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Aging underlies heterogeneity between comorbidity and multimorbidity frameworks.

Marco Vincenzo Lenti1, Catherine Klersy2, Alice Silvia Brera1

  • 1Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.

Internal and Emergency Medicine
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Summary

Age, not the number of diseases, significantly impacts patient outcomes in hospitals. This study found age is the primary driver of differences between comorbid and multimorbid patients and influences mortality and readmission rates.

Keywords:
Chronic diseaseClinical complexityMultiple chronic conditionsPolypharmacy

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Area of Science:

  • Geriatrics
  • Internal Medicine
  • Epidemiology

Background:

  • Distinguishing between comorbidity and multimorbidity is crucial for understanding patient complexity.
  • Multiple chronic conditions (MCC) are prevalent in hospitalized patients, necessitating clear definitions and impact assessments.

Purpose of the Study:

  • To evaluate the prevalence of comorbidity and multimorbidity in an internal medicine ward.
  • To compare these conditions with patient characteristics, including age, Cumulative Illness Rating Scale (CIRS) index, polytherapy, and mortality.
  • To determine the independent predictors of in-hospital and 30-day mortality and readmission.

Main Methods:

  • Single-center, observational study of 1394 consecutive internal medicine patients.
  • Categorization of patients into no MCC, comorbidity, and multimorbidity groups.
  • Statistical comparison with CIRS index, age, gender, polytherapy, 30-day readmission, and mortality data.

Main Results:

  • 96.2% of patients had MCC; 20.5% had comorbidity, and 75.7% had multimorbidity.
  • Both age and CIRS index increased significantly with the progression from comorbidity to multimorbidity (p < 0.001).
  • Age was independently associated with in-hospital mortality, 30-day mortality, and 30-day readmission (p < 0.05), whereas comorbidity and multimorbidity were not.

Conclusions:

  • Age is the most significant factor differentiating comorbid and multimorbid patients.
  • Age independently predicts major adverse outcomes in a hospital setting, overshadowing the mere presence of multiple conditions.