Abstract
The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65 years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan–Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5 years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan–Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions.
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Funding
The authors disclose receipt of the following financial support: ELES-PS (ref: CSO2011-30210-C02-01), funded by the I+D+I National Plan, Spanish Ministry of Education and Science; ENCAGE-CM (ref: S2015/HUM-3367), funded by the I+D Activity Program of Madrid Community research groups on social sciences and humanities and co-funded by the European Social Fund; and ENVACES (ref: CSO2015-64115-R), funded by the Spanish Ministry of Economy, Industry and Competitiveness and co-funded by the European Social Fund. In addition, this work arises from the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS), which has received funding from the European Union, in the framework of the Health Programme (2008–2013). Sole responsibility lies with the author, and the Consumers, Health, Agriculture and Food Executive Agency is not responsible for any use that may be made of the information contained therein.
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Wijers, I.G.M., Ayala, A., Rodriguez-Blazquez, C. et al. The Disease Burden Morbidity Assessment in older adults and its association with mortality and other health outcomes. Eur J Ageing 16, 193–203 (2019). https://doi.org/10.1007/s10433-018-0491-2
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DOI: https://doi.org/10.1007/s10433-018-0491-2