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Survival in relation to multimorbidity patterns in older adults in primary care in Barcelona, Spain (2010–2014): a longitudinal study based on electronic health records
  1. Carolina Ibarra-Castillo1,
  2. Marina Guisado-Clavero1,2,3,
  3. Concepció Violan-Fors1,2,
  4. Mariona Pons-Vigués1,2,4,
  5. Tomàs López-Jiménez1,2,
  6. Albert Roso-Llorach1,2
  7. Collaborators
    1. 1 Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
    2. 2 Universitat Autònoma de Barcelona, Bellaterra, Spain
    3. 3 Institut Català de la Salut, Barcelona, Spain
    4. 4 Universitat de Girona, Girona, Spain
    1. Correspondence to Mr Albert Roso-Llorach, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona 08007, Spain; aroso{at}


    Background Several studies have analysed the characteristics of multimorbidity patterns but none have evaluated the relationship with survival. The purpose of this study was to compare survival across older adults with different chronic multimorbidity patterns (CMPs).

    Methods Prospective longitudinal observational study using electronic health records for 190 108 people aged ≥65 years in Barcelona, Spain (2009–2014). CMPs were identified by cluster analysis. Mortality rates were estimated using the Catalan population structure and individual time at risk. Survival according to CMP (Cox regression) was analysed using hazard ratios (HRs) and 95% confidence intervals (CIs) with stratification by sex and age group (65–79, 80–94) and adjustment for age at onset, deprivation index, number of chronic conditions and invoiced drugs.

    Results The highest mortality rates were observed in men, adults aged 80–94 years, socially disadvantaged quintiles and people prescribed more drugs and with fewer conditions. Using the musculoskeletal pattern as the reference category, men with the digestive-respiratory pattern had a higher risk of death, with adjusted HRs of 6.16 (95% CI 5.37 to 7.06) in the 65–79 age group and 2.62 (95% CI 2.31 to 2.97) in the 80–94 age group. In women, the cardiovascular pattern was associated with the highest risk, with adjusted HRs of 6.34 (95% CI 5.28 to 7.61) in the 65–79 age group and 3.05 (95% CI 2.73 to 3.41) in the 80–94 age group. These patterns were also associated with the highest mortality rates.

    Conclusions Mortality and survival vary according to CMPs in older adults stratified by sex and age. Our findings are useful for guiding the design and implementation of clinical management strategies.

    • Ageing
    • multimorbidity
    • survival analysis
    • chronic disease
    • primary health care

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    • CI-C and MG-C contributed equally.

    • Contributors CI-C, MG-C: conception and design; CI-C, AR-L, TL-J: analysis of data; CI-C, MG-C, AR-L, TL-J: data analysis tools; all authors: drafting of article.

    • Funding This manuscript constitutes a part of the Public Health Master of Science of CI-C and the PhD thesis of MG-C in the Public Health Department of the Universitat Autònoma de Barcelona. This work was supported by a predoctoral grant from Catalan Health Institute in Barcelona; by the Catalan Society of General Practitioners (CAMFiC) and by SIDIAP grant to MG-C in 2015; this latter organisation allowed us to explore their dataset to obtain the results. This study was also funded through the Network for Prevention and Health Promotion in Primary Health Care (redIAPP, RD12/0005/0001; RD16/0007/001). The funders had no role in the study design or data collection, analysis and interpretation; writing of the manuscript; and decision to submit for publication.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval The study protocol was approved by the Clinical Research Ethics Committee at Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) (P17/026).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Enriqueta Pujol-Ribera, Talita Duarte-Salles, Anne Murray.