The Differential Impact of Multimorbidity Patterns and Subsequent Accumulation on Longitudinal Trajectories of Physical Function Decline in a Population-based Cohort of Older People

2021 ◽  
Author(s):  
Huiying Liu ◽  
Xinyan Zhang ◽  
Beizhuo Chen ◽  
Boye Fang ◽  
Vivian W Q Lou ◽  
...  
Keyword(s):  
Physical Function ◽  
Chronic Conditions ◽  
Latent Class ◽  
Negative Binomial ◽  
Functional Decline ◽  
Population Based ◽  
Differential Impact ◽  
Future Studies ◽  
Longitudinal Trajectories ◽  
Binomial Models

Abstract Background Although both the patterns and accumulation of multimorbidity are important for predicting physical function, studies have not simultaneously examined their impact on functional decline. This study aimed to associate multimorbidity patterns and subsequently developed conditions with longitudinal trajectories of functional decline, and it tested whether the effects of newly developed conditions on functional decline varied across distinct multimorbidity patterns. Methods We included 6,634 participants aged at least 60 years from the China Health and Retirement Longitudinal Survey. Latent class analysis identified multimorbidity patterns from 14 chronic conditions. Mixed negative binomial models estimated the changes in physical function measured across four waves as a function of multimorbidity patterns, subsequently developed conditions and their interactions. Results Five distinct patterns were identified three years before wave 1: stomach/arthritis (15.7%), cardiometabolic (6.7%), arthritis/hypertension (47.9%), hepatorenal/multi-system (18.3%), and lung/asthma (11.4%). The hepatorenal/multi-system and the lung/asthma pattern were associated with worse baseline physical function, and the hypertension/arthritis pattern was associated with greater decline of physical function. The effect of developing new conditions on decline of physical function over time was most evident for individuals from the cardiometabolic pattern. Discussion Considering both the combinations and progressive nature of multimorbidity is important for identifying individuals at greater risk of disability. Future studies are warranted to differentiate the factors responsible for the progression of chronic conditions in distinct multimorbidity patterns and investigate the potential implications for improved prediction of functional decline.

scholarly journals Exploring the Intersection of Chronic Disease, Function, and Social Care in Adult Day Care Clients With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 84-84
Author(s):  
Tina Sadarangani ◽  
Jonelle Boafo ◽  
Bei Wu ◽  
Abraham Brody ◽  
Gary Yu
Keyword(s):  
Chronic Conditions ◽  
Latent Class ◽  
Functional Decline ◽  
Concomitant Disease ◽  
Adult Day Care ◽  
Complex Needs ◽  
Center Staff ◽  
Adult Day Centers ◽  
Risk Of Falls ◽  
Using Data

Abstract The interrelationships among dementia, concomitant disease, and social determinants of health are poorly understood and have critical implications for disease course, treatments, and caregiving needs. The aim of this study was to identify patterns of co-occurring chronic conditions among persons with dementia and the relationship of these patterns with clinical characteristics, demographic predictors and functional status. A latent class analysis (LCA) was conducted using data from 53 California adult day centers (n=3,053). Four distinct groups emerged: “dementia only”; “dementia +: > 2; + > 3; + >5 chronic conditions. Having dementia + >5 was associated (p <.001) with greater risk of falls, isolation, medication mismanagement, and reduced likelihood of using an adaptive device. Dementia in day center clients is complicated by clinical conditions, functional decline, and a need for supports that may be lacking. Center staff must be trained and resourced to manage the complex needs of persons with dementia.

scholarly journals Community-Based Antibiotic Prescribing Attributable to Respiratory Syncytial Virus and Other Common Respiratory Viruses in Young Children: A Population-Based Time-series Study of Scottish Children

2020 ◽  
Author(s):  
Tiffany Fitzpatrick ◽  
William Malcolm ◽  
Jim McMenamin ◽  
Arlene Reynolds ◽  
Astrid Guttmann ◽  
...  
Keyword(s):  
Time Series ◽  
Respiratory Syncytial Virus ◽  
Chronic Conditions ◽  
Negative Binomial ◽  
Respiratory Viruses ◽  
Population Based ◽  
Antibiotic Prescribing ◽  
Viral Pathogen ◽  
Viral Illness ◽  
Syncytial Virus

Abstract Background Inappropriate antibiotic prescribing, such as for viral illness, remains common in primary care. The objective of this study was to estimate the proportion of community-prescribed antibiotics to children aged less than 5 years attributable to common respiratory viruses. Methods We fitted time-series negative binomial models to predict weekly antibiotic prescribing rates from positive viral pathogen tests for the period 1 April 2009 through 27 December 2017 using comprehensive, population-based administrative data for all children (<5 years) living in Scotland. Multiple respiratory viral pathogens were considered, including respiratory syncytial virus (RSV), influenza, human metapneumovirus (HMPV), rhinovirus, and human parainfluenza (HPIV) types 1–4. We estimated the proportion of antibiotic prescriptions explained by virus circulation according to type of virus, by age group, presence of high-risk chronic conditions, and antibiotic class. Results We included data on 6 066 492 antibiotic prescriptions among 452 877 children. The antibiotic-prescribing rate among all Scottish children (<5 years) was 609.7 per 1000 child-years. Our final model included RSV, influenza, HMPV, HPIV-1, and HPIV-3. An estimated 6.9% (95% confidence interval, 5.6–8.3%), 2.4% (1.7–3.1%), and 2.3% (.8–3.9%) of antibiotics were attributable to RSV, influenza, and HMPV, respectively. RSV was consistently associated with the highest proportion of prescribed antibiotics, particularly among children without chronic conditions and for amoxicillin and macrolide prescriptions. Conclusions Nearly 14% of antibiotics prescribed to children in this study were estimated to be attributable to common viruses for which antibiotics are not recommended. A future RSV vaccine could substantially reduce unnecessary antibiotic prescribing among children.

scholarly journals OP0074 MULTIMORBIDITY CLUSTERS, DETERMINANTS AND TRAJECTORIES IN OSTEOARTHRITIS IN THE UK: FINDINGS FROM THE CLINICAL PRACTICE RESEARCH DATALINK

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 49.1-50
Author(s):  
S. Swain ◽  
C. Coupland ◽  
V. Strauss ◽  
C. Mallen ◽  
C. F. Kuo ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Index Date ◽  
Latent Class ◽  
Rapid Onset ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Research Support ◽  
Gradual Onset ◽  
The Uk ◽  
Slow Onset

Background:Multimorbidity (≥2 chronic conditions) escalates the risk of adverse health outcomes. However, its burden in people with osteoarthritis (OA) remains largely unknown.Objectives:To identify the clusters of patients with multimorbidity and associated factors in OA and non-OA populations and to estimate the risk of developing multimorbidity clusters after the index date (after diagnosis).Methods:The study used the Clinical Practice Research Datalink – a primary care database from the UK. Firstly, age, sex and practice matched OA and non-OA people aged 20+ were identified to explore patterns and associations of clusters of multimorbidity within each group. Non-OA controls were assigned with same index date as that of matched OA cases. Secondly, multimorbidity trajectories for 20 years after the index date were examined in people without any comorbidities at baseline in both OA and non-OA groups. Latent class analysis was used to identify clusters and latent class growth modelling was used for cluster trajectories. The associations between clusters and age, sex, body mass index (BMI), alcohol use, smoking habits at baseline were quantified through multinomial logistic regression.Results:In total, 47 long-term conditions were studied in 443,822 people (OA- 221922; non-OA- 221900), with a mean age of 62 years (standard deviation ± 13 years), and 58% being women. The prevalence of multimorbidity was 76.6% and 68.9% in the OA and non-OA groups, respectively. In the OA group five clusters were identified including relatively healthy (18%), ‘cardiovascular (CVD) and musculoskeletal (MSK)’ (12.3%), metabolic syndrome (28.2%), ‘pain and psychological (9.1%), and ‘musculoskeletal’ (32.4%). The non-OA group had similar patterns except that the ‘pain+ psychological’ cluster was replaced by ‘thyroid and psychological’. (Figure 1) Among people with OA, ‘CVD+MSK’ and metabolic syndrome clusters were strongly associated with obesity with a relative risk ratio (RRR) of 2.04 (95% CI 1.95-2.13) and 2.10 (95% CI 2.03-2.17), respectively. Women had four times higher risk of being in the ‘pain+ psychological’ cluster than men when compared to the gender ratio in the healthy cluster, (RRR 4.28; 95% CI 4.09-4.48). In the non-OA group, obesity was significantly associated with all the clusters.Figure 1: Posterior probability distribution of chronic conditions across the clusters in Osteoarthritis (OA, n=221922) and Non-Osteoarthritis (Non-OA, n=221900) group. COPD- Chronic Obstructive Pulmonary Disease; CVD- Cardiovascular; MSK- MusculoskeletalOA (n=24139) and non-OA (n=24144) groups had five and four multimorbidity trajectory clusters, respectively. Among the OA population, 2.7% had rapid onset of multimorbidity, 9.5% had gradual onset and 11.6% had slow onset, whereas among the non-OA population, there was no rapid onset cluster, 4.6% had gradual onset and 14.3% had slow onset of multimorbidity. (Figure 2)Figure 2: Clusters of multimorbidity trajectories after index date in OA (n=24139) and Non-OA (n=24144)Conclusion:Distinct identified groups in OA and non-OA suggests further research for possible biological linkage within each cluster. The rapid onset of multimorbidity in OA should be considered for chronic disease management.Supported by:Acknowledgments:We would like to thank the University of Nottingham, UK, Beijing Joint Care Foundation, China and Foundation for Research in Rheumatology (FOREUM) for supporting the study.Disclosure of Interests:Subhashisa Swain: None declared, Carol Coupland: None declared, Victoria Strauss: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Chang-Fu Kuo: None declared, Aliya Sarmanova: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium

A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Jimenez ◽  
M Cainzos-Achirica ◽  
D Monterde ◽  
L Garcia-Eroles ◽  
C Enjuanes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Conditions ◽  
Temporal Trends ◽  
Population Level ◽  
Population Based ◽  
Relative Increase ◽  
Funding Source ◽  
Private Company ◽  
Healthcare Database ◽  
Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

Long-term trajectories of decline in cognition and daily functioning before and after stroke

2021 ◽  
pp. jnnp-2021-326043
Author(s):  
Alis Heshmatollah ◽  
Lisanne J. Dommershuijsen ◽  
Lana Fani ◽  
Peter J. Koudstaal ◽  
M. Arfan Ikram ◽  
...  
Keyword(s):  
Continuous Monitoring ◽  
Mini Mental State Examination ◽  
Functional Decline ◽  
Population Based ◽  
Daily Functioning ◽  
Linear Mixed Effects ◽  
Before And After ◽  
State Examination

ObjectiveAlthough knowledge on poststroke cognitive and functional decline is increasing, little is known about the possible decline of these functions before stroke. We determined the long-term trajectories of cognition and daily functioning before and after stroke.MethodsBetween 1990 and 2016, we repeatedly assessed cognition (Mini-Mental State Examination (MMSE), 15-Word Learning, Letter–Digit Substitution, Stroop, Verbal Fluency, Purdue Pegboard) and basic and instrumental activities of daily living (BADL and IADL) in 14 712 participants within the population-based Rotterdam Study. Incident stroke was assessed through continuous monitoring of medical records until 2018. We matched participants with incident stroke to stroke-free participants (1:3) based on sex and birth year. Trajectories of cognition and daily functioning of patients who had a stroke 10 years before and 10 years after stroke and the corresponding trajectories of stroke-free individuals were constructed using adjusted linear mixed effects models.ResultsDuring a mean follow-up of 12.5±6.8 years, a total of 1662 participants suffered a first-ever stroke. Patients who had a stroke deviated from stroke-free controls up to 10 years before stroke diagnosis in cognition and daily functioning. Significant deviations before stroke were seen in scores of MMSE (6.4 years), Stroop (5.7 years), Purdue Pegboard (3.8 years) and BADL and IADL (2.2 and 3.0 years, respectively).ConclusionPatients who had a stroke have steeper declines in cognition and daily functioning up to 10 years before their first-ever stroke compared with stroke-free individuals. Our findings suggest that accumulating intracerebral pathology already has a clinical impact before stroke.

scholarly journals Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1118
Author(s):  
Ralf Wagner ◽  
David Peterhoff ◽  
Stephanie Beileke ◽  
Felix Günther ◽  
Melanie Berr ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Latent Class ◽  
Care Home ◽  
Case Fatality ◽  
The Elderly ◽  
Population Based ◽  
Class Analysis ◽  
Population Based Study ◽  
Targeted Testing ◽  
June July

SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020, with particularly high case fatality ratio (CFR). To estimate seroprevalence, underreported infections, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020, we conducted a population-based study including home visits for the elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests. Latent class analysis yielded 8.6% standardized county-wide seroprevalence, a factor of underreported infections of 5.0, and 2.5% overall IFR. Seroprevalence was two-fold higher among medical workers and one third among current smokers with similar proportions of registered infections. While seroprevalence did not show an age-trend, the factor of underreported infections was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were <0.5% below 60 years of age, 1.0% for age 60–69, and 13.2% for age 70+. Senior care homes accounted for 45% of COVID-19-related deaths, reflected by an IFR of 7.5% among individuals aged 70+ and an overall IFR of 1.4% when excluding senior care home residents from our computation. Our data underscore senior care home infections as key determinant of IFR additionally to age, insufficient targeted testing in the young, and the need for further investigations on behavioral or molecular causes of the fewer infections among current smokers.

scholarly journals Factors Contributing to the Relationship between Driving Mileage and Crash Frequency of Older Drivers

2019 ◽  
Vol 11 (23) ◽  
pp. 6643 ◽  
Author(s):  
Lee ◽  
Guldmann ◽  
Choi
Keyword(s):  
Negative Binomial ◽  
Age Groups ◽  
Urban Environments ◽  
Vehicle Miles Traveled ◽  
Crash Frequency ◽  
Rural Environments ◽  
Lower Likelihood ◽  
Conditional Autoregressive ◽  
The Relationship ◽  
Binomial Models

As a characteristic of senior drivers aged 65 +, the low-mileage bias has been reported in previous studies. While it is thought to be a well-known phenomenon caused by aging, the characteristics of urban environments create more opportunities for crashes. This calls for investigating the low-mileage bias and scrutinizing whether it has the same impact on other age groups, such as young and middle-aged drivers. We use a crash database from the Ohio Department of Public Safety from 2006 to 2011 and adopt a macro approach using Negative Binomial models and Conditional Autoregressive (CAR) models to deal with a spatial autocorrelation issue. Aside from the low-mileage bias issue, we examine the association between the number of crashes and the built environment and socio-economic and demographic factors. We confirm that the number of crashes is associated with vehicle miles traveled, which suggests that more accumulated driving miles result in a lower likelihood of being involved in a crash. This implies that drivers in the low mileage group are involved in crashes more often, regardless of the driver’s age. The results also confirm that more complex urban environments have a higher number of crashes than rural environments.

Multiple developmental pathways underlying conduct problems: A multitrajectory framework

2020 ◽  
pp. 1-10
Author(s):  
Jules R. Dugré ◽  
Stéphane Potvin
Keyword(s):  
Conduct Disorder ◽  
Conduct Problems ◽  
Latent Class ◽  
Population Based ◽  
Anxiety Symptoms ◽  
Behavioral Approach ◽  
Parameter Estimates ◽  
Childhood And Adolescence ◽  
Increased Risk ◽  
Psychological Features

Abstract In the past decades, there has been an overemphasis of a descriptive/behavioral approach to study conduct disorder. In an equifinal perspective, we aimed to examine the developmental multitrajectory groups of psychological features (irritability, interpersonal callousness, hyperactivity/impulsivity, and depressive–anxiety symptoms) and their associations with conduct problems. In a population-based cohort (n = 1,309 participants followed from 5 months to 17 years old), latent-class growth analysis was performed for each psychological feature to identify a two-trajectory model (from ages 6 to 12 years). Based on parameter estimates of the two-trajectory models for each of the four psychological features, a parallel process growth mixture model identified eight significant developmental patterns that were subsequently compared with typically developing children. Furthermore, we observed that while interpersonal callousness conferred an increased risk for childhood and adolescence conduct problems, its co-occurrence with hyperactivity/impulsivity, irritability, and/or depressive–anxiety symptoms heightened the general risk, but also predicted distinct subtypes of conduct problems (i.e., aggressive and rule-breaking behaviors). Thus, by studying complex developmental combinations of psychological features, we observed qualitatively distinct pathways towards conduct problems. A multitrajectory framework of psychological features should be considered as a significant step towards unveiling the multiple etiological pathways leading to conduct disorder and its substantial clinical heterogeneity.

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