eprintid: 10200891 rev_number: 11 eprint_status: archive userid: 699 dir: disk0/10/20/08/91 datestamp: 2024-12-02 09:52:45 lastmod: 2024-12-02 09:53:15 status_changed: 2024-12-02 09:52:45 type: article metadata_visibility: show sword_depositor: 699 creators_name: Islam, Nazrul creators_name: Shabnam, Sharmin creators_name: Khan, Nusrat creators_name: Gillies, Clare creators_name: Zaccardi, Francesco creators_name: Banerjee, Amitava creators_name: Nafilyan, Vahé creators_name: Khunti, Kamlesh creators_name: Dambha-Miller, Hajira creators_name: CVD-COVID-UK/COVID-IMPACT Consortium, title: Combinations of multiple long term conditions and risk of hospital admission or death during winter 2021-22 in England: population based cohort study ispublished: pub divisions: UCL divisions: B02 divisions: DD4 note: 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/. abstract: 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. date: 2024-11-12 date_type: published publisher: BMJ official_url: http://dx.doi.org/10.1136/bmjmed-2024-001016 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2338548 doi: 10.1136/bmjmed-2024-001016 medium: Electronic-eCollection pii: bmjmed-2024-001016 lyricists_name: Banerjee, Amitava lyricists_id: ABANE83 actors_name: Banerjee, Amitava actors_id: ABANE83 actors_role: owner funding_acknowledgements: SP/19/3/34678 [British Heart Foundation] full_text_status: public publication: BMJ Medicine volume: 3 number: 1 article_number: e001016 event_location: England issn: 2754-0413 citation: Islam, Nazrul; Shabnam, Sharmin; Khan, Nusrat; Gillies, Clare; Zaccardi, Francesco; Banerjee, Amitava; Nafilyan, Vahé; ... CVD-COVID-UK/COVID-IMPACT Consortium; + view all <#> Islam, Nazrul; Shabnam, Sharmin; Khan, Nusrat; Gillies, Clare; Zaccardi, Francesco; Banerjee, Amitava; Nafilyan, Vahé; Khunti, Kamlesh; Dambha-Miller, Hajira; CVD-COVID-UK/COVID-IMPACT Consortium; - view fewer <#> (2024) Combinations of multiple long term conditions and risk of hospital admission or death during winter 2021-22 in England: population based cohort study. BMJ Medicine , 3 (1) , Article e001016. 10.1136/bmjmed-2024-001016 <https://doi.org/10.1136/bmjmed-2024-001016>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10200891/2/Combinations%20of%20multiple%20long%20term%20conditions%20and%20risk%20of%20hospital%20admission%20or%20death%20during%20winter%202021-22%20in%20England%20popul.pdf