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J Browne, DA Edwards, KM Rhodes, DJ Brimicombe, RA Payne

The association of multimorbidity with health service utilisation among patients with dementia in the UK: a population-based study. J Browne, DA Edwards, KM Rhodes, DJ Brimicombe, RA Payne. Background. Ageing population Increasing prevalence of dementia

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J Browne, DA Edwards, KM Rhodes, DJ Brimicombe, RA Payne

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  1. The association of multimorbidity with health service utilisation among patients with dementia in the UK: a population-based study J Browne, DA Edwards, KM Rhodes, DJ Brimicombe, RA Payne

  2. Background • Ageing population • Increasing prevalence of dementia • Changing demands on healthcare and social care funding and service design Canadian Study of Health and Aging

  3. Background • It’s not just about “dementia patients” • Dementia is commonly associated with additional comorbidities Barnett, Lancet 2012

  4. How do comorbidities impact upon health service utilisation in the dementia population?

  5. Methods • Retrospective cohort study • CPRD • Incident dementia cases diagnosed 2008/9 • 65 Read codes, including any subtype and unspecified • 5-year follow-up • minimum 3-months

  6. Methods Barnett, Lancet 2012

  7. Methods • Primary care consultations • All hospital admissions • All primary care prescriptions • Time to death

  8. Methods • Association between comorbidity count and outcome • Negative binomial regression (service use) • Cox regression (death) • Adjustment for age, gender, practice, dementia treatment, deprivation

  9. Baseline characteristics

  10. Prevalence of comorbidities

  11. Service utilisation Mean follow-up 3.0 years

  12. Survival • Death rate 12.7 per 100 patient years • HR 1.56 (95% CI 1.37-1.78), ≥6 vs. 2-3 comorbidities p<0.001

  13. Consequences • For a woman aged 80-85 years with 6 or more comorbidities, over 3 years: • 18 more consultations • 131 more prescriptions • 2 more hospitalisations • Additional cost £5137 (compared to similar individual with 2-3 comorbidities)

  14. Strengths and limitations • First such study in UK • Large, representative sample • Range of relevant outcomes • Misclassification of comorbidities varying with health service contact • Crude measures of service use • Differential loss to follow-up

  15. Conclusions • Comorbidities are very common in the context of dementia • Comorbidities drive a substantial increase in health service utilisation • Multimorbidity must be considered when planning care services for people with dementia

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