TY  - JOUR
UR  - http://dx.doi.org/10.1136/bmjmed-2024-001016
ID  - discovery10200891
N2  - Objective: To describe which combinations of long term conditions were associated with a higher risk of hospital admission or death during winter 2021-22 (the third wave of the covid-19 pandemic) in adults in England.
//
Design: Population based cohort study.
//
Setting: Linked primary and secondary care data from the General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) database, Hospital Episode Statistics, and Office for National Statistics death registry, comprising pseudoanonymised routinely collected electronic medical records from the whole population of England registered at a general practice, 1 December 2021 to 31 March 2022.
//
Participants: 48?253?125 individuals, registered in GDPPR in England, aged ?18 years, and alive on 1 December 2021.
//
Main outcomes measures: All cause hospital admissions and deaths associated with combinations of multiple long term conditions compared with those with no long term conditions, during the winter season (1 December 2021 to 31 March 2022). Overdispersed Poisson regression models were used to estimate the incidence rate ratios after adjusting for age, sex, ethnic group, and index of multiple deprivation.
//
Results: Complete data were available for 48?253?125 adults, of whom 15?million (31.2%) had multiple long term conditions. Rates of hospital admissions and deaths among individuals with no long term conditions were 96.3 and 0.8 per 1000 person years, respectively. Compared with those with no long term conditions, the adjusted incidence rate ratio of hospital admissions were 11.0 (95% confidence interval (CI) 9.4 to 12.7) for those with a combination of cancer, chronic kidney disease, cardiovascular disease, and type 2 diabetes mellitus; 9.8 (8.3 to 11.4) for those with cancer, chronic kidney disease, cardiovascular disease, and osteoarthritis; and 9.6 (8.6 to 10.7) for those with cancer, chronic kidney disease, and cardiovascular disease. Compared with those with no long term conditions, the adjusted rate ratio of death was 21.4 (17.5 to 26.0) for those with chronic kidney disease, cardiovascular disease, and dementia; 23.2 (17.5 to 30.3) for those with cancer, chronic kidney disease, cardiovascular disease, and dementia; and 24.3 (19.1 to 30.4) for those with chronic kidney disease, cardiovascular disease, dementia, and osteoarthritis. Cardiovascular disease with dementia appeared in all of the top five combinations of multiple long term conditions for mortality, and this two disease combination was associated with a substantially higher rate of death than many three, four, and five disease combinations.
//
Conclusions: In this study, rates of hospital admission and death varied by combinations of multiple long term conditions and were substantially higher in those with than in those without any long term conditions. High risk combinations for prioritisation and preventive action by policy makers were highlighted to help manage the challenges imposed by winter pressures on the NHS.
IS  - 1
AV  - public
TI  - Combinations of multiple long term conditions and risk of hospital admission or death during winter 2021-22 in England: population based cohort study
Y1  - 2024/11/12/
SN  - 2754-0413
PB  - BMJ
A1  - Islam, Nazrul
A1  - Shabnam, Sharmin
A1  - Khan, Nusrat
A1  - Gillies, Clare
A1  - Zaccardi, Francesco
A1  - Banerjee, Amitava
A1  - Nafilyan, Vahé
A1  - Khunti, Kamlesh
A1  - Dambha-Miller, Hajira
A1  - CVD-COVID-UK/COVID-IMPACT Consortium
JF  - BMJ Medicine
N1  - This is an open access article distributed in accordance
with the Creative Commons Attribution 4.0 Unported (CC BY 4.0)
license, which permits others to copy, redistribute, remix, transform
and build upon this work for any purpose, provided the original
work is properly cited, a link to the licence is given, and indication
of whether changes were made. See: https://creativecommons.org/
licenses/by/4.0/.
VL  - 3
ER  -