The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study
Top Cited Papers
- 19 February 2013
- journal article
- research article
- Published by CMA Impact Inc. in CMAJ : Canadian Medical Association Journal
- Vol. 185 (5), E221-E228
- https://doi.org/10.1503/cmaj.121349
Abstract
Background: Multimorbidity, the presence of more than 1 long-term disorder, is associated with increased use of health services, but unplanned admissions to hospital may often be undesirable. Furthermore, socioeconomic deprivation and mental health comorbidity may lead to additional unplanned admissions. We examined the association between unplanned admission to hospital and physical multimorbidity, mental health and socioeconomic deprivation. Methods: We conducted a retrospective cohort study using data from 180 815 patients aged 20 years and older who were registered with 40 general practices in Scotland. Details of 32 physical and 8 mental health morbidities were extracted from the patients’ electronic health records (as of Apr. 1, 2006) and linked to hospital admission data. We then recorded the occurrence of unplanned or potentially preventable unplanned acute (nonpsychiatric) admissions to hospital in the subsequent 12 months. We used logistic regression models, adjusting for age and sex, to determine associations between unplanned or potentially preventable unplanned admissions to hospital and physical multimorbidity, mental health and socioeconomic deprivation. Results: We identified 10 828 (6.0%) patients who had at least 1 unplanned admission to hospital and 2037 (1.1%) patients who had at least 1 potentially preventable unplanned admission to hospital. Both unplanned and potentially preventable unplanned admissions were independently associated with increasing physical multimorbidity (for ≥ 4 v. 0 conditions, odds ratio [OR] 5.87 [95% confidence interval (CI) 5.45–6.32] for unplanned admissions, OR 14.38 [95% CI 11.87–17.43] for potentially preventable unplanned admissions), mental health conditions (for ≥ 1 v. 0 conditions, OR 2.01 [95% CI 1.92–2.09] for unplanned admissions, OR 1.80 [95% CI 1.64–1.97] for potentially preventable unplanned admissions) and socioeconomic deprivation (for most v. least deprived quintile, OR 1.56 [95% CI 1.43–1.70] for unplanned admissions, OR 1.98 [95% CI 1.63–2.41] for potentially preventable unplanned admissions). Interpretation: Physical multimorbidity was strongly associated with unplanned admission to hospital, including admissions that were potentially preventable. The risk of admission to hospital was exacerbated by the coexistence of mental health conditions and socioeconomic deprivation.This publication has 20 references indexed in Scilit:
- Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional studyThe Lancet, 2012
- Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trialsBMJ, 2011
- Epidemiology and impact of multimorbidity in primary care: a retrospective cohort studyBritish Journal of General Practice, 2011
- Multimorbidity - not just an older person's issue. Results from an Australian biomedical studyBMC Public Health, 2010
- An ‘endless struggle’: a qualitative study of general practitioners’ and practice nurses’ experiences of managing multimorbidity in socio-economically deprived areas of ScotlandChronic Illness, 2010
- Costly Hospital Readmissions and Complex Chronic IllnessINQUIRY: The Journal of Health Care Organization, Provision, and Financing, 2008
- The Relationship Between Multimorbidity and Patients’ Ratings of CommunicationJournal of General Internal Medicine, 2008
- The Inverse Care Law: Clinical Primary Care Encounters in Deprived and Affluent Areas of ScotlandAnnals of Family Medicine, 2007
- Prevalence of Multimorbidity Among Adults Seen in Family PracticeAnnals of Family Medicine, 2005
- National survey of the prevalence, incidence, primary care burden, and treatment of heart failure in ScotlandHeart, 2004