The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort.
Adult
Aged
Chronic Disease
Cluster Analysis
Cohort Studies
Comorbidity
Diabetes Complications
/ epidemiology
Diabetes Mellitus, Type 2
/ complications
England
/ epidemiology
Female
Forecasting
Humans
Male
Middle Aged
Prevalence
Primary Health Care
/ statistics & numerical data
Risk Factors
Young Adult
CPRD
Comorbidity
Prevalence
Primary care
Type 2 diabetes mellitus
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
25 07 2019
25 07 2019
Historique:
received:
08
04
2019
accepted:
20
06
2019
entrez:
27
7
2019
pubmed:
28
7
2019
medline:
15
1
2020
Statut:
epublish
Résumé
The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions. We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation. More people living in the most deprived areas had ≥ 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics. Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.
Sections du résumé
BACKGROUND
The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions.
METHODS
We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation.
RESULTS
More people living in the most deprived areas had ≥ 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics.
CONCLUSIONS
Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.
Identifiants
pubmed: 31345214
doi: 10.1186/s12916-019-1373-y
pii: 10.1186/s12916-019-1373-y
pmc: PMC6659216
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
145Subventions
Organisme : Medical Research Council
ID : MC_PC_13042
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K006665/1
Pays : United Kingdom
Organisme : Department of Health
ID : RP-PG-0617-20005
Pays : United Kingdom
Organisme : Department of Health
ID : RP_2014-04-026
Pays : United Kingdom
Commentaires et corrections
Type : ErratumIn
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