Measuring multimorbidity in older adults: comparing different data sources

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Abstract

Background

Multimorbidity is a global health issue, particularly for older adults in the primary care setting. An adequate portrayal of its epidemiology is essential to properly identify and understand the health care needs of this population. This study aimed to compare the differences in the prevalence of selected chronic conditions and multimorbidity, including its associated characteristics, using health survey/self-reported (SR) information only, administrative (Adm) data only and the combined (either) sources.

Methods

This was a secondary analysis of survey data from the first cycle of the Longitudinal Survey on Senior’s Health and Health Services Use linked to health-Adm data. The analytical sample consisted of 1625 community-dwelling older adults (≥65 years) recruited in the waiting rooms of primary health clinics in a selected administrative region of the province of Quebec. Seventeen chronic conditions were assessed according to two different data sources. We examined the differences in the observed prevalence of chronic conditions and multimorbidity and the agreement between data sources.

Results

The prevalence of each of the 17 chronic conditions ranged from 1.2 to 68.7% depending on the data source. The agreement between different data sources was highly variable, with kappa coefficients (κ) ranging from 0.05 to 0.73. Multimorbidity was very high in this population, with an estimated prevalence of up to 95.9%. In addition, we found that the association between sociodemographic and behavioural factors and the presence of multimorbidity varied according to the different data sources and thresholds.

Conclusions

This is the first study to simultaneously investigate chronic conditions and multimorbidity prevalence among primary care older adults using combined SR and health-Adm data. Our results call attention to (1) the possibility of underestimating cases when using a single data source and (2) the potential benefits of integrating information from different data sources to increase case identification. This is an important aspect of characterizing the health care needs of this fast-growing population.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1173-4) contains supplementary material, which is available to authorized users.

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Most cited references 36

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Population-based norms for the Mini-Mental State Examination by age and educational level.

R Crum, J C Anthony, S S Bassett … (1993)

To report the distribution of Mini-Mental State Examination (MMSE) scores by age and educational level. National Institute of Mental Health Epidemiologic Catchment Area Program surveys conducted between 1980 and 1984. Community populations in New Haven, Conn; Baltimore, Md; St Louis, Mo; Durham, NC; and Los Angeles, Calif. A total of 18,056 adult participants selected by probability sampling within census tracts and households. Summary scores for the MMSE are given in the form of mean, median, and percentile distributions specific for age and educational level. The MMSE scores were related to both age and educational level. There was an inverse relationship between MMSE scores and age, ranging from a median of 29 for those 18 to 24 years of age, to 25 for individuals 80 years of age and older. The median MMSE score was 29 for individuals with at least 9 years of schooling, 26 for those with 5 to 8 years of schooling, and 22 for those with 0 to 4 years of schooling. Cognitive performance as measured by the MMSE varies within the population by age and education. The cause of this variation has yet to be determined. Mini-Mental State Examination scores should be used to identify current cognitive difficulties and not to make formal diagnoses. The results presented should prove to be useful to clinicians who wish to compare an individual patient's MMSE scores with a population reference group and to researchers making plans for new studies in which cognitive status is a variable of interest.

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Defining and measuring multimorbidity: a systematic review of systematic reviews

Marjorie C Johnston, Michael A Crilly, Corri Black … (2019)

Multimorbidity, the coexistence of multiple health conditions, is a growing public health challenge. Research and intervention development are hampered by the lack of consensus regarding defining and measuring multimorbidity. The aim of this systematic review was to pool the findings of systematic reviews examining definitions and measures of multimorbidity.

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The epidemiology of multimorbidity in primary care: a retrospective cohort study

Anna Cassell, Duncan Edwards, Amelia Harshfield … (2018)

Background Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available. Aim To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation. Design and setting Retrospective cohort study, undertaken in England. Method The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified. Results In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions. Conclusion Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

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Author and article information

Contributors

Samantha Gontijo Guerra:

ORCID: http://orcid.org/0000-0001-8073-7835

+(450) 466-5000 , samantha.gontijo.guerra@USherbrooke.ca

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 14 June 2019

Publication date PMC-release: 14 June 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 166

Affiliations

[1 ]Centre de recherche Charles-Le Moyne - Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC Canada

[2 ]ISNI 0000 0000 9064 6198, GRID grid.86715.3d, Université de Sherbrooke, Campus Longueuil, ; 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8 Canada

[3 ]ISNI 0000 0000 9064 6198, GRID grid.86715.3d, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, , Université de Sherbrooke, ; Longueuil, QC Canada

Author information

Samantha Gontijo Guerra http://orcid.org/0000-0001-8073-7835

Article

Publisher ID: 1173

DOI: 10.1186/s12877-019-1173-4

PMC ID: 6570867

PubMed ID: 31200651

SO-VID: f0ffe890-45df-4e70-b9c0-64c2efe68753

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 December 2018

Date accepted : 29 May 2019

Funding

Funded by: CIHR Doctoral Research Award the Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Awards (CGSD)

Award ID: GSD 146258

Award Recipient : Samantha Gontijo Guerra

Funded by: FRQS Senior Research salary award

Award ID: n/a

Award Recipient : Helen-Maria Vasiliadis

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: chronic conditions,multimorbidity,prevalence,epidemiology,self-report,health administrative data,primary health care,older adults,data sources,agreement between sources

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: chronic conditions, multimorbidity, prevalence, epidemiology, self-report, health administrative data, primary health care, older adults, data sources, agreement between sources

Measuring multimorbidity in older adults: comparing different data sources

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Most cited references 36

Population-based norms for the Mini-Mental State Examination by age and educational level.

Defining and measuring multimorbidity: a systematic review of systematic reviews

The epidemiology of multimorbidity in primary care: a retrospective cohort study

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