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Multicentric Assessment of a Multimorbidity-Adjusted Disability Score to Stratify Depression-Related Risks Using Temporal Disease Maps: Instrument Validation Study.
González-Colom, Rubèn; Mitra, Kangkana; Vela, Emili; Gezsi, Andras; Paajanen, Teemu; Gál, Zsófia; Hullam, Gabor; Mäkinen, Hannu; Nagy, Tamas; Kuokkanen, Mikko; Piera-Jiménez, Jordi; Roca, Josep; Antal, Peter; Juhasz, Gabriella; Cano, Isaac.
Afiliação
  • González-Colom R; Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
  • Mitra K; Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
  • Vela E; Catalan Health Service, Barcelona, Spain.
  • Gezsi A; Digitalization for the Sustainability of the Healthcare - Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.
  • Paajanen T; Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary.
  • Gál Z; Department of Public Health and Welfare, Finnish Health and Welfare Institute, Helsinki, Finland.
  • Hullam G; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.
  • Mäkinen H; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
  • Nagy T; Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary.
  • Kuokkanen M; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
  • Piera-Jiménez J; Department of Public Health and Welfare, Finnish Health and Welfare Institute, Helsinki, Finland.
  • Roca J; Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary.
  • Antal P; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.
  • Juhasz G; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
  • Cano I; Department of Public Health and Welfare, Finnish Health and Welfare Institute, Helsinki, Finland.
J Med Internet Res ; 26: e53162, 2024 Jun 24.
Article em En | MEDLINE | ID: mdl-38913991
ABSTRACT

BACKGROUND:

Comprehensive management of multimorbidity can significantly benefit from advanced health risk assessment tools that facilitate value-based interventions, allowing for the assessment and prediction of disease progression. Our study proposes a novel methodology, the Multimorbidity-Adjusted Disability Score (MADS), which integrates disease trajectory methodologies with advanced techniques for assessing interdependencies among concurrent diseases. This approach is designed to better assess the clinical burden of clusters of interrelated diseases and enhance our ability to anticipate disease progression, thereby potentially informing targeted preventive care interventions.

OBJECTIVE:

This study aims to evaluate the effectiveness of the MADS in stratifying patients into clinically relevant risk groups based on their multimorbidity profiles, which accurately reflect their clinical complexity and the probabilities of developing new associated disease conditions.

METHODS:

In a retrospective multicentric cohort study, we developed the MADS by analyzing disease trajectories and applying Bayesian statistics to determine disease-disease probabilities combined with well-established disability weights. We used major depressive disorder (MDD) as a primary case study for this evaluation. We stratified patients into different risk levels corresponding to different percentiles of MADS distribution. We statistically assessed the association of MADS risk strata with mortality, health care resource use, and disease progression across 1 million individuals from Spain, the United Kingdom, and Finland.

RESULTS:

The results revealed significantly different distributions of the assessed outcomes across the MADS risk tiers, including mortality rates; primary care visits; specialized care outpatient consultations; visits in mental health specialized centers; emergency room visits; hospitalizations; pharmacological and nonpharmacological expenditures; and dispensation of antipsychotics, anxiolytics, sedatives, and antidepressants (P<.001 in all cases). Moreover, the results of the pairwise comparisons between adjacent risk tiers illustrate a substantial and gradual pattern of increased mortality rate, heightened health care use, increased health care expenditures, and a raised pharmacological burden as individuals progress from lower MADS risk tiers to higher-risk tiers. The analysis also revealed an augmented risk of multimorbidity progression within the high-risk groups, aligned with a higher incidence of new onsets of MDD-related diseases.

CONCLUSIONS:

The MADS seems to be a promising approach for predicting health risks associated with multimorbidity. It might complement current risk assessment state-of-the-art tools by providing valuable insights for tailored epidemiological impact analyses of clusters of interrelated diseases and by accurately assessing multimorbidity progression risks. This study paves the way for innovative digital developments to support advanced health risk assessment strategies. Further validation is required to generalize its use beyond the initial case study of MDD.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Multimorbidade Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: J Med Internet Res Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Multimorbidade Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Revista: J Med Internet Res Ano de publicação: 2024 Tipo de documento: Article