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Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 16178

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Special Issue Editors

Dr. Maria João Forjaz

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Guest Editor

1. National Centre of Epidemiology, Institute of Health Carlos III, REDISSEC, Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
2. Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Institute of Health Carlos III, Madrid, Spain
Interests: patient reported outcomes; multimorbidity; older adults; quality of life; comorbidity
Special Issues, Collections and Topics in MDPI journals

Dr. Antonio Gimeno-Miguel

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Guest Editor

1. EpiChron Research Group, Aragon Health Sciences Institute (IACS), Institute for Health Research Aragón (IIS Aragón), REDISSEC, Miguel Servet University Hospital, Zaragoza, Spain
2. Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Institute of Health Carlos III, Madrid, Spain
Interests: epidemiology; public health; chronic diseases; multimorbidity; real-world data
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Julián Librero López

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Guest Editor

1. Navarrabiomed, Research Centre of the Government of Navarra and the Public University of Navarra, REDISSEC, Complejo Hospitalario de Navarra, Edificio de investigación, Irunlarrea 3, 31008 Pamplona, Spain
2. Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Institute of Health Carlos III, Madrid, Spain
Interests: multimorbidity; pharmacoepidemiology; health care evaluation; causal inferences; real-world data; public health

Special Issue Information

Dear Colleagues,

The aging of the population is resulting in an unprecedented accumulation of chronic conditions that usually coexist in a single individual. Multimorbidity poses a challenge for patients, caregivers, and health systems worldwide, as it requires a paradigm shift from disease-centered to person-centered care.

Although considerable research effort has been conducted during the past two decades to describe the epidemiology and impact on the health of multimorbidity, there are still some gaps that remain to be filled. In this context, the increasing availability of electronic health records (what is now known as real-world data) for research purposes represents an opportunity to conduct large-scale population-based studies on chronic diseases and multimorbidity. However, the use of large databases also presents some challenges for researchers and clinicians concerning data curation and management, study design, and statistical analyses, which have rapidly evolved from traditional statistical techniques to artificial intelligence and machine learning algorithms.

It is also essential to evaluate any experiences of care reorientation that face the reality of fragility derived from comorbidity, and to design, implement, and assess specific care models and interventions for people with multiple chronic conditions.

In this Special Issue, we are looking for both observational and intervention studies on the multimorbidity and comorbidity of major chronic diseases to help in the characterization and clinical management of this public health problem. Reviews on this topic and methodological papers on the use of real-world data for the study of multimorbidity are also welcome.

We are looking forward to your contribution to this Special Issue.

Dr. Maria João Forjaz
Dr. Antonio Gimeno-Miguel
Prof. Dr. Julián Librero López
Guest Editors

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Keywords

multimorbidity
comorbidity
chronic diseases
real-world data
real-world evidence
intervention

Published Papers (7 papers)

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Research

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19 pages, 2370 KiB

Open AccessArticle

Relationship between Built-Up Environment, Air Pollution, Activity Frequency and Prevalence of Hypertension—An Empirical Analysis from the Main City of Lanzhou

by Haili Zhao, Minghui Wu, Yuhan Du, Fang Zhang and Jialiang Li

Int. J. Environ. Res. Public Health 2023, 20(1), 743; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20010743 - 31 Dec 2022

Cited by 2 | Viewed by 1564

Abstract

In the process of promoting the strategy of a healthy China, the built environment, as a carrier of human activities, can effectively influence the health level of residents in the light of its functional types. Based on the POI data of four main urban areas in Lanzhou, this paper classifies the built environment in terms of function into four types. The association between different types of built environments and the prevalence of hypertension was investigated by using the community as the study scale, and activity frequency, air pollution and green space were used as mediating variables to investigate whether they could mediate the relationship between built environments and hypertension. The results indicate that communities with a high concentration of commercial service facilities, road and traffic facilities and industrial facilities have a relatively high prevalence of hypertension. By determining the direct, indirect and overall effects of different functional types of built environment on the prevalence of hypertension, it was learned that the construction of public management and service facilities can effectively mitigate the negative effects of hypertension in the surrounding residents. The results of the study contribute to the rational planning of the structure of the built environment, which is beneficial for optimizing the urban structure and preventing and controlling chronic diseases such as hypertension. Full article

(This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions)

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13 pages, 380 KiB

Open AccessArticle

Multimorbidity Profiles and Infection Severity in COVID-19 Population Using Network Analysis in the Andalusian Health Population Database

by Jonás Carmona-Pírez, Ignatios Ioakeim-Skoufa, Antonio Gimeno-Miguel, Beatriz Poblador-Plou, Francisca González-Rubio, Dolores Muñoyerro-Muñiz, Juliana Rodríguez-Herrera, Juan Antonio Goicoechea-Salazar, Alexandra Prados-Torres and Román Villegas-Portero

Int. J. Environ. Res. Public Health 2022, 19(7), 3808; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19073808 - 23 Mar 2022

Cited by 3 | Viewed by 1819

Abstract

Identifying the population at risk of COVID-19 infection severity is a priority for clinicians and health systems. Most studies to date have only focused on the effect of specific disorders on infection severity, without considering that patients usually present multiple chronic diseases and that these conditions tend to group together in the form of multimorbidity patterns. In this large-scale epidemiological study, including primary and hospital care information of 166,242 patients with confirmed COVID-19 infection from the Spanish region of Andalusia, we applied network analysis to identify multimorbidity profiles and analyze their impact on the risk of hospitalization and mortality. Our results showed that multimorbidity was a risk factor for COVID-19 severity and that this risk increased with the morbidity burden. Individuals with advanced cardio-metabolic profiles frequently presented the highest infection severity risk in both sexes. The pattern with the highest severity associated in men was present in almost 28.7% of those aged ≥ 80 years and included associations between cardiovascular, respiratory, and metabolic diseases; age-adjusted odds ratio (OR) 95% confidence interval (1.71 (1.44–2.02)). In women, similar patterns were also associated the most with infection severity, in 7% of 65–79-year-olds (1.44 (1.34–1.54)) and in 29% of ≥80-year-olds (1.35 (1.18–1.53)). Patients with mental health patterns also showed one of the highest risks of COVID-19 severity, especially in women. These findings strongly recommend the implementation of personalized approaches to patients with multimorbidity and SARS-CoV-2 infection, especially in the population with high morbidity burden. Full article

(This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions)

10 pages, 329 KiB

Open AccessArticle

Relationship between Multimorbidity and Disability in Elderly Patients with Coexisting Frailty Syndrome

by Maria Jędrzejczyk, Weronika Foryś, Michał Czapla and Izabella Uchmanowicz

Int. J. Environ. Res. Public Health 2022, 19(6), 3461; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063461 - 15 Mar 2022

Cited by 11 | Viewed by 3260

Abstract

Background: Multimorbidity is a common problem worldwide. It carries the risk of reduced quality of life, disability, frequent hospitalizations, and death. The present study was designed to assess the relationships that exist between multimorbidity and disability in elderly patients. Methods: The study included 100 patients and was conducted between October 2020 and January 2021. Inclusion criteria included age >65 years, presence of a minimum of two comorbidities in the subject, and consent to participate in the study. Standardized survey instruments such as Tilburg Frailty Indicator (TFI), Charlson Comorbidities Index (CCI), Assessment of Basic Activities of Daily Living—Katz Scale (ADL), and Assessment of Complex Activities of Daily Living—Lawton Scale (IADL) were used in the study. Results: The majority of the subjects (92) had a frailty syndrome (TFI). A small group of respondents (8%) suffered from severe comorbidities (CCI). Among the subjects surveyed, 71% maintained full function in performing simple activities of daily living (ADL), while 29% demonstrated moderate disability on the scale. Full independence in performing complex activities of daily living (IADL) was present in 33% of the respondents, and 67% were partially independent. Independence in complex activities of daily living (IADL) was significantly higher in patients with fewer comorbidities. The severity of comorbidities (CCI) had a significant effect on the decrease in the level of independence (ADL and IADL). Independence in performing complex activities (IADL) was worse among older patients. Conclusions: An increase in the number of comorbidities contributes to a decrease in the level of performance of complex activities of daily living. The severity of comorbidities significantly reduces the level of independence of the subjects in simple and complex activities of daily living. In patients with a higher level of independence in performing simple and complex activities, the co-occurrence of frailty syndrome was less severe. As the age of the subjects increases, the frequency in which they show moderate dependence on third parties in performing complex activities of daily living increases. Full article

(This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions)

10 pages, 574 KiB

Open AccessArticle

Applying the FAIR4Health Solution to Identify Multimorbidity Patterns and Their Association with Mortality through a Frequent Pattern Growth Association Algorithm

by Jonás Carmona-Pírez, Beatriz Poblador-Plou, Antonio Poncel-Falcó, Jessica Rochat, Celia Alvarez-Romero, Alicia Martínez-García, Carmen Angioletti, Marta Almada, Mert Gencturk, A. Anil Sinaci, Jara Eloisa Ternero-Vega, Christophe Gaudet-Blavignac, Christian Lovis, Rosa Liperoti, Elisio Costa, Carlos Luis Parra-Calderón, Aida Moreno-Juste, Antonio Gimeno-Miguel and Alexandra Prados-Torres

Int. J. Environ. Res. Public Health 2022, 19(4), 2040; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042040 - 11 Feb 2022

Cited by 5 | Viewed by 2355

Abstract

The current availability of electronic health records represents an excellent research opportunity on multimorbidity, one of the most relevant public health problems nowadays. However, it also poses a methodological challenge due to the current lack of tools to access, harmonize and reuse research datasets. In FAIR4Health, a European Horizon 2020 project, a workflow to implement the FAIR (findability, accessibility, interoperability and reusability) principles on health datasets was developed, as well as two tools aimed at facilitating the transformation of raw datasets into FAIR ones and the preservation of data privacy. As part of this project, we conducted a multicentric retrospective observational study to apply the aforementioned FAIR implementation workflow and tools to five European health datasets for research on multimorbidity. We applied a federated frequent pattern growth association algorithm to identify the most frequent combinations of chronic diseases and their association with mortality risk. We identified several multimorbidity patterns clinically plausible and consistent with the bibliography, some of which were strongly associated with mortality. Our results show the usefulness of the solution developed in FAIR4Health to overcome the difficulties in data management and highlight the importance of implementing a FAIR data policy to accelerate responsible health research. Full article

(This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions)

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11 pages, 349 KiB

Open AccessArticle

Quality-of-Life Determinants in People with Diabetes Mellitus in Europe

by Álvaro Fuentes-Merlos, Domingo Orozco-Beltrán, Jose A. Quesada Rico and Raul Reina

Int. J. Environ. Res. Public Health 2021, 18(13), 6929; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136929 - 28 Jun 2021

Cited by 3 | Viewed by 1882

Abstract

This study aims to analyze self-perceived health and lifestyles in the European Union Member States Iceland, Norway, and the United Kingdom, examining associations with diabetes prevalence; and to identify the demographic, economic and health variables associated with diabetes in this population. We performed a cross-sectional study of 312,172 people aged 15 years and over (150,656 men and 161,516 women), using data collected from the European Health Interview Survey (EHIS). The EHIS includes questions on the health status and health determinants of the adult population, as well as health care use and accessibility. To estimate the magnitudes of the associations with diabetes prevalence, we fitted multivariate logistic models. The EHIS data revealed a prevalence of diabetes in Europe of 6.5% (n = 17,029). Diabetes was associated with being physically inactive (OR 1.14; 95% CI 1.02–1.28), obese (OR 2.75; 95% CI 2.60–2.90), male (OR 1.46; 95% CI 1.40–1.53) and 65–74 years old (OR 3.47; 95% CI 3.09–3.89); and having long-standing health problems (OR 7.39; 95% CI, 6.85–7.97). These results were consistent in the bivariate and multivariate analyses, with an area under the receiver operating characteristic curve of 0.87 (95% CI 0.87–0.88). In a large European health survey, diabetes was clearly associated with a poorer perceived quality of life, physical inactivity, obesity, and other comorbidities, as well as non-modifiable factors such as older age and male sex. Full article

(This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions)

Review

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19 pages, 1988 KiB

Open AccessReview

The Magnitude of NCD Risk Factors in Ethiopia: Meta-Analysis and Systematic Review of Evidence

by Fisaha Haile Tesfay, Kathryn Backholer, Christina Zorbas, Steven J. Bowe, Laura Alston and Catherine M. Bennett

Int. J. Environ. Res. Public Health 2022, 19(9), 5316; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19095316 - 27 Apr 2022

Cited by 2 | Viewed by 2727

Abstract

Background: Non-communicable Diseases (NCDs) and their risk factors are the leading contributors to morbidity and mortality globally, particularly in low- and middle-income countries including Ethiopia. To date, there has been no synthesis of the literature on the relative prevalence of NCD risk factors in Ethiopia. Methodology: We conducted a systematic review and meta-analysis of primary studies reporting on the prevalence of NCD risk factors in Ethiopia published in English from 2012 to July 2020. Pre-tested NCD search terms were applied to Medline, Embase, Scopus, CINAHL, and Global Health. Three reviewers screened and appraised the quality of the identified papers. Data extraction was conducted using a pilot tested proforma. Meta-analysis was conducted using Stata 16 and pooled prevalence estimated with associated 95% confidence intervals. Clinically heterogeneous studies that did not fulfil the eligibility criteria for meta-analysis were narratively synthesised. I² was used to assess statistical heterogeneity. Results: 47 studies fulfilled the inclusion criteria and contributed 68 NCD risk factor prevalence estimates. Hypertension was the most frequently examined NCD risk factor, with a pooled prevalence of 21% (n = 27 studies). The pooled prevalence percentages for overweight and obesity were 19.2% and 10.3%, respectively (n = 7 studies each), with a combined prevalence of 26.8% (n = 1 study). It was not possible to pool the prevalence of alcohol consumption, smoking, metabolic disorders, or fruit consumption because of heterogeneity across studies. The prevalence of alcohol use, as reported from the included individual studies, ranged from 12.4% to 13.5% (n = 7 studies). More than 90% of participants met the WHO-recommended level of physical activity (n = 5 studies). The prevalence of smoking was highly variable, ranging between 0.8% and 38.6%, as was the prevalence of heavy alcohol drinking (12.4% to 21.1%, n = 6 studies) and metabolic syndrome (4.8% to 9.6%, n = 5 studies). Fruit consumption ranged from 1.5% up to the recommended level, but varied across geographic areas (n = 3 studies). Conclusion and recommendations: The prevalence of NCD risk factors in Ethiopia is relatively high. National NCD risk factor surveillance is required to inform the prioritisation of policies and interventions to reduce the NCD burden in Ethiopia. Full article

(This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions)

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Other

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13 pages, 1290 KiB

Open AccessStudy Protocol

Effects of a Primary Care-Based Intervention on the Identification and Management of Patients with Coronary Heart Disease and Mental or Cognitive Comorbidity—A Study Protocol

by Lena Sannemann, Lisa Bach, Kira Isabel Hower, Peter Ihle, Kai Keller, Charlotte Leikert, Christin Leminski, Adriana Meixner, Ingo Meyer, Laura Nordmeyer, Samia Peltzer, Sophie Peter, Belinda Werner, Ludwig Kuntz, Holger Pfaff, Frank Schulz-Nieswandt, Christian Albus, Frank Jessen and on behalf of the CoRe-Net Study Group

Int. J. Environ. Res. Public Health 2023, 20(10), 5814; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20105814 - 13 May 2023

Viewed by 1479

Abstract

Mental and cognitive disorders (MCD) negatively affect the incidence and prognosis of coronary heart disease (CHD). Medical guidelines recommend the appropriate management of comorbid MCD in patients with CHD, yet there is evidence that the implementation in primary care is not always adequate. We present the protocol for a pilot study that aims to develop a minimally invasive intervention and evaluate its feasibility in the primary care setting to improve the identification and management of comorbid MCD in patients with CHD. The study consists of two consecutive parts and will be carried out in Cologne, Germany. Part 1 comprises the development and tailoring of the intervention, which is guided by qualitative interviews with primary care physicians (PCPs, n = 10), patients with CHD and MCD and patient representatives (n = 10). Part II focuses on the implementation and evaluation of the intervention in n = 10 PCP offices. Changes in PCP behaviour will be analysed by comparing routine data in the practice management system six months before and six months after study participation. In addition, we will explore the influence of organisational characteristics and perform a socio-economic impact assessment. The outcomes of this mixed-method study will inform the feasibility of a PCP-based intervention to improve quality of care in patients with CHD and comorbid MCD. Full article

(This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions)

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