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Multicenter Study
. 2017 Mar 9;7(3):e012546.
doi: 10.1136/bmjopen-2016-012546.

Association of comorbidity and health service usage among patients with dementia in the UK: a population-based study

Jorge Browne  1   2 , Duncan A Edwards  2   3 , Kirsty M Rhodes  3 , D James Brimicombe  2   2 , Rupert A Payne  2   4
Affiliations
Multicenter Study

Association of comorbidity and health service usage among patients with dementia in the UK: a population-based study

Jorge Browne et al. BMJ Open. .

Abstract

Background: The majority of people with dementia have other long-term diseases, the presence of which may affect the progression and management of dementia. This study aimed to identify subgroups with higher healthcare needs, by analysing how primary care consultations, number of prescriptions and hospital admissions by people with dementia varies with having additional long-term diseases (comorbidity).

Methods: A retrospective cohort study based on health data from the Clinical Practice Research Datalink (CPRD) was conducted. Incident cases of dementia diagnosed in the year starting 1/3/2008 were selected and followed for up to 5 years. The number of comorbidities was obtained from a set of 34 chronic health conditions. Service usage (primary care consultations, hospitalisations and prescriptions) and time-to-death were determined during follow-up. Multilevel negative binomial regression and Cox regression, adjusted for age and gender, were used to model differences in service usage and death between differing numbers of comorbidities.

Results: Data from 4999 people (14 866 person-years of follow-up) were analysed. Overall, 91.7% of people had 1 or more additional comorbidities. Compared with those with 2 or 3 comorbidities, people with ≥6 comorbidities had higher rates of primary care consultations (rate ratio (RR) 1.31, 95% CI 1.25 to 1.36), prescriptions (RR 1.68, 95% CI 1.57 to 1.81), and hospitalisation (RR 1.62, 95% CI 1.44 to 1.83), and higher risk of death (HR 1.56, 95% CI 1.37 to 1.78).

Discussion: In the UK, people with dementia with higher numbers of comorbidities die earlier and have considerably higher health service usage in terms of primary care consultations, hospital admissions and prescribing. This study provides strong evidence that comorbidity is a key factor that should be considered when allocating resources and planning care for people with dementia.

Keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PRIMARY CARE; Service Use; comorbidity; multimorbidity.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow of the participants through the study. CPRD, Clinical Practice Research Datalink.
Figure 2
Figure 2
Survival probabilities plotted over time for each comorbidity group.
See this image and copyright information in PMC

References

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