Tracking the Development of Multimorbidity In the Australian Longitudinal Study on Women’s Health

Abstract

IntroductionWith population ageing the prevalence of multi-morbidity (the co-occurrence of two or more chronic medical conditions) is increasing.
 Objectives and ApproachOur goal was to use data linkage to obtain clinically validated data on the incidence of a range of common chronic conditions developed by participants in the Australian Longitudinal Study on Women’s Health (57,000 women) and hence to track the cumulative incidence of multi-morbidity over time.
 ResultsThe major data sources differed for different conditions, e.g. the Pharmaceutical Benefits Scheme was important for identifying musculoskeletal conditions, whereas hospital admission data was crucial for identifying stroke. The most common combinations of conditions differed for women at different ages, e.g., mental health, musculoskeletal and respiratory conditions were most common for women born in 1989-95, whereas heart disease was a prominent part of multi-morbidity for women born in 1921-26. Among these older women about 50% had 3 or more chronic conditions in 2002 (when they were aged 76-81) and this increased to over 80% by 2015 (when they were 89-93). For comparison, among women born in 1973-78 fewer than 5% had 2 or more chronic conditions in 2002 (when they were aged 24-29) and this increased to about 15% in 2016 (when they were 38-43).
 Conclusion / ImplicationsRecord linkage from multiple data sources, repeated over a long time span, is a powerful method for studying the development of multi-morbidity patterns in cohorts.

Impact of multimorbidity and complex multimorbidity on healthcare utilisation in older Australian adults aged 45 years or more: a large population-based cross-sectional data linkage study

“…While no prior Australian evaluation was conducted on the impact of CMM on healthcare utilisation, several studies reported that older people with MM used more healthcare services than those without MM 9 16–19. However, they are not directly comparable due to the variation in the number and type of chronic conditions involved.…”

“…Previous international9 16 17 and Australian studies18–23 exploring the impact of MM on health service use showed greater health service utilisation among those with MM versus those without MM. However, limitations of Australian studies include that they have varied in how they defined MM, and most were restricted to subpopulations defined by sex,19 22 location (small urban areas or rural)18 20 or employment status 21.…”

“…Previous international 9 16 17 and Australian studies 18–23 exploring the impact of MM on health service use showed greater health service utilisation among those with MM versus those without MM. However, limitations of Australian studies include that they have varied in how they defined MM, and most were restricted to subpopulations defined by sex, 19 22 location (small urban areas or rural) 18 20 or employment status. 21 Some restricted their analysis to one modality of service use (emergency admissions or GP visits only) 18 22 or to older adults ≥60 years old 20 ; while others assessed the impact of specific comorbidities of interest on service use (cancer, psychological distress, or anxiety and depression).…”

Longitudinal analysis of the Alternative Healthy Eating Index-2010 and incident non-communicable diseases over 15 years in the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health

“…Women were excluded from the current analyses if they had missing data on diet at both S3 and S5 or had NCDs (CHD, HT, cancer and DM) recorded at S1, S2 and S3. There may be fluctuations with acute episodes in depression and/or anxiety (41) , and a high prevalence of asthma in this age group (42) . Therefore, we did not exclude women who had a history of depression and/or anxiety, or asthma; however, adjustments were made for the history of these conditions and a current episode was considered an incident case.…”