Multimorbidity gender patterns in hospitalized elderly patients

Abstract

Patients with multimorbidity and complex health care needs are usually vulnerable elders with several concomitant advanced chronic diseases. Our research aim was to evaluate differences in patterns of multimorbidity by gender in this population and their possible prognostic implications, measured as in-hospital mortality, 1-month readmissions, and 1-year mortality. We focused on a cohort of elderly patients with well-established multimorbidity criteria admitted to a specific unit for chronic complex-care patients. Multimorbidity criteria, the Charlson, PROFUND and Barthel indexes, and the Pfeiffer test were collected prospectively during their stays. A total of 843 patients (49.2% men) were included, with a median age of 84 [interquartile range (IQR) 79-89] years. The women were older, with greater functional dependence [Barthel index: 40 (IQR:10-65) vs. 60 (IQR: 25-90)], showed more cognitive deterioration [Pfeiffer test: 5 (IQR:1-9) vs. 1 (0-6)], and had worse scores on the PROFUND index [15 (IQR:9-18) vs. 11.5 (IQR: 6-15)], all p <0.0001, while men had greater comorbidity measured with the Charlson index [5 (IQR: 3-7) vs. 4 (IQR: 3-6); p = 0.002]. In the multimorbidity criteria scale, heart failure, autoimmune diseases, dementia, and osteoarticular diseases were more frequent in women, while ischemic heart disease, chronic respiratory diseases, and neoplasms predominated in men. In the analysis of grouped patterns, neurological and osteoarticular diseases were more frequent in females, while respiratory and cancer predominated in males. We did not find gender differences for in-hospital mortality, 1-month readmissions, or 1-year mortality. In the multivariate analysis age, the Charlson, Barthel and PROFUND indexes, along with previous admissions, were independent predictors of 1-year mortality, while gender was non-significant. The Charlson and PROFUND indexes predicted mortality during follow-up more accurately in men than in women (AUC 0.70 vs. 0.57 and 0.74 vs. 0.62, respectively), with both p<0.001. In conclusion, our study shows differing patterns of multimorbidity by gender, with greater functional impairment in women and more comorbidity in men, although without differences in the prognosis. Moreover, some of these prognostic indicators had differing accuracy for the genders in predicting mortality.

Do Sex-Related Differences of Comorbidity Burden and/or In-Hospital Mortality Exist in Cancer Patients? A Retrospective Study in an Internal Medicine Setting

“…However, in renal transplant recipients, the female gender exhibited a stronger association with IHM as well as solid organ cancers and post-transplant lymphoproliferative disorders [ 33 ]. We found that women showed lower comorbidities, and this finding is in agreement with the results of a recent study showing a greater functional impairment in females and more comorbidity in males, but no differences in the prognosis [ 34 ].…”

Predictors of in-hospital mortality in critically ill Geriatric patients

“…In comparison to other comorbidities, only history of dementia was associated with increased mortality hazard independent of other mortality risk factors and it is consistent with previous studies reporting this significant association between cognitive impairment and in-hospital mortality as in another prospective cohort study including hospitalized elderly patients [23] , and a retrospective cohort study using databases of older people in England [24] . The importance of cognitive impairment in outcome prediction is also supported by large scale studies utilizing data from the Chinese Longitudinal Healthy Longevity Survey [25] , and an integrative review of 104 articles reporting poorer hospital outcomes of older people with cognitive impairment [26] .…”

“…Despite the prognostic role of age among hospitalized elderly patients [23] and the associated risk of treatment restriction in older adults [37] , this study showed that chronologic age is not a predictor of mortality and should not lead to treatment restriction. This finding is supported by other studies [7,45,46] as frailty, comorbidity and severity of illness are more important than age per se [47] .…”

Time trends in hospital admissions in very elderly patients (≥85 years-old) in Spain: data from the Spanish National Discharge Database (2000 - 2015)

“…women. This result is consistent with other recent studies that show differences in hospitalization patterns depending on gender in elderly patients: women admitted in Spanish hospitals tend to be older and with lower Charlson index scores than men (12).…”