Resumen de Distribution of multiple chronic conditions and their impact on the Spanish population
INTRODUCTION Although the need for comprehensive management of patients with multiple co-occurring conditions has been highlighted, policies and guidelines are still focused on the management of individual diseases. Thus, a better understanding of multimorbidity is considered fundamental to the development of new preventive and management strategies. OBJECTIVES 1. To examine the distribution of chronic conditions and multimorbidity patterns in the Spanish older adult population. 2. To assess the association between individual physical conditions (e.g., diabetes, angina) and the prevalence of mental disorders in the population over 50 years of age. 3. To evaluate the relationship between physical multimorbidity and the prevalence of mental disorders in the Spanish population over 50 years of age. 4. To study the individual and cumulative impact of chronic physical conditions on visual impairment in the population over 50 years old. 5. To analyze the relationship between visual impairment and the presence of mental disorders and cognitive impairment in the population over 50 years old. 6. To explore the individual and cumulative impact of chronic physical and mental conditions on quality of life and disability in the population over 50 years of age. 7. To examine general trends in quality of life and disability across gender in relation to the individual and cumulative effects of chronic conditions. METHODS Data from this cross-sectional study were collected from the Collaborative Research on Ageing in Europe (COURAGE) Project. A total of 4,583 participants from Spain were included; 3,625 aged over 50. An exploratory factor analysis was conducted to detect multimorbidity patterns in the population over 50 years of age. Crude and adjusted binary logistic regressions were performed to identify the associations between physical and mental conditions. Crude and adjusted binary logistic regressions were conducted to assess the associations between visual impairment and chronic physical conditions, physical multimorbidity, mental disorders and cognitive impairment. Finally, crude and adjusted multiple linear regressions were performed to detect associations between chronic conditions and quality of life, and between chronic conditions and disability. Separate models were used to assess the importance of the increasing number of diseases on quality of life and disability, adjusting for same covariates. Additional analogous regressions were performed for males and females to assess gender trends. RESULTS Three multimorbidity patterns emerged: ‘cardio-respiratory’ (angina, asthma, chronic lung disease), ‘mental-arthritis’ (arthritis, depression, anxiety) and the ‘aggregated pattern’ (angina, hypertension, stroke, diabetes, cataracts, edentulism, and arthritis). All conditions were related to at least one pattern. Angina, arthritis, asthma, chronic lung disease and the number of physical conditions were associated with depression [OR 2.01 (1.40,2.90); OR 1.62 (1.19,2.21); OR 1.86 (1.31,2.64); OR 2.66 (1.84,3.86); OR for 3+ diseases 4.38 (2.31,8.33)]. Angina and the number of physical conditions were associated with a higher risk of anxiety [OR 3.39 (1.84,6.22); OR for 3+ diseases 5.23 (1.76,15.53)]. The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR for 3+ diseases 1.75 (1.38,2.23); OR for 3+ diseases 1.69 (1.27,2.24)]. Arthritis, stroke and diabetes were associated with poorer distance visual acuity results [OR 1.79 (1.46,2.21); OR 1.59 (1.05,2.42); OR 1.27 (1.01,1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (1.86,4.87)]. With regard to mental health, poor subjective distance and near visual performance was associated with depression [OR 1.61 (1.14,2.27); OR 1.48 (1.03,2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning. All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, stroke and anxiety were found to have the greatest impact on disability [? 15.70 (13.62,17.77); ? 12.15 (8.08,16.22); ? 11.17 (2.49,19.86)] and quality of life [? -14.00 (-15.85,-12.14); ? -8.16 (-11.77,-4.55), ? -7.82 (-11.57,-4.08)]. The number of chronic conditions was associated with substantially lower quality of life [? for 4+ diseases: -18.10 (-20.95,-15.25)] and greater disability [? for 4+ diseases: 27.64 (24.99,30.29)]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. Effect size across gender resulted in small-moderate values. CONCLUSIONS 1. Multimorbidity is present in a large proportion of the older Spanish population, especially in those aged over 50. The prevalence of multimorbidity affects more than half of men and over two-thirds of women over 65 years. Chronic conditions tend to appear in certain multimorbidity patterns: “cardio-respiratory” (angina, asthma, COPD), “mental arthritis” (arthritis, anxiety, depression), “aggregate pattern” (angina, cataract, hypertension, edentulism, diabetes, arthritis, stroke). 2. With regard to the analysis of the impact of individual physical diseases on mental health, a higher risk of depression is present in people with asthma, angina, COPD and arthritis, whereas only angina is associated with anxiety. 3. The number of chronic conditions is greatly associated with the diagnosis of depression and anxiety. 4. Visual impairment is common in the Spanish older population. Stroke, arthritis and diabetes are individually associated with worse distance visual acuity, while stroke is associated with worse near visual acuity. The number of physical conditions is greatly associated with worse distance and near visual acuity. 5. Subjective distance visual acuity problems are related to a higher risk of depression, while no measure of visual acuity is associated with changes in the prevalence of anxiety. All measures of visual impairment (distance/near and objective/subjective) are related to impaired cognitive functioning. 6. All chronic conditions assessed (angina, anxiety, arthritis, asthma, cataract, COPD, depression, diabetes, edentulism, stroke), except for hypertension, impact negatively on disability and quality of life in the Spanish older population. Stroke and mental disorders (depression, anxiety) are the conditions that have the strongest impact on these outcomes. Conditions with fewer symptoms (diabetes, edentulism, cataract) tend to have a lower impact on health outcomes than those with more symptoms (angina, COPD, arthritis). The number of chronic conditions impacts greatly both on quality of life and disability. 7. Women have slightly poorer results in quality of life and disability than men. Individually, some conditions affect quality of life and disability only in men or women. The effect of the number of chronic conditions is important in both sexes.
