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BMC Health Services Research
Published in: BMC Health Services Research 1/2012

Open Access 01-12-2012 | Research article

The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study

Authors: Ingmar Schäfer, Heike Hansen, Gerhard Schön, Susanne Höfels, Attila Altiner, Anne Dahlhaus, Jochen Gensichen, Steffi Riedel-Heller, Siegfried Weyerer, Wolfgang A Blank, Hans-Helmut König, Olaf von dem Knesebeck, Karl Wegscheider, Martin Scherer, Hendrik van den Bussche, Birgitt Wiese

Published in: BMC Health Services Research | Issue 1/2012

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Abstract

Background

Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern.

Methods

The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses.

Results

Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status.

Conclusions

Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups.

Trial registration

ISRCTN89818205
Appendix
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Literature
1.
Van den Akker M, Buntinx F, Knottnerus A: Comorbidity or multimorbidity. What's in a name?. Eur J Gen Pract. 1996, 2: 15-21.CrossRef
2.
3.
Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, van den Satariano WA, Bos GA: Causes and consequences of comorbidity A review. J Clin Epidemiol. 2001, 54: 661-674. 10.1016/S0895-4356(00)00363-2.CrossRefPubMed
4.
Marengoni A: Prevalence and impact of chronic diseases and multimorbidity in the aging population. A clinical and epidemiological approach. 2008, Stockholm: Karolinska Institutet
5.
Fortin M, Hudon C, Haggerty J, van den Akker M, Almiral J: Prevalence estimates of multimorbidity a comparative study of two sources. BMC Health Serv Res. 2010, 10: 111-10.1186/1472-6963-10-111.CrossRefPubMedPubMedCentral
6.
Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L: Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005, 3: 223-228. 10.1370/afm.272.CrossRefPubMedPubMedCentral
7.
Van den Bussche H, Koller D, Kolonko T, Hansen H, Wegscheider K, Glaeske G, von Leitner EC, Schäfer I, Schön G: Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011, 11: 101-10.1186/1471-2458-11-101.CrossRefPubMedPubMedCentral
8.
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW: Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases. JAMA. 2005, 294: 716-724. 10.1001/jama.294.6.716.CrossRefPubMed
9.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L: Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011, 10: 430-439. 10.1016/j.arr.2011.03.003.CrossRefPubMed
10.
Knesebeck OVD, Vonneilich N: Gesundheitliche Ungleichheit im Alter [Health inequalities among the aged.]. Z Gerontol Geriat. 2009, 42: 459-464. 10.1007/s00391-009-0078-9.CrossRef
11.
McMunn A, Breeze E, Goodman A, Nazroo J, Oldfield Z: Social determinants of health in older age. Social determinants of health. Edited by: Marmot M, Wilkinson R. 2006, Oxford: University Press, 267-296.
12.
Kok R, Avendano M, Mackenbach JP: The association between socioeconomic status and changes in health in Europe. Health, ageing and retirement in Europe (2004-2007): starting the longitudinal dimension. Edited by: Börsch-Supan A, Brugiavini A, Jürges H, Kapteyn A, Mackenbach J, Siegrist J, Weber G. 2008, Mannheim: Strauss, 123-128.
13.
Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L: Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009, 57: 225-230. 10.1111/j.1532-5415.2008.02109.x.CrossRefPubMed
14.
Holden L, Scuffham PA, Hilton MF, Muspratt A, Ng SK, Whiteford HA: Patterns of multimorbidity in working Australians. Population Health Metrics. 2011, 9: 15-10.1186/1478-7954-9-15.CrossRefPubMedPubMedCentral
15.
Schäfer I, von Leitner EC, Schön G, Koller D, Hansen H, Kolonko T, Kaduszkiewicz H, Wegscheider K, Glaeske G, van den Bussche H: Multimorbidity patterns in the elderly: A new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010, 5: e15941-10.1371/journal.pone.0015941.CrossRefPubMedPubMedCentral
16.
Schäfer I, Hansen H, Schön G, Maier W, Höfels S, Altiner A, Fuchs A, Gerlach FM, Petersen JJ, Gensichen J, Schulz S, Riedel-Heller S, Luppa M, Weyerer S, Werle J, Bickel H, Barth K, König HH, Rudolph A, Wiese B, Prokein J, Bullinger M, von dem Knesebeck O, Eisele M, Kaduszkiewicz H, Wegscheider K, van den Bussche H: The German MultiCare-study: Patterns of multimorbidity in primary health care - protocol of a prospective cohort study. BMC Health Serv Res. 2009, 9: 145-10.1186/1472-6963-9-145.CrossRefPubMedPubMedCentral
17.
18.
19.
Kassenärztliche Bundesvereinigung: Grunddaten 2006 zur vertragsärztlichen Versorgung in Deutschland. [Basic data for 2006 of statutory health care in Germany.]. 2006, [http://​www.​kbv.​de/​publikationen/​125.​html] zur vertragsärztlichen Versorgung in Deutschland. [Basic data for 2006 of statutory health care in Germany.]
20.
Messung soziodemographischer Merkmale in der Epidemiologie. Edited by: Ahrens W, Bellach BM, Jöckel KH. 1998, München: Urban & Vogel
21.
Brauns H, Steinmann S: Educational reform in France, West-Germany and the United Kingdom: Updating the CASMIN educational classification. ZUMA-Nachrichten. 1999, 44: 7-44.
22.
Hoffmeyer-Zlotnik JHP: Operationalisierung von "Beruf" als zentrale Variable zur Messung von sozio-ökonomischem Status [Operationalization of "occupation" as a key variable for the measurement of socioeconomic status.]. ZUMA-Nachrichten. 1993, 32: 135-141.
23.
Robert S, House JS: SES differentials in health by age and alternative indicators of SES. J Aging Health. 1996, 8: 359-388. 10.1177/089826439600800304.CrossRefPubMed
24.
25.
Gower JC: A general coefficient of similarity and some of its properties. Biometrics. 1971, 27: 857-871. 10.2307/2528823.CrossRef
26.
Terluin B, van Marwijk HWJ, Ader HJ, de Vet HCW, Penninx BWJH, Hermens MLM, van Boeijen CA, van Balkom AJLM, van der Klink JJL, Stalman WAB: The Four-Dimensional Symptom Questionnaire (4DSQ): A validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry. 2006, 6: 34-10.1186/1471-244X-6-34.CrossRefPubMedPubMedCentral
27.
Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol. 1986, 5: 165-173. 10.1300/J018v05n01_09.CrossRef
28.
Morris JC: The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology. 1993, 43: 2412-2414.CrossRefPubMed
29.
Collin C, Wade DT, Davies S, Horne V: The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988, 10: 61-63. 10.3109/09638288809164103.CrossRefPubMed
30.
Lawton MP, Brody EM: Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1969, 9: 179-186. 10.1093/geront/9.3_Part_1.179.CrossRefPubMed
31.
Bös K, Abel T, Woll A, Niemann S, Tittlbach S, Schott N: Der Fragebogen zur Erfassung des motorischen Funktionsstatus (FFB-MOT) [The Physical Fitness Questionnaire (FFB-Mot)]. Diagnostica. 2002, 48: 101-111. 10.1026//0012-1924.48.2.101.CrossRef
32.
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International Physical Activity Questionnaire: 12-Country reliability and validity. Med Sci Sports Exercise. 2003, 35: 1381-1395. 10.1249/01.MSS.0000078924.61453.FB.CrossRef
33.
Welsh K, Butters N, Hughes JP, Mohs RC, Heyman A: Detection and staging of dementia in Alzheimer's Disease: Use of the neuropsychological measures developed for the Consortium to Established a Registry for Alzheimer's Disease. Arch Neurol. 1992, 49: 448-452. 10.1001/archneur.1992.00530290030008.CrossRefPubMed
34.
Klasen BW, Hallner D, Schaub C, Willburger R, Hasenbring M: Validation and reliability of the German version of the Chronic Pain Grade questionnaire in primary care back pain patients. Psychosoc Med. 2004, 1: Doc07.PubMedPubMedCentral
35.
Group EuroQol: EuroQol - a new facility for the measurement of health-related quality of life. Health Policy. 1990, 16: 199-208.CrossRef
36.
Szende A, Oppe M, Devlin N: EQ-5D value sets. Inventory, comparative review and user guide. 2007, Berlin: Springer NetherlandCrossRef
37.
Bush K: The AUDIT alcohol consumption questions (AUDIT-C) An effective brief screening test for problem drinking. Arch Int Med. 1998, 158: 1789-1795. 10.1001/archinte.158.16.1789.CrossRef
38.
Hinz A, Schumacher J, Albani C, Schmid G, Brähler E: Bevölkerungsrepräsentative Normierung der Skala zur Allgemeinen Selbstwirksamkeitserwartung [Standardization of the General Self-Efficacy Scale in the German population.]. Diagnostica. 2006, 52: 26-32. 10.1026/0012-1924.52.1.26.CrossRef
39.
Fydrich T, Sommer G, Brähler E: F-SozU: Fragebogen zur Sozialen Unterstützung. [F-SozU: Questionnaire on social support.]. 2007, Göttingen: Hogrefe
40.
Senioren in der Gemeinschaftsverpflegung. [Elderly people in communal feeding.]. Edited by: Aid Infodienst, Deutsche Gesellschaft für Ernährung (DGE). 2007, Bonn: AID
41.
42.
Zhang J, Yu KF: What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998, 280: 1690-1691. 10.1001/jama.280.19.1690.CrossRefPubMed
43.
44.
Datenreport 2006. Edited by: Statistisches Bundesamt. 2006, Bonn: Bundeszentrale für politische Bildung
45.
46.
Kopetsch T: Dem deutschen Gesundheitswesen gehen die Ärzte aus! Studie zur Altersstruktur-und Arztzahlentwicklung. 2010, Berlin: Bundesärztekammer und Kassenärztliche Bundesvereinigung, [The German public health sector is running short of physicians! Study on the development of age structure and numbers of physicians.]
47.
Rothgang H, Kulik D, Müller R, Unger R: GEK Pflegereport 2009. 2009, Schwäbisch Gmünd: Asgard Verlagsservice, [GEK report on nursing care.]
48.
Luck T, Riedel-Heller SG, Kaduszkiewicz H, Bickel H, Jessen F, Pentzek M, Wiese B, Kölsch H, van den Bussche H, Abholz HH, Mösch E, Gorfer S, Angermeyer MC, Maier W, Weyerer S: Mild cognitive impairment in general practice: Age-specific prevalence and correlates results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Dement Geriatr Cogn Disord. 2007, 24: 307-316. 10.1159/000108099.CrossRefPubMed
49.
Im Blickpunkt: Ältere Menschen in Deutschland und der EU. Edited by: Statistisches Bundesam. 2011, Bonn: Focus on the Elderly in Germany and the EU
50.
Weber G, Ed: Socio-Economic Status. Health, Ageing and Retirement in Europe - First Results from SHARE. Edited by: Börsch-Supan A, Brugiavini A, Jürges H, Mackenbach J, Siegrist J, Weber G. 2005, Mannheim: Mannheim Research Institute for the Economics of Aging, 295-347.
51.
Mayer KU, Wagner M: Lebenslagen und soziale Ungleichheit im hohen Alter. [Living conditions and social inequality in old age.]. Die Berliner Altersstudie. Edited by: Lindenberger U, Smith J, Mayer KU, Baltes PB. 2010, Berlin: Akademie Verlag, 251-275.
52.
Börsch-Supan A, Ed: Who Are Our 50+ Olds?. Health, Ageing and Retirement in Europe - First Results from SHARE. Edited by: Börsch-Supan A, Brugiavini A, Jürges H, Mackenbach J, Siegrist J, Weber G. Mannheim. 2005, Mannheim Research Institute for the Economics of Aging, 29-79.
53.
Van den Akker M, Buntinx F, Metsemakers JFM, Roos S, Knottnerus JA: Multimorbidity in general practice: Prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998, 51: 367-375. 10.1016/S0895-4356(97)00306-5.CrossRefPubMed
54.
Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, Murphy AW: The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011.
55.
Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA: Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2011, 61: e12-e21. 10.3399/bjgp11X548929.CrossRefPubMed
56.
Britt HC, Harrison CM, Miller GC, Knox SA: Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008, 189: 72-77.PubMed
57.
Gater R, Tansella M, Korten A, Tiemens BG, Mavreas VG, Olatawura MO: Sex Differences in the Prevalence and Detection of Depressive and Anxiety Disorders in General Health Care Settings. Report From the World Health Organization Collaborative Study on Psychological Problems in General Health Care. Arch Gen Psychiatry. 1998, 55: 405-413. 10.1001/archpsyc.55.5.405.CrossRefPubMed
58.
Waldron I, Hughes ME, Brooks TL: Marriage protection and marriage selection--Prospective evidence for reciprocal effects of marital status and health. Soc Sci Med. 1996, 43: 113-123. 10.1016/0277-9536(95)00347-9.CrossRefPubMed
59.
Michael YL, Berkman LF, Colditz GA, Kawachi I: Living arrangements, social integration, and change in functional health status. Am J Epidemiol. 2001, 153: 123-131. 10.1093/aje/153.2.123.CrossRefPubMed
60.
Marengoni A, Winblad B, Karp A, Fratiglioni L: Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health. 2008, 98: 1198-1200. 10.2105/AJPH.2007.121137.CrossRefPubMedPubMedCentral
61.
Nagel G, Peter R, Braig S, Hermann S, Rohrmann S, Linseisen J: The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Publ Health. 2008, 8: 384-10.1186/1471-2458-8-384.CrossRef
62.
Van den Akker M, Buntinx F, Metsemakers JFM, Knottnerus JA: Marginal impact of psychosocial factors on multimorbidity: results of an explorative nested case-control study. Soc Sci Med. 2000, 50: 1679-1693. 10.1016/S0277-9536(99)00408-6.CrossRefPubMed
63.
Erler A, Beyer M, Muth C, Gerlach FM, Brennecke R: Garbage in - Garbage out? Validität von Abrechnungsdiagnosen in hausärztlichen Praxen [Garbage in - Garbage out? Validity of Coded Diagnoses from GP Claims Records.]. Gesundheitswesen. 2009, 71: 823-831. 10.1055/s-0029-1214399.CrossRefPubMed
64.
Zimmermann T, Kaduszkiewicz H, van den Bussche H, Schön G, Wegscheider K, Werle J, Weyerer S, Wiese B, Olbrich J, Weeg D, Riedel-Heller S, Luppa M, Jessen F, Abholz HH, Maier W, Pentzek M: Reliabilität ärztlicher Morbiditätsangaben zu chronischen Krankheiten. Ergebnisse einer Längsschnittstudie im hausärztlichen Bereich. [Reliability of morbidity data reported by GPs. Results of a longitudinal study in primary care.]. Bundesgesundheitsbl. 2012, 55: 260-269. 10.1007/s00103-011-1414-y.CrossRef
Metadata
Title
The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study
Authors
Ingmar Schäfer
Heike Hansen
Gerhard Schön
Susanne Höfels
Attila Altiner
Anne Dahlhaus
Jochen Gensichen
Steffi Riedel-Heller
Siegfried Weyerer
Wolfgang A Blank
Hans-Helmut König
Olaf von dem Knesebeck
Karl Wegscheider
Martin Scherer
Hendrik van den Bussche
Birgitt Wiese
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2012
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-12-89

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