Rising to the challenge of multimorbidity

Whitty, Christopher J. M.; MacEwen, Carrie; Goddard, Andrew; Alderson, Derek; Marshall, Martin; Calderwood, Carmelita; Atherton, Frank; McBride, Michael; Atherton, John C.; Stokes-Lampard, Helen; Reid, Wendy; Powis, Stephen H.; Marx, Clare

doi:10.1136/bmj.l6964

Cited by 260 publications

(244 citation statements)

References 6 publications

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“…These ndings emphasise the modulating role which comorbidities play in predicting outcomes among hospitalised COVID19 positive patients. The UK's Chief Medical O cer has highlighted that comorbidities and the proportion of patients with two or more medical conditions simultaneously, multi-morbidities, is rising presenting a challenge to the entire medical profession including within acute and long term hospital settings (24). Studies have previously explored the independent comorbidity risk factors associated with COVID19 patients (25) but not the role of comorbidities as modulators of outcomes, irrespective of deprivation, among COVID19-positive patients.…”

Section: Discussionmentioning

confidence: 99%

To what extent are social determinants of health, including household overcrowding, air pollution and housing quality deprivation, modulators of presentation, ITU admission and outcomes among patients with SARS-COV-2 infection in an urban catchment area in Birmingham, United Kingdom?

Soltan

Crowley

Melville

et al. 2020

Preprint

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Background: Internationally, researchers have called for evidence to support tackling health inequalities during the Severe acute respiratory syndrome coronavirus 2(COVID19) pandemic. UK Office for National Statistics data suggests that patients in regions of most deprived overall, generic Index of Multiple Deprivation Score(IMDS) are twice as likely to die of COVID19 than other causes. The Intensive Care National Audit and Research Centre (ICNARC) report that BAME patients account for 34% of critically ill COVID19 patients nationally despite constituting 14% of the population. This paper is the first to explore the roles of social determinants of health, including specific IMDS sub-indices with indicators for household quality deprivation, household overcrowding deprivation and air pollution deprivation, as modulators of presentation, Intensive Care Unit(ITU) admission and outcomes among COVID19 patients of all ethnicities. Methods: An in-depth retrospective cohort study of 408 hospitalised COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including two-step cluster analyses were applied. Results: Patients admitted from highest living environment(LE) deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services(BHS) deprivation indices were at increased risk of ITU admission. Admission to ITU significantly increased the risk of death. Black, Asian and Minority Ethnic(BAME) patients were more likely, than white patients, to present with multi-lobar pneumonia, be admitted to ITU and be admitted from highest BHS and LE deprivation indices. Comorbidities and frailty significantly increased the risk of death among COVID19 patients irrespective of deprivation.Conclusions: Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Patents of BAME ethnicity are more likely to be admitted from regions of highest air pollution, housing quality and household overcrowding deprivation; this is likely to contribute an explanation towards the higher ITU admissions reported among COVID19 BAME patients. These findings have urgent implications for supporting front line clinical decisions, disseminating practical advice around applying social distancing messages at the household level and informing wider pandemic strategy.

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Section: Discussionmentioning

confidence: 99%

To what extent are social determinants of health, including household overcrowding, air pollution and housing quality deprivation, modulators of presentation, ITU admission and outcomes among patients with SARS-COV-2 infection in an urban catchment area in Birmingham, United Kingdom?

Soltan

Crowley

Melville

et al. 2020

Preprint

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“…The role of vascular surgical interventions to promote ulcer healing has therefore increased in importance, but a more holistic approach to multimorbidity has also emerged as an essential component of multidisciplinary management 9. For example, palliative care is increasingly discussed as an alternative to amputation for patients with intractable, necrotic, or gangrenous ulcers, no prospect of satisfactory healing, and when amputation is not in a patient’s best interests or consistent with their wishes.…”

Section: Demographic Shiftmentioning

confidence: 99%

Rapid access to multidisciplinary diabetes foot care teams

Valabhji¹

2020

BMJ

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“…Whitty and colleagues discuss the rising number of patients with multimorbidity 1. We struggle to remember the last patient on acute take or in clinic who had fewer than two medical problems, and multimorbidity requires a holistic approach that necessitates time and thought 2.…”

mentioning

confidence: 99%