Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service

ObjectivesTo describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department.DesignPopulation based cohort study.SettingEmergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019.ParticipantsAdults (≥18 years) attending emergency departments.Data sourcesLinked data from emergency departments, hospital discharges, and cancer registries, and national mortality data.Main outcome measuresMultimorbidity was defined as at least two conditions from the Elixhauser comorbidity index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30 day mortality (primary outcome), hospital admission, reattendance at the emergency department within seven days, and time spent in emergency department (secondary outcomes). Primary analysis was stratified by age (<65 v≥65 years).Results451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73v43 years), more likely to arrive by emergency ambulance (57.8%v23.7%), and more likely to be triaged as very urgent (23.5%v9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2%v1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1%v20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8%v3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older.ConclusionsAlmost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.

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Impact of household characteristics on patient outcomes post hip fracture: a Welsh nationwide observational cohort study

MacRae,

Meyer,

Mercer

et al. 2024

BMC Public Health

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Background Hip fracture is common in older people and has significant health and care implications. This study aimed to examine the impact of household characteristics (living alone or living with someone who is themselves ill) on adverse outcomes following hip fracture. Methods A cohort study of hip fracture patients aged ≥ 50 years living alone or with one co-resident using Welsh nationwide data between January 2013 and December 2018. Outcomes were emergency hospital admission within 30 days and care-home admission and mortality within one year of hospital discharge. Analysis used cause-specific Cox proportional hazards models to examine associations with living alone and with co-resident chronic disease status. Results Of the 12,089 hip fracture patients discharged, 56.0% lived alone. Compared to hip fracture patients living with a co-resident, those living alone were more commonly women (78.4% versus 65.2%), older (mean 83.1 versus 78.5 years), and had more long-term conditions (mean 5.7 versus 5.3). In unadjusted analyses, compared to living with a co-resident with 0–1 long-term condition and no dementia, living alone (hazard ratio [HR] 1.44, 95%CI 1.23–1.68), living with someone with dementia (HR 1.57, 95%CI 1.07–2.30), and living with someone with 4 + physical long-term conditions (HR 1.24, 95%CI 1.03–1.49) were associated with an increase in mortality, but no significant association was found in adjusted analysis. Adjusted for age, sex, socioeconomic position, and long-term condition count of the hip fracture patient, living alone (adjusted HR [aHR] 2.26, 95%CI 1.81–2.81) and living with a co-resident with dementia (aHR 2.38, 95%CI 1.59–3.57) were both associated with more than double the risk of care home admission. There were no significant associations with 30-day hospital admission. Conclusions Hip fracture patients who live alone have higher one-year mortality, but associations are explained by the demographic and clinical characteristics of those living alone. However, living alone or living with a co-resident with dementia was independently associated with an additional doubling of the risk of care home admission. Household-based approaches to research and health policy may help target risk groups following hip fracture community discharge and further research is needed to understand the mechanisms by which these associations act.

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Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service

Cited by 4 publications

References 29 publications

Using primary and routinely collected data to determine prevalence and patterns of multimorbidity in rural China: a representative cross-sectional study of 6474 Chinese adults

Using primary and routinely collected data to determine prevalence and patterns of multimorbidity in rural China: a representative cross-sectional study of 6474 Chinese adults

Multimorbidity and adverse outcomes following emergency department attendance: population based cohort study

Impact of household characteristics on patient outcomes post hip fracture: a Welsh nationwide observational cohort study

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