Wang J.J.
        • Wong S.Y.S.
        • Wong M.C.S.
        • Li F.J.
        • Wang P.X.
        • et al.
        Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China.
        BMC Med. 2014; 12: 188https://doi.org/10.1186/s12916-014-0188-0
        • Katikireddi S.V.
        • Skivington K.
        • Leyland A.H.
        • Hunt K.
        • Mercer S.W.
        The contribution of risk factors to socioeconomic inequalities in multimorbidity across the lifecourse: a longitudinal analysis of the Twenty-07 cohort.
        BMC Med. 2017; 15: 152https://doi.org/10.1186/s12916-017-0913-6
        • Wikstrom K.
        • Lindstrom J.
        • Harald K.
        • Peltonen M.
        • Laatikainen T.
        Clinical and lifestyle-related risk factors for incident multimorbidity: 10-year follow-up of Finnish population-based cohorts 1982-2012.
        Eur J Intern Med. 2015; 26: 211-216https://doi.org/10.1016/j.ejim.2015.02.012
        • Fortin M.
        • Lapointe L.
        • Hudon C.
        • Vanasse A.
        • Ntetu A.L.
        • Maltais D.
        Multimorbidity and quality of life in primary care: a systematic review.
        Health Qual Life Outcomes. 2004; 2https://doi.org/10.1186/1477-7525-2-51
        • Nunes B.P.
        • Flores T.R.
        • Mielke G.I.
        • Thumé E.
        • Facchini L.A.
        Multimorbidity and mortality in older adults: a systematic review and meta-analysis.
        Arch Gerontol Geriatr. 2016; 67: 130-138https://doi.org/10.1016/j.archger.2016.07.008
        • Mondor L.
        • Maxwell C.J.
        • Hogan D.B.
        • Bronskill S.E.
        • Gruneir A.
        • Lane N.E.
        • et al.
        Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: a retrospective analysis of a population-based cohort.
        PLoS Med. 2017; 14: e1002249https://doi.org/10.1371/journal.pmed.1002249
        • Gruneir A.
        • Bronskill S.E.
        • Maxwell C.J.
        • Bai Y.Q.
        • Kone A.J.
        • Thavorn K.
        • et al.
        The association between multimorbidity and hospitalization is modified by individual demographics and physician continuity of care: a retrospective cohort study.
        BMC Health Serv Res. 2016; 16: 154https://doi.org/10.1186/s12913-016-1415-5
        • Alonso-Moran E.
        • Nuno-Solinis R.
        • Onder G.
        • Tonnara G.
        Multimorbidity in risk stratification tools to predict negative outcomes in adult population.
        Eur J Intern Med. 2015; 26: 182-189https://doi.org/10.1016/j.ejim.2015.02.010
        • Alonso-Moran E.
        • Nuno-Solinis R.
        • Orueta J.F.
        • Fernandez-Ruanova B.
        • Alday-Jurado A.
        • Gutierrez-Fraile E.
        Health-related quality of life and multimorbidity in community-dwelling telecare-assisted elders in the Basque Country.
        Eur J Intern Med. 2015; 26: 169-175https://doi.org/10.1016/j.ejim.2015.02.013
        • Forjaz M.J.
        • Rodriguez-Blazquez C.
        • Ayala A.
        • Rodriguez-Rodriguez V.
        • de Pedro-Cuesta J.
        • Garcia-Gutierrez S.
        • et al.
        Chronic conditions, disability, and quality of life in older adults with multimorbidity in Spain.
        Eur J Intern Med. 2015; 26: 176-181https://doi.org/10.1016/j.ejim.2015.02.016
        • The Academy of Medical Sciences
        Multimorbidity: a priority for global health research. London.
        2018
        • Violan C.
        • Foguet-Boreu Q.
        • Roso-Llorach A.
        • Rodriguez-Blanco T.
        • Pons-Vigues M.
        • Pujol-Ribera E.
        • et al.
        Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study.
        BMC Public Health. 2014; 14: 530https://doi.org/10.1186/1471-2458-14-530
        • Rocca W.A.
        • Boyd C.M.
        • Grossardt B.R.
        • Bobo W.V.
        • Finney Rutten L.J.
        • Roger V.L.
        • et al.
        Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity.
        Mayo Clin Proc. 2014; 89: 1336-1349https://doi.org/10.1016/j.mayocp.2014.07.010
        • Violan C.
        • Foguet-Boreu Q.
        • Flores-Mateo G.
        • Salisbury C.
        • Blom J.
        • Freitag M.
        • et al.
        Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies.
        PLoS One. 2014; 9: e102149https://doi.org/10.1371/journal.pone.0102149
        • Marengoni A.
        • Angleman S.
        • Melis R.
        • Mangialasche F.
        • Karp A.
        • Garmen A.
        Aging with multimorbidity: a systematic review of the literature.
        Ageing Res Rev. 2011; 10: 430-439https://doi.org/10.1016/j.arr.2011.03.003
        • Navickas R.
        • Visockienė Ž.
        • Puronaitė R.
        • Rukšėnienė M.
        • Kasiulevičius V.
        • Jurevičienė E.
        Prevalence and structure of multiple chronic conditions in Lithuanian population and the distribution of the associated healthcare resources.
        Eur J Intern Med. 2015; 26: 160-168https://doi.org/10.1016/j.ejim.2015.02.015
        • Lipscombe L.L.
        • Hux J.E.
        Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995-2005: a population-based study.
        Lancet. 2007; 369: 750-756https://doi.org/10.1016/S0140-6736(07)60361-4
        • Dattalo M.
        • Dugoff E.
        • Ronk K.
        • Kennelty K.
        • Gilmore-Bykovskyi A.
        • Apples Kind A.J.
        Oranges: four Definitions of Multiple Chronic Conditions and their Relationship to 30-Day Hospital Readmission.
        J Am Geriatr Soc. 2017; 65 ([doi:10.1111/jgs.14539]): 712-720
        • Fisher K.
        • Griffith L.
        • Gruneir A.
        • Panjwani D.
        • Gandhi S.
        • Sheng L.L.
        • et al.
        Comorbidity and its relationship with health service use and cost in community-living older adults with diabetes: a population-based study in Ontario.
        Canada Diabetes Res Clin Pract. 2016; 122: 113-123https://doi.org/10.1016/j.diabres.2016.10.009
        • Chamberlain A.M.
        • Alonso A.
        • Gersh B.J.
        • Manemann S.M.
        • Killian J.M.
        • Weston S.A.
        • et al.
        Multimorbidity and the risk of hospitalization and death in atrial fibrillation: a population-based study.
        Am Heart J. 2017; 185: 74-84https://doi.org/10.1016/j.ahj.2016.11.008
        • Payne R.A.
        • Abel G.A.
        • Guthrie B.
        • Mercer S.W.
        The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study.
        Can Med Assoc J. 2013; 185: E221-E228https://doi.org/10.1503/cmaj.121349
        • Weir D.L.
        • McAlister F.A.
        • Majumdar S.R.
        • Eurich D.T.
        The Interplay between Continuity of Care, Multimorbidity, and adverse events in patients with Diabetes.
        Med Care. 2016; 54: 386-393https://doi.org/10.1097/MLR.0000000000000493
        • McLean G.
        • Hindle J.V.
        • Guthrie B.
        • Mercer S.W.
        Co-morbidity and polypharmacy in Parkinson's disease: insights from a large Scottish primary care database.
        BMC Neurol. 2017; 17: 126https://doi.org/10.1186/s12883-017-0904-4
        • Weatherburn C.J.
        • Guthrie B.
        • Mercer S.W.
        • Morales D.R.
        Comorbidities in adults with asthma: Population-based cross-sectional analysis of 1.4 million adults in Scotland.
        Clin Exp Allergy. 2017; 47: 1246-1252https://doi.org/10.1111/cea.12971
        • Chung R.Y.
        • Mercer S.
        • Yip B.H.K.
        • Chan S.W.C.
        • Lai F.T.T.
        • Wang H.H.X.
        • et al.
        The association between types of regular primary care and hospitalization among people with and without multimorbidity: a household survey on 25,780 Chinese.
        Sci Rep. 2016; 6 ([doi:10.1038/srep29758)29758
        • Leslie D.L.
        • Marcantonio E.R.
        • Zhang Y.
        • Leo-Summers L.
        • Inouye S.K.
        One-year health care costs associated with delirium in the elderly population.
        Arch Intern Med. 2008; 168: 27-32https://doi.org/10.1001/archinternmed.2007.4
        • Yang Z.
        • Hardin J.W.
        • Addy C.L.
        Score tests for zero-inflation in overdispersed count data.
        Commun Stat - Theory Methods. 2010; 39: 2008-2030https://doi.org/10.1080/03610920902948228
        • Atkins D.C.
        • Baldwin S.A.
        • Zheng C.
        • Gallop R.J.
        • Neighbors C.
        A tutorial on count regression and zero-altered count models for longitudinal substance use data.
        Psychol Addict Behav. 2013; 27: 166-177https://doi.org/10.1037/a0029508
        • Prina A.M.
        • Deeg D.
        • Brayne C.
        • Beekman A.
        • Huisman M.
        The association between depressive symptoms and non-psychiatric hospitalisation in older adults.
        PLoS One. 2012; 7https://doi.org/10.1371/journal.pone.0034821
        • Zolnierek C.D.
        Non-psychiatric hospitalization of people with mental illness: Systematic review.
        J Adv Nurs. 2009; 65: 1570-1583https://doi.org/10.1111/j.1365-2648.2009.05044.x
        • Larsen F.B.
        • Pedersen M.H.
        • Friis K.
        • Gluèmer C.
        • Lasgaard M.
        A Latent class analysis of multimorbidity and the relationship to socio-demographic factors and health-related quality of life. A national population-based study of 162,283 Danish adults.
        PLoS One. 2017; 12https://doi.org/10.1371/journal.pone.0169426
        • Fulop T.
        • Larbi A.
        • Witkowski J.M.
        • McElhaney J.
        • Loeb M.
        • Mitnitski A.
        • et al.
        Aging, frailty and age-related diseases.
        Biogerontology. 2010; 11: 547-563https://doi.org/10.1007/s10522-010-9287-2
        • Cesari M.
        • Franchi C.
        • Cortesi L.
        • Nobili A.
        • Ardoino I.
        • Mannucci P.M.
        Implementation of the Frailty index in hospitalized older patients: results from the REPOSI register.
        Eur J Intern Med. 2018; 56: 11-18https://doi.org/10.1016/j.ejim.2018.06.001
        • Ilinca S.
        • Calciolari S.
        The patterns of health care utilization by elderly Europeans: Frailty and its implications for health systems.
        Health Serv Res. 2015; 50: 305-320https://doi.org/10.1111/1475-6773.12211
        • Zucchelli A.
        • Vetrano D.L.
        • Marengoni A.
        • Grande G.
        • Romanelli G.
        • Calderón-Larrañaga A.
        • et al.
        Frailty predicts short-term survival even in older adults without multimorbidity.
        Eur J Intern Med. 2018; 56: 53-56https://doi.org/10.1016/j.ejim.2018.06.012
        • Cheung J.
        • Yu R.
        • Wu Z.
        • Wong S.
        • Woo J.
        Geriatric syndromes, multimorbidity, and disability overlap and increase healthcare use among older Chinese.
        BMC Geriatr. 2018; 18https://doi.org/10.1186/s12877-018-0840-1
        • Pasina L.
        • Djade C.D.
        • Tettamanti M.
        • Franchi C.
        • Salerno F.
        • Corrao S.
        • et al.
        Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI Study.
        J Clin Pharm Ther. 2014; 39: 511-515https://doi.org/10.1111/jcpt.12178
        • Bo M.
        • Fonte G.
        • Pivaro F.
        • Bonetto M.
        • Comi C.
        • Giorgis V.
        • et al.
        Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients.
        Geriatr Gerontol Int. 2015; 16: 314-321https://doi.org/10.1111/ggi.12471
        • Rose M.
        • Pan H.
        • Levinson M.R.
        • Staples M.
        Can frailty predict complicated care needs and length of stay.
        Intern Med J. 2014; 44: 800-805https://doi.org/10.1111/imj.12502
        • Byles J.E.
        • D'Este C.
        • Parkinson L.
        • O'Connell R.
        • Treloar C.
        Single index of multimorbidity did not predict multiple outcomes.
        J Clin Epidemiol. 2005; 58: 997-1005https://doi.org/10.1016/j.jclinepi.2005.02.025
        • Brilleman S.L.
        • Salisbury C.
        Comparing measures of multimorbidity to predict outcomes in primary care: a cross sectional study.
        Fam Pract. 2013; 30: 172-178https://doi.org/10.1093/fampra/cms060
        • Gassmann D.
        • Cheetham M.
        • Siebenhuener K.
        • Holzer B.M.
        • Meindl-Fridez C.
        • Hildenbrand F.F.
        • et al.
        The multimorbidity interaction severity index (MISI): a proof of concept study.
        Medicine (Baltimore). 2017; 96: e6144https://doi.org/10.1097/MD.0000000000006144
        • Tedstone Doherty D.
        • Kartalova-O'Doherty Y.
        Gender and self-reported mental health problems: Predictors of help seeking from a general practitioner.
        Br J Health Psychol. 2010; 15: 213-228https://doi.org/10.1348/135910709X457423
      1. Lai AH-Y, Kuang Z, Yam CH-K, Ayub S, Yeoh E-K. Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong. Health Soc Care Commun n d.:n/a-n/a. doi:https://doi.org/10.1111/hsc.12523.

        • Taheri P.A.
        • Butz D.A.
        • Greenfield L.J.
        Length of stay has minimal impact on the cost of hospital admission.
        J Am Coll Surg. 2000; 191 ([doi: 10.1016/S1072-7515(00)00352-5]): 123-130
        • Hong Kong Census and Statistics Department
        Hong Kong Population projections 2017-2066. Hong Kong.
        2017