Does age modify the relationship between morbidity severity and physical health in English and Dutch family practice populations?
To investigate the co-influences of age and morbidity severity on physical health in adult family practice populations.
Morbidity data in a 12-month period for 7,833 older English consulters aged 50 years and over and 6,846 Dutch consulters aged 18 years and over was linked to their physical health status obtained from cross-sectional health surveys. Individual patients were categorised using 78 consulting morbidities classified by a chronicity measure (acute, acute-on-chronic and chronic) into an ordinal scale of morbidity severity ranging from single to multiple chronicity groups. Associations between morbidity severity, age and SF-12 Physical Component Summary (PCS) score were assessed using linear regression methods.
Increased age and higher morbidity severity were significantly associated with poorer physical health. Of the explained total variance in adjusted PCS scores, an estimated 43% was attributed to increasing age, 40% to morbidity severity and 17% to deprivation for English consulters; the figures were 21, 42 and 31%, respectively for Dutch consulters. The largest differences in PCS scores between severity categories were observed in the younger age groups.
Morbidity severity and age mainly act separately in adversely influencing physical health. In ageing populations who will experience higher multimorbidity, this study underlines the importance that health care and public health will need to address morbidity severity and ageing as related but distinct issues.
KeywordsAgeing Comorbidity Epidemiologic studies Family practice Quality of life
UTK is currently funded by a National Institute for Health Research Post-Doctoral Fellowship, and was funded by the Medical Research Council (MRC) Training Fellowship in Health Services Research at the start of this work. Project funding was from the Claire Wand Fund, North Staffordshire Primary Care Research Consortium, MRC Programme grant and NHS Research and Development funds.
- 5.Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59(3), 255–263.PubMedGoogle Scholar
- 7.van den Akker, M., Buntinx, F., Metsemakers, J. F., Roos, S., & Knottnerus, J. A. (1998). Multimorbidity in general practice: Prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. Journal of Clinical Epidemiology, 51(5), 367–375. doi: 10.1016/S0895-4356(97)00306-5.CrossRefPubMedGoogle Scholar
- 13.Guccione, A. A., Felson, D. T., Anderson, J. J., Anthony, J. M., Zhang, Y., Wilson, P. W., et al. (1994). The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. American Journal of Public Health, 84(3), 351–358. doi: 10.2105/AJPH.84.3.351.CrossRefPubMedGoogle Scholar
- 17.Guralnik, J. M., Ferrucci, L., Penninx, B. W., Kasper, J. D., Leveille, S. G., Bandeen-Roche, K., et al. (1999). New and worsening conditions and change in physical and cognitive performance during weekly evaluations over 6 months: The Women’s Health and Aging Study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 54(8), M410–M422.PubMedGoogle Scholar
- 20.Kadam, U. T., Schellevis, F. G., van der Windt, D. A. W. M., de Vet, H. C. W., Bouter, L. M., & Croft, P. R. (2008). Morbidity severity classifying routine consultations from English and Dutch general practice indicated physical health status. Journal of Clinical Epidemiology, 61(4), 386–393. doi: 10.1016/j.jclinepi.2007.05.014.CrossRefPubMedGoogle Scholar
- 22.Thomas, E., Wilkie, R., Peat, G., Hill, S., Dziedzic, K., & Croft, P. (2004). The North Staffordshire Osteoarthritis Project—NorStOP: Prospective, 3-year study of the epidemiology and management of clinical osteoarthritis in a general population of older adults. BMC Musculoskeletal Disorders, 5, 2. doi: 10.1186/1471-2474-5-2.CrossRefPubMedGoogle Scholar
- 23.Westert, G. P., Schellevis, F. G., de Bakker, D. H., Groenewegen, P. P., Bensing, J. M., & van der Zee, J. (2005). Monitoring health inequalities through general practice: The Second Dutch National Survey of General Practice. European Journal of Public Health, 15(1), 59–65. doi: 10.1093/eurpub/cki116.CrossRefPubMedGoogle Scholar
- 24.Harding, A., & Stuart-Buttle, C. (1998). The development and role of the Read Codes. Journal of American Health Information Management Association, 69(5), 34–38.Google Scholar
- 28.Townsend, P., Phillimore, P., & Beattie, A. (1988). Health and deprivation: Inequality and the north. London: Croom Helm.Google Scholar
- 31.Schram, M. T., Frijters, D., van de Lisdonk, E. H., Ploemacher, J., de Craen, A. J., de Waal, M. W., et al. (2008). Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. Journal of Clinical Epidemiology, 61(11), 1104–1112. doi: 10.1016/j.jclinepi.2007.11.021.CrossRefPubMedGoogle Scholar