Globally, there is a paucity of multimorbidity and comorbidity data, especially for minority ethnic groups and younger people. We estimated the frequency of common disease combinations and identified ...non-random disease associations for all ages in a multiethnic population.
In this population-based study, we examined multimorbidity and comorbidity patterns stratified by ethnicity or race, sex, and age for 308 health conditions using electronic health records from individuals included on the Clinical Practice Research Datalink linked with the Hospital Episode Statistics admitted patient care dataset in England. We included individuals who were older than 1 year and who had been registered for at least 1 year in a participating general practice during the study period (between April 1, 2010, and March 31, 2015). We identified the most common combinations of conditions and comorbidities for index conditions. We defined comorbidity as the accumulation of additional conditions to an index condition over an individual's lifetime. We used network analysis to identify conditions that co-occurred more often than expected by chance. We developed online interactive tools to explore multimorbidity and comorbidity patterns overall and by subgroup based on ethnicity, sex, and age.
We collected data for 3 872 451 eligible patients, of whom 1 955 700 (50·5%) were women and girls, 1 916 751 (49·5%) were men and boys, 2 666 234 (68·9%) were White, 155 435 (4·0%) were south Asian, and 98 815 (2·6%) were Black. We found that a higher proportion of boys aged 1–9 years (132 506 47·8% of 277 158) had two or more diagnosed conditions than did girls in the same age group (106 982 40·3% of 265 179), but more women and girls were diagnosed with multimorbidity than were boys aged 10 years and older and men (1 361 232 80·5% of 1 690 521 vs 1 161 308 70·8% of 1 639 593). White individuals (2 097 536 78·7% of 2 666 234) were more likely to be diagnosed with two or more conditions than were Black (59 339 60·1% of 98 815) or south Asian individuals (93 617 60·2% of 155 435). Depression commonly co-occurred with anxiety, migraine, obesity, atopic conditions, deafness, soft-tissue disorders, and gastrointestinal disorders across all subgroups. Heart failure often co-occurred with hypertension, atrial fibrillation, osteoarthritis, stable angina, myocardial infarction, chronic kidney disease, type 2 diabetes, and chronic obstructive pulmonary disease. Spinal fractures were most strongly non-randomly associated with malignancy in Black individuals, but with osteoporosis in White individuals. Hypertension was most strongly associated with kidney disorders in those aged 20–29 years, but with dyslipidaemia, obesity, and type 2 diabetes in individuals aged 40 years and older. Breast cancer was associated with different comorbidities in individuals from different ethnic groups. Asthma was associated with different comorbidities between males and females. Bipolar disorder was associated with different comorbidities in younger age groups compared with older age groups.
Our findings and interactive online tools are a resource for: patients and their clinicians, to prevent and detect comorbid conditions; research funders and policy makers, to redesign service provision, training priorities, and guideline development; and biomedical researchers and manufacturers of medicines, to provide leads for research into common or sequential pathways of disease and inform the design of clinical trials.
UK Research and Innovation, Medical Research Council, National Institute for Health and Care Research, Department of Health and Social Care, Wellcome Trust, British Heart Foundation, and The Alan Turing Institute.
Objective
Exaggerated exercise blood pressure (BP) is associated with higher left-ventricular mass index (LVMI). Paradoxically, exercise BP and LVMI may be higher with greater fitness, but underlying ...factors are poorly understood. This study aimed to determine the influence of fitness on exercise BP and its relationship with LVMI in adolescents.
Methods
4835 adolescents from the Avon Longitudinal Study of Parents and Children, aged 15.4(0.3) years, 49% male completed a submaximal cycle test. Exercise BP was measured immediately on test cessation and fitness calculated as physical work capacity 170 adjusted for lean body-mass. LVMI (n = 1589), cardiac output (CO, n = 1628) and total peripheral resistance (TPR, n = 1628) were measured by echocardiography 2.4 (0.4) years later.
Results
Each unit of fitness was associated with a 6.46 mmHg increase (95% CI: 5.83, 7.09) in exercise systolic BP. Exercise systolic BP increased step-wise by third of fitness (difference 6.06 mmHg, 95% CI:4.99, 7.13 first vs. middle; 11.13 mmHg, 10.05, 12.20 middle vs. highest). Each 5 mmHg increase in exercise systolic BP was associated with 0.25 g/m
2
. 7 (0.16–0.35) greater LVMI, attenuated with adjustment for fitness. There was evidence of an interaction between fitness and exercise BP on LVMI, more-marked in the middle fitness third (difference −0.27g/m2.7, −0.51,0.04 vs. first third), but similar in lowest and highest fitness thirds. CO increased (difference 0.06 L/min, −0.05,0.17; 0.23 L/min, 0.12,0.34), TPR decreased (difference −0.13AU, −0.84,0.59; −1.08AU, −0.1.80,−0.35 with fitness.
Conclusion
Fitness may modify associations between exercise BP and LVMI in adolescence. Higher CO, but lower TPR suggests a physiological exercise BP-LVMI relationship with higher fitness, rather than pathological elevations in exercise BP and LVMI.
Background: When the Avon Longitudinal Study of Parents and Children (ALSPAC) was planned, it was assumed that the clinical obstetric data would be easily accessible from the newly developed National ...Health Service computerised ‘STORK’ system. Pilot studies, however, showed that, although fairly accurate in regard to aspects of labour and delivery, it was, at the time (1990-2), inadequate for identifying the full antenatal and postnatal details of clinical complications and treatments of the women in the Study. Methods: A scheme was therefore developed to train research staff to find and abstract relevant details from clinical records onto proformas designed for the purpose. Extracting such data proved very time consuming (up to six hours for complicated pregnancies) and consequently expensive. Funding for the enterprise was obtained piecemeal using specific focussed grants to extract data for subsamples of the Study, including a random sample to serve as controls. Results: To date, detailed records have been completed for 8369 pregnancies, and a further 5336 (13,705 in total) have complete details on specific prenatal areas, including serial measures of maternal blood pressure, proteinuria and weight. In this Data Note we describe the information abstracted from the obstetric medical records concerning the mother during pregnancy, labour, delivery and the first two weeks of the puerperium. Information abstracted relating to the fetus (including fetal monitoring, presentation, method of delivery) and neonate (signs of asphyxia, resuscitation, treatment and well-being) will be described in a further Data Note. Conclusions: These data add depth to ALSPAC concerning ways in which the signs and symptoms, procedures and treatments of the mother prenatally, intrapartum and postnatally, may impact on the long-term health and development of both mother and child. They augment the data collected from the mothers’ questionnaires and the ‘STORK’ digital hospital data.
All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the ...identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance.
Data form obese women (BMI ≥ 30 kg/m
) with singleton pregnancies included in the UPBEAT trial were used in this analysis. Multivariable logistic regression was used to identify sociodemographic, clinical and biochemical factors at 15
to 18
weeks' gestation associated with uncomplicated pregnancy and birth, defined as delivery of a term live-born infant without antenatal or labour complications. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Internal validation and calibration were also performed. Women were divided into fifths of risk and pregnancy outcomes were compared between groups. Sensitivity, specificity, and positive and negative predictive values were calculated using the upper fifth as the positive screening group.
Amongst 1409 participants (BMI 36.4, SD 4.8 kg/m
), the prevalence of uncomplicated pregnancy and birth was 36% (505/1409). Multiparity and increased plasma adiponectin, maternal age, systolic blood pressure and HbA1c were independently associated with uncomplicated pregnancy and birth. These factors achieved an AUROC of 0.72 (0.68-0.76) and the model was well calibrated. Prevalence of gestational diabetes, preeclampsia and other hypertensive disorders, preterm birth, and postpartum haemorrhage decreased whereas spontaneous vaginal delivery increased across the fifths of increasing predicted risk of uncomplicated pregnancy and birth. Sensitivity, specificity, and positive and negative predictive values were 38%, 89%, 63% and 74%, respectively. A simpler model including clinical factors only (no biomarkers) achieved an AUROC of 0.68 (0.65-0.71), with sensitivity, specificity, and positive and negative predictive values of 31%, 86%, 56% and 69%, respectively.
Clinical factors and biomarkers can be used to help stratify pregnancy and delivery risk amongst obese pregnant women. Further studies are needed to explore alternative pathways of care for obese women demonstrating different risk profiles for uncomplicated pregnancy and birth.
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