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Prados-Torres A, Poblador-Plou B, Gimeno-Miguel A, Calderón-Larrañaga A, Poncel-Falcó A, Gimeno-Feliú LA, González-Rubio F, Laguna-Berna C, Marta-Moreno J, Clerencia-Sierra M, Aza-Pascual-Salcedo M, Bandrés-Liso AC, Coscollar-Santaliestra C, Pico-Soler V, Abad-Díez JM. Cohort Profile: The Epidemiology of Chronic Diseases and Multimorbidity. The EpiChron Cohort Study. Int J Epidemiol 2019; 47:382-384f. [PMID: 29346556 PMCID: PMC5913592 DOI: 10.1093/ije/dyx259] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- A Prados-Torres
- EpiChron Research Group on Chronic Diseases: Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, University of Zaragoza, Health Services Research on Chronic Patients Network (REDISSEC), Spain, JA-CHRODIS+, EU
| | - B Poblador-Plou
- IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, REDISSEC, Spain
| | - A Gimeno-Miguel
- IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, REDISSEC, Spain
| | - A Calderón-Larrañaga
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden, REDISSEC, Spain
| | | | - L A Gimeno-Feliú
- Primary Care Health Centre (PCHC) San Pablo, Zaragoza, SALUD, University of Zaragoza, REDISSEC, Spain
| | | | - C Laguna-Berna
- IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, REDISSEC, Spain
| | - J Marta-Moreno
- Miguel Servet University Hospital, Zaragoza, SALUD, REDISSEC, Spain
| | | | | | | | - C Coscollar-Santaliestra
- Primary Care Health Centre (PCHC) San Pablo, Zaragoza, SALUD, University of Zaragoza, REDISSEC, Spain
| | - V Pico-Soler
- PCHC Torrero-La Paz, Zaragoza, SALUD, REDISSEC, Spain
| | - J M Abad-Díez
- Aragon Health Service (SALUD), Department of Health, GRISSA Research Group, Spain
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Calderón-Larrañaga A, Abad-Díez JM, Gimeno-Feliu LA, Marta-Moreno J, González-Rubio F, Clerencia-Sierra M, Poblador-Plou B, Poncel-Falcó A, Prados-Torres A. Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter? Eur J Intern Med 2015; 26:203-10. [PMID: 25765442 DOI: 10.1016/j.ejim.2015.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 12/29/2022]
Abstract
AIM To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity. METHODS Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n=65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes. RESULTS Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]:1.25; 95% confidence interval [CI]:1.12-1.39, IRR:1.21; 95% CI:1.06-1.39), average length of stay (IRR:1.47; 95% CI:1.25-1.73), and total and priority emergency room visits (IRR:1.26; 95% CI:1.17-1.35, IRR:1.30; 95% CI:1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR:1.38; 95% CI:1.33-1.43) and to different specialties (IRR:1.36; 95% CI:1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR:1.08; 95% CI:1.06-1.11), but especially for those with mental comorbidity (IRR:1.17; 95% CI:1.14-1.21). CONCLUSION In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent.
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Affiliation(s)
- A Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain.
| | - J M Abad-Díez
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Dept. of Health, Welfare and Family, DG Planning and Assurance, Government of Aragon, Vía Univérsitas 36, 50009 Zaragoza, Spain
| | - L A Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; San Pablo Health Centre, Aragon Health Service (SALUD), C/Aguadores 7, 50003 Zaragoza, Spain
| | - J Marta-Moreno
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Miguel Servet University Hospital, Department of Neurology, Aragon Health Service (SALUD), Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain
| | - F González-Rubio
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Delicias Sur Health Centre, Aragon Health Service (SALUD), C/Manuel Dronda 1, 50009 Zaragoza, Spain
| | - M Clerencia-Sierra
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Socio-Sanitary Assessment Unit, Miguel Servet University Hospital, Aragon Health Service (SALUD), Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain
| | - B Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain
| | - A Poncel-Falcó
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Zaragoza-Sector III Primary Care Directorate, Aragon Health Service (SALUD), C/Condes de Aragón 30, 50009 Zaragoza, Spain
| | - A Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain
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