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Clustering populations by health and social care with multiple long-term conditions: a cohort study — the English Longitudinal Study of Ageing (ELSA)

医学 老年学 社会经济地位 星团(航天器) 队列研究 潜在类模型 逻辑回归 队列 置信区间 医疗保健 优势比 人口学 可能性 纵向研究 人口 环境卫生 统计 社会学 病理 内科学 经济 程序设计语言 经济增长 计算机科学 数学
作者
Hajira Dambha‐Miller,Yvonne Nartey,Nusrat Khan,Glenn Simpson,Sharon Lin,Ralph Kwame Akyea,Andrew Farmer
出处
期刊:British Journal of General Practice [Royal College of General Practitioners]
卷期号:73 (suppl 1): bjgp23X734337-bjgp23X734337 被引量:1
标识
DOI:10.3399/bjgp23x734337
摘要

The integration of health and social care services is a potential solution for improving care, despite monetary constraints and increasing demand. How two or more multiple long-term conditions (MLTC) cluster, interact and associate with socioeconomic factors, and affect access to unscheduled primary healthcare services is understudied.To cluster an MLTC population by health and social care, examine clusters, and quantify associations with health outcomes.A retrospective cohort study was conducted using the ELSA database (2002 to 2019) on 19802 participants aged ≥50 years. Ten major health conditions, and social care need, including difficulty in activities of daily living (ADL) and mobility, for example, were used to cluster MLTC by latent class modelling. Multivariate logistic regression models were used to establish further association.The mean age of the participants at baseline (wave 2) was about 66 years and 55% of participants were female, with more than 60% developing MLTC in their lifetime (waves 2 to 9). Of the five distinct latent clusters, cluster 5 was the most significant cluster composed of lung diseases, stroke, dementia, and high ADL and mobility difficulty scores. The majority of the participants were aged 70-79 years, female, and married. The odds of having a longer nursing home stay were 8.97 (95% confidence interval = 4.36 to 18.45), and death was 10% higher in this cluster compared to the highest probability cluster 4 in the maximally adjusted regression model.This study identified MLTC clusters by social care need with the highest primary care demand. Targeting clinical practice to prevent MLTC progression for these groups may lessen future pressures on primary care demand.

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