The Associations of Multimorbidity With Health-Related Productivity Loss in a Large and Diverse Public Sector Setting: A Cross-Sectional Survey

Comorbidity patterns in cardiovascular diseases: the role of life-stage and socioeconomic status

Cardiovascular diseases stand as a prominent global cause of mortality, their intricate origins often entwined with comorbidities and multimorbid conditions. Acknowledging the pivotal roles of age, sex, and social determinants of health in shaping the onset and progression of these diseases, our study delves into the nuanced interplay between life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Leveraging data from a cross-sectional survey encompassing Mexican adults, we unearth a robust association between these variables and the prevalence of comorbidities linked to cardiovascular conditions. To foster a comprehensive understanding of multimorbidity patterns across diverse life-stages, we scrutinize an extensive dataset comprising 47,377 cases diagnosed with cardiovascular ailments at Mexico's national reference hospital. Extracting sociodemographic details, primary diagnoses prompting hospitalization, and additional conditions identified through ICD-10 codes, we unveil subtle yet significant associations and discuss pertinent specific cases. Our results underscore a noteworthy trend: younger patients of lower socioeconomic status exhibit a heightened likelihood of cardiovascular comorbidities compared to their older counterparts with a higher socioeconomic status. By empowering clinicians to discern non-evident comorbidities, our study aims to refine therapeutic designs. These findings offer profound insights into the intricate interplay among life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Armed with data-supported approaches that account for these factors, clinical practices stand to be enhanced, and public health policies informed, ultimately advancing the prevention and management of cardiovascular disease in Mexico.

Income and economic productivity loss associated with comorbidity: longitudinal analysis of linked individual-level data for a whole country

OBJECTIVE

To estimate the income loss from having two or more diseases, over and above the independent and separate effects of having a single disease.

METHODS

We used linked health income data from 2006-2007 to 2015-2016 for 25-64 years, for the entire New Zealand population. Fixed effects OLS regression was used to estimate within-individual income loss for diseases separately, and to estimate if having two or more diseases together resulted in reduced (subadditive) or additional (superadditive) income impacts (relative to adding together the income impacts for each disease when experienced singly).

RESULTS

Of the 169 comorbidity pairs for both sexes, 28 (17%) had a statistically significant superadditive (n=14) or subadditive (n=14) effect of having two diseases. The combined total income gain from deleting all diseases and comorbidities was US$2.269 billion (95% CI US$$2.125 to US$2.389 billion), or a 3.61% (95% CI 3.38% to 3.80%) increase in income. Of this, 8.8% or US$200 million (95% CI US$193 to US$207 million) was attributable to a tendency for comorbidity interactions to increase income loss more than expected for common disease pairings.

CONCLUSIONS

This national longitudinal study found that disease is associated with income loss, but most of this impact is due to the distinct and independent impact of separate diseases. Nevertheless, there was a tendency for two or more diseases to disproportionately increase income loss more than the summed impacts of each of these diseases if experienced singly.

A complex intervention for multimorbidity in primary care: A feasibility study

Aim

To assess the feasibility of a patient-centered complex intervention for multimorbidity (CIM) based on general practice in collaboration with community health-care centers and outpatient clinics.

Methods

Inclusion criteria were age ≥18 years, diagnoses of two or more of three chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), and chronic heart conditions), and a hospital contact during the previous year. The CIM included extended consultations and nurse care manager support in general practice and intensified cross-sectorial collaboration. Elements included a structured care plan based on patients' care goals, coordination of services, and, if appropriate, shifting outpatient clinic visits to general practice, medication review, referral to rehabilitation, and home care. The acceptability dimension of feasibility was assessed with validated questionnaires, observations, and focus groups.

Results

Forty-eight patients were included (mean age 72.2 (standard deviation (SD) 9.5, range 52-89); 23 (48%) were men. Thirty-seven patients had two diseases; most commonly COPD and cardiovascular disease (46%), followed by diabetes and cardiovascular disease (23%), and COPD and diabetes (15%). Eleven (23%) patients had all three conditions. Focus group interviews with patients with multimorbidity identified three main themes: (1) lack of care coordination existed across health-care sectors before the CIM, (2) extended consultations provided better care coordination, and (3) patients want to be involved in planning their treatment and care. In focus groups, health-care professionals discussed two main themes: (1) patient-centered care and (2) culture and organizational change. Completion rates for questionnaires were 98% (47/48).

Conclusions

Patients and health-care professionals found the CIM acceptable.