Multimorbidity Patterns, Hospital Uses and Mortality by Race and Ethnicity Among Oldest-Old Patients.
Healthcare Service Utilization
Multiple Chronic Conditions
Racial-ethnic Variations
Journal
Journal of racial and ethnic health disparities
ISSN: 2196-8837
Titre abrégé: J Racial Ethn Health Disparities
Pays: Switzerland
ID NLM: 101628476
Informations de publication
Date de publication:
21 Feb 2024
21 Feb 2024
Historique:
received:
22
08
2023
accepted:
31
01
2024
revised:
30
01
2024
medline:
21
2
2024
pubmed:
21
2
2024
entrez:
21
2
2024
Statut:
aheadofprint
Résumé
Adults aged 85 years and older ("oldest-old") are perceived as survivors resilient to age-related risk factors. Although considerable heterogeneity has been often observed in this population, less is known about the unmet needs in health and healthcare service utilization for diverse patients in healthcare systems. We examined racial-ethnic variation in patterns of multimorbidity associated with emergency department (ED), clinic visits, and mortality among the oldest-old patients with multimorbidity. Administrative and clinical data from an integrated healthcare system for five years included 25,801 oldest-old patients with two or more chronic conditions. Hierarchical cluster analysis identified patterns of multimorbidity by four racial-ethnic groups (White, Black, Hispanic, & Other). Clusters associated with ED and clinic visits, and mortality were analyzed using generalized estimation equations and proportional hazards survival model, respectively. Hypothyroidism, Alzheimer's disease and related dementia, bone & joint conditions, metabolism syndrome, and pulmonary-vascular clusters were commonly observed across the groups. While most clusters were significantly associated with ED and clinic visits among White patients, bone & joint conditions cluster was the most significantly associated with ED and clinic visits among Black (RR = 1.32, p <.01 for ED; RR = 1.67, p <.0001 for clinic) and Hispanic patients (RR = 1.36, p <.0001 for ED; RR = 1.39, p <.0001 for clinic). Similar patterns were observed in the relationship between multimorbidity clusters and mortality. Patterns of multimorbidity and its significant association with the uses of ambulatory and emergency care varied by race-ethnicity. More studies are needed to explore barriers when minoritized patients are faced with the use of hospital services.
Sections du résumé
BACKGROUNDS
BACKGROUND
Adults aged 85 years and older ("oldest-old") are perceived as survivors resilient to age-related risk factors. Although considerable heterogeneity has been often observed in this population, less is known about the unmet needs in health and healthcare service utilization for diverse patients in healthcare systems. We examined racial-ethnic variation in patterns of multimorbidity associated with emergency department (ED), clinic visits, and mortality among the oldest-old patients with multimorbidity.
METHODS
METHODS
Administrative and clinical data from an integrated healthcare system for five years included 25,801 oldest-old patients with two or more chronic conditions. Hierarchical cluster analysis identified patterns of multimorbidity by four racial-ethnic groups (White, Black, Hispanic, & Other). Clusters associated with ED and clinic visits, and mortality were analyzed using generalized estimation equations and proportional hazards survival model, respectively.
RESULTS
RESULTS
Hypothyroidism, Alzheimer's disease and related dementia, bone & joint conditions, metabolism syndrome, and pulmonary-vascular clusters were commonly observed across the groups. While most clusters were significantly associated with ED and clinic visits among White patients, bone & joint conditions cluster was the most significantly associated with ED and clinic visits among Black (RR = 1.32, p <.01 for ED; RR = 1.67, p <.0001 for clinic) and Hispanic patients (RR = 1.36, p <.0001 for ED; RR = 1.39, p <.0001 for clinic). Similar patterns were observed in the relationship between multimorbidity clusters and mortality.
CONCLUSIONS
CONCLUSIONS
Patterns of multimorbidity and its significant association with the uses of ambulatory and emergency care varied by race-ethnicity. More studies are needed to explore barriers when minoritized patients are faced with the use of hospital services.
Identifiants
pubmed: 38381325
doi: 10.1007/s40615-024-01929-x
pii: 10.1007/s40615-024-01929-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIA NIH HHS
ID : 1R33AG057806
Pays : United States
Informations de copyright
© 2024. W. Montague Cobb-NMA Health Institute.
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