Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns

Abstract

Objective After stratifying for age, sex and multimorbidity at baseline, our aim is to analyse time trends in incident multimorbidity and polypharmacy in the 15-year clinical trajectories of individual patients in a family medicine setting. Methods This study was carried out using data from the Registration Network Family Medicine in the South of the Netherlands. The clinical trajectories of 10037 subjects during the 15-year period (2000–2014) were analyzed in a repeated measurement of using a generalized estimating equations model as well as a multilevel random intercept model with repeated measurements to determine patterns of incident multimorbidity and polypharmacy. Hierarchical age-period-cohort models were used to generate age and cohort trajectories for comparison with prevalence trends in multimorbidity literature. Results Multimorbidity was more common in females than in males throughout the duration of the 15-year trajectory (females: 39.6%; males: 33.5%). With respective ratios of 11.7 and 5.9 between the end and the beginning of the 15-year period, the youngest female and male groups showed a substantial increase in multimorbidity prevalence. Ratios in the oldest female and male groups were 2.2 and 1.9 respectively. Females had higher levels of multimorbidity than males in the 0-24-year and 25-44-year age groups, but the levels converged to a prevalence of 92.2% in the oldest male and 90.7% in the oldest female group. Similar, albeit, moderate differences were found in polypharmacy patterns. Conclusions We sought to specify the progression of multimorbidity from an early age. As a result, our study adds to the multimorbidity literature by specifying changes in chronic disease accumulation with relation to polypharmacy, and by tracking differences in patient trajectories according to age and sex. Multimorbidity and polypharmacy are common and their prevalence is accelerating, with a relatively rapid increase in younger groups. From the point of view of family medicine, this underlines the need for a longitudinal approach and a life course perspective in patient care.

Population-Based Trends in Complexity of Hospital Inpatients

“…Population-level analyses in Canada, the Netherlands, Sweden, Switzerland, and Taiwan all report increasing multimorbidity and polypharmacy in the general nonhospitalized population. 17,18,[21][22][23]25 These forces alone might increase the number of unplanned hospital admissions through the emergency department and expand the number of acute medical issues requiring attention during any given hospital stay. Several US studies also report that in-hospital adverse events remain discouragingly common despite several decades' focus on hospital-based quality improvement efforts.…”

“…These results build on the limited existing evidence that hospital inpatient complexity has increased over time. Population-level analyses in Canada, the Netherlands, Sweden, Switzerland, and Taiwan all report increasing multimorbidity and polypharmacy in the general nonhospitalized population . These forces alone might increase the number of unplanned hospital admissions through the emergency department and expand the number of acute medical issues requiring attention during any given hospital stay.…”

“…First, population aging means that hospital inpatients are more likely to be elderly or frail . Second, the global epidemic of noncommunicable diseases might have increased the prevalence of multimorbidity among inpatients . Third, new prescription drugs and new indications for treatment might have encouraged polypharmacy and increased the likelihood of medication-related adverse events .…”

“…18,19 Second, the global epidemic of noncommunicable diseases might have increased the prevalence of multimorbidity among inpatients. [20][21][22][23] Third, new prescription drugs and new indications for treatment might have encouraged polypharmacy and increased the likelihood of medication-related adverse events. [24][25][26][27][28] Fourth, advances in medical technology mean that some hospital inpatients have previously unsurvivable conditions, such as widely metastatic cancer or advanced organ failure.…”

The multidisciplinary team in diagnosing and treatment of patients with diabetes and comorbidities: A scoping review

“…This finding is expected though as multimorbidity is strongly associated with polypharmacy, and therefore must be adjusted accordingly to avoid adverse events. 60 , 61 Hence, intensification of medication adjustment seems an important part of the management of people with diabetes and comorbidities. Again, the many different components that are incorporated into the MDT interventions across studies reflect the diversity of these teams.…”