Multimorbidity in a marginalised, street-health Australian population: a retrospective cohort study

Abstract

ObjectivesDemographic and presentation profile of patients using an innovative mobile outreach clinic compared with mainstream practice.DesignRetrospective cohort study.SettingPrimary care mobile street health clinic and mainstream practice in Western Australia.Participants2587 street health and 4583 mainstream patients.Main outcome measuresPrevalence and patterns of chronic diseases in anatomical domains across the entire age spectrum of patients and disease severity burden using Cumulative Illness Rating Scale (CIRS).ResultsMultimorbidity (2+ CIRS domains) prevalence was significantly higher in the street health cohort (46.3%, 1199/2587) than age–sex-adjusted mainstream estimate (43.1%, 2000/4583), p=0.011. Multimorbidity prevalence was significantly higher in street health patients <45 years (37.7%, 615/1649) compared with age–sex-adjusted mainstream patients (33%, 977/2961), p=0.003 but significantly lower if 65+ years (62%, 114/184 vs 90.7%, 322/355, p<0.001). Controlling for age and gender, the mean CIRS Severity Index score for street health (M=1.4, SD=0.91) was significantly higher than for mainstream patients (M=1.1, SD=0.80), p<0.001. Furthermore, 44.2% (530/1199) of street health patients had at least one level 3 or 4 score across domains compared with 18.3% (420/2294) for mainstream patients, p<0.001. Street health population comprised 29.6% (766/2587) Aboriginal patients with 50.4% (386/766) having multimorbidity compared with 44.6% (813/1821) for non-Aboriginals, p=0.007. There were no comprehensive data on Indigenous status in the mainstream cohort available for comparison. Musculoskeletal, respiratory and psychiatric domains were most commonly affected with multimorbidity significantly associated with male gender, increasing age and Indigenous status.ConclusionsAge–sex-adjusted multimorbidity prevalence and disease severity is higher in the street health cohort. Earlier onset (23–34 years) multimorbidity is found in the street health cohort but prevalence is lower in 65+ years than in mainstream patients. Multimorbidity prevalence is higher for Aboriginal patients of all ages.

Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre cross-sectional study

“…Portuguese epidemiologic data follows the same tendency, with a high prevalence of multimorbidity (72.7 %) amongst adult patients attending primary care [4]. Factors such as social deprivation [5], marginalisation [6], mental health disorders [5], and poor housing conditions [7] are associated with an increased prevalence of multimorbidity.…”

Multimorbidity among Aboriginal people in New South Wales contributes significantly to their higher mortality

“…A representative national survey found that nearly half the patients attending general practices in Australia had multiple chronic diseases (47.4%, equating to 32.6% of the general population) 9 . The only assessment of multimorbidity in Indigenous Australians found a higher prevalence of multimorbidity among Aboriginal people attending a Fremantle street health clinic serving a marginalised population than among its non‐Aboriginal patients (50.4% v 44.6%) 10 …”

“…9 The only assessment of multimorbidity in Indigenous Australians found a higher prevalence of multimorbidity among Aboriginal people attending a Fremantle street health clinic serving a marginalised population than among its non-Aboriginal patients (50.4% v 44.6%). 10 The aims of our study were to compare the prevalence of multimorbidity and its impact on mortality among Aboriginal and non-Aboriginal Australians in New South Wales who had been hospitalised at least once during the previous 10 years. Given the small proportion of Torres Strait Islander people in the NSW hospital data (0.1%), 11 in this article we use the descriptor "Aboriginal" to refer to the original people of NSW and their descendants.…”

Challenges in the care of familial hypercholesterolemia: a community care perspective

“…[27] This information is critical to appreciate the different demographics of the unselected, undifferentiated populations and presentations seen in primary care compared to the highly selective, well differentiated populations referred to specialists for tertiary level care. The primary care physician requires considerable adaptability and flexibility to meet the health needs of individual patients often with multiple morbidities [28][29][30] and contrasts with the specialist tertiary clinic that deals with the health needs of a group of patients all with same range of diseases or illnesses.…”