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dc.contributor.authorZhu, Yajing
dc.contributor.authorEdwards, Duncan
dc.contributor.authorMant, Jonathan
dc.contributor.authorPayne, Rupert A.
dc.contributor.authorKiddle, Steven
dc.date.accessioned2021-04-10T15:24:28Z
dc.date.available2021-04-10T15:24:28Z
dc.date.issued2020-04-10
dc.date.submitted2019-11-28
dc.identifier.others12916-020-01543-8
dc.identifier.other1543
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/319703
dc.description.abstractAbstract: Background: Multimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects. Additionally, multimorbidity is often negatively associated with participation in research cohorts. Therefore, we set out to identify clusters of multimorbidity patients and how they are differentially associated with mortality and service use across age groups in a population-representative sample. Methods: Linked primary and secondary care electronic health records contributed by 382 general practices in England to the Clinical Practice Research Datalink (CPRD) were used. The study included a representative set of multimorbid adults (18 years old or more, N = 113,211) with two or more long-term conditions (a total of 38 conditions were included). A random set of 80% of the multimorbid patients (N = 90,571) were stratified by age groups and clustered using latent class analysis. Consistency between obtained multimorbidity phenotypes, classification quality and associations with demographic characteristics and primary outcomes (GP consultations, hospitalisations, regular medications and mortality) was validated in the remaining 20% of multimorbid patients (N = 22,640). Results: We identified 20 patient clusters across four age strata. The clusters with the highest mortality comprised psychoactive substance and alcohol misuse (aged 18–64); coronary heart disease, depression and pain (aged 65–84); and coronary heart disease, heart failure and atrial fibrillation (aged 85+). The clusters with the highest service use coincided with those with the highest mortality for people aged over 65. For people aged 18–64, the cluster with the highest service use comprised depression, anxiety and pain. The majority of 85+-year-old multimorbid patients belonged to the cluster with the lowest service use and mortality for that age range. Pain featured in 13 clusters. Conclusions: This work has highlighted patterns of multimorbidity that have implications for health services. These include the importance of psychoactive substance and alcohol misuse in people under the age of 65, of co-morbid depression and coronary heart disease in people aged 65–84 and of cardiovascular disease in people aged 85+.
dc.languageen
dc.publisherBioMed Central
dc.subjectResearch Article
dc.subjectMultimorbidity phenotype
dc.subjectChronic conditions
dc.subjectLatent class analysis
dc.subjectPattern recognition
dc.subjectValidation
dc.subjectAge stratification
dc.titleCharacteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study
dc.typeArticle
dc.date.updated2021-04-10T15:24:28Z
prism.issueIdentifier1
prism.publicationNameBMC Medicine
prism.volume18
dc.identifier.doi10.17863/CAM.66824
dcterms.dateAccepted2020-02-26
rioxxterms.versionofrecord10.1186/s12916-020-01543-8
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
dc.identifier.eissn1741-7015
pubs.funder-project-idMedical Research Council (MR/P021573/1)


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