Development and validation of the Cambridge Multimorbidity Score

Abstract

BACKGROUND: Health services have failed to respond to the pressures of multimorbidity. Improved measures of multimorbidity are needed for conducting research, planning services and allocating resources. METHODS: We modelled the association between 37 morbidities and 3 key outcomes (primary care consultations, unplanned hospital admission, death) at 1 and 5 years. We extracted development (n = 300 000) and validation (n = 150 000) samples from the UK Clinical Practice Research Datalink. We constructed a general-outcome multimorbidity score by averaging the standardized weights of the separate outcome scores. We compared performance with the Charlson Comorbidity Index. RESULTS: Models that included all 37 conditions were acceptable predictors of general practitioner consultations (C-index 0.732, 95% confidence interval [CI] 0.731-0.734), unplanned hospital admission (C-index 0.742, 95% CI 0.737-0.747) and death at 1 year (C-index 0.912, 95% CI 0.905-0.918). Models reduced to the 20 conditions with the greatest combined prevalence/weight showed similar predictive ability (C-indices 0.727, 95% CI 0.725-0.728; 0.738, 95% CI 0.732-0.743; and 0.910, 95% CI 0.904-0.917, respectively). They also predicted 5-year outcomes similarly for consultations and death (C-indices 0.735, 95% CI 0.734-0.736, and 0.889, 95% CI 0.885-0.892, respectively) but performed less well for admissions (C-index 0.708, 95% CI 0.705-Disclaimer: This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare Products Regulatory Agency. The data are provided by patients and collected by the NHS as part of their care and support. Linked mortality data were provided by the UK Office for National Statistics through NHS Digital. The interpretation and conclusions contained in this study are those of the authors alone.

COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study

“…Third, across most age and multimorbidity count strata the estimated YLL per person remained substantial and generally above 5 years. This means that even after accounting for multimorbidity count, most individuals lost considerably more than the "1-2 years" suggested by some commentators 23 perhaps reflecting the high prevalence of multimorbidity in this population, especially in those over the age of 50 years 24,25 . Finally, whilst the YLL remained high across most age-and multimorbidity count strata, the presence of multimorbidity did indeed influence the magnitude of the YLL.…”

Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study

“…These conditions included atrial fibrillation, alcohol problem, anxiety, asthma, chronic obstructive pulmonary disease, depression, diabetes, epilepsy, heart failure, hearing loss, hyperlipidemia, hypertension, Parkinson’s disease, rheumatoid arthritis, and transient ischemic attack. The codes for each condition were developed as part of a project developing the Cambridge Multimorbidity Score[ 21 ] and are publicly available on the website: http://www.phpc.cam.ac.uk/pcu/cprd_cam/codelists/ . We used number of consultations within 365 days before index stroke as a measure of healthcare utilization.…”

Multimorbidity, Polyiatrogenesis, and COVID‐19

“…There is no agreed way of how to measure multimorbidity: Some researchers classify multimorbidity by how many disorders occur together, while others look for systematic clusters among co-occurring problems. What problems are counted in one of these clusters also varies, some researchers consider only a handful of chronic disorders as constitutive of multimorbidity (Dugravot et al 2020), while others capture dozens of conditions (Payne et al 2020). Multimorbidity overlaps with other constructs, such as frailty (Hanlon et al 2018) and disability (Stineman et al 2012).…”

“…2020), while others capture dozens of conditions (Payne et al. 2020). Multimorbidity overlaps with other constructs, such as frailty (Hanlon et al.…”