Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy).

OBJECTIVE: Chronic comorbidities are common in people with multiple sclerosis (PwMS), thus worsening their prognosis and quality of life, and increasing disease burden. The aim of the present study was to evaluate the prevalence of common comorbidities in PwMS in Tuscany (Central Italy) and to compare it with the general population. METHODS: The prevalence of comorbidities, including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, stroke, heart failure (HF), cardiac infarction and ischemic heart disease (IHD), was assessed in PwMS and in general population resident in Tuscany, aged > 20 years, using administrative data. RESULTS: In total, we identified 8,274 PwMS. Among them, 34% had at least one comorbidity, with hypertension being the most common (28.5%). Comparing PwMS with the general population, PwMS had a higher frequency of hypertension and stroke when considering the whole group, and of diabetes, COPD, and IHD when considering sex and age subgroups. This increased risk was especially evident in the young and intermediate age groups, where multiple sclerosis may play an important role as risk factor for some comorbidities. In PwMS, as well as in the general population, prevalence of chronic diseases was higher in males and increased with age. CONCLUSIONS: Comorbidities frequently coexist with multiple sclerosis and they may have an impact on this complex disease, from the health, clinical, and socioeconomic points of view. Therefore, a routine screening of chronic comorbidities should be a crucial step in clinical practice, as well as the promotion of healthy lifestyles to prevent the onset and to reduce their burden.

Increasing prevalence of multiple sclerosis in Tuscany, Italy.

BACKGROUND AND RATIONALE: An increase of prevalence and incidence of multiple sclerosis (MS) has been reported in several countries, especially taking into account a long-term evaluation. This increasing trend often reflects improved case identification and ascertainment due to the refinement of diagnostic criteria. The aim of this study was to update the prevalence rate of MS in Tuscany (central Italy) as of 2017, and to assess if there has been an increasing trend of prevalence in this Region considering a short period of analysis, from 2014 to 2017. METHODS: To capture prevalent cases, a case-finding algorithm based on administrative data, previously created and validated, was used. As data sources, we considered hospital discharge records, drug-dispensing records, disease-specific exemptions from copayment to health care, home and residential long-term care, and inhabitant registry. RESULTS: As of January 1, 2017, 7809 cases were identified, of which 69.4% were females and 30.6% were males. Considering temporal variation, an increasing trend was observed, with standardized rates rising from 189.2 in 2014 to 208.7 per 100,000 in 2017. CONCLUSIONS: Results confirm that prevalence increases every year, probably mainly due to the difference between incidence and mortality, resulting in an increasing trend. Moreover, administrative data may accurately identify MS patients in a routinary way and monitor this cohort along disease care pathways.

Prevalence and clustering of chronic diseases in Tuscany (Central Italy): evidence from a large administrative data warehouse.

BACKGROUND: chronic diseases and multimorbidity are on the rise and have a great impact on health and services. OBJECTIVES: to assess the prevalence and patterns of chronic diseases. DESIGN: cross-sectional population-based study on administrative data. SETTING AND PARTICIPANTS: the study includes 3,234,276 Tuscany (Central Italy) inhabitants aged over 15, observed as at 01.01.2019. MAIN OUTCOME MEASURES: subjects were classified as affected or not affected by one of the 17 chronic diseases considered, according to administrative data algorithms. Population prevalence was estimated overall and stratified by gender, age range, and socioeconomic level. A factor analysis was performed in order to evaluate multimorbidity. RESULTS: in Tuscany, 444.8 per 1,000 inhabitants aged over 15 have a chronic disease. The prevalence is 463.5 per 1,000 among females and 424.5 per 1,000 among males, but the two age-adjusted prevalences are equal. The prevalence of chronic patients increases with the level of socioeconomic disadvantage. The most frequent disease is hypertension (308.7 per 1,000), followed by dyslipidaemia (251 per 1,000) and diabetes (75.7 per 1,000). Inflammatory rheumatic diseases and neurological diseases are more prevalent among females than males. The prevalence identified among males almost doubles in comparison to females for all other diseases, in particular for circulatory system diseases. Chronic patients suffer from at least two pathologies in 53.2% of cases. On average, males have more diseases than females. The cardiovascular factor (circulatory system diseases and related) and the neurological factor (neurological diseases and mental disorders) emerged from the factor analysis. CONCLUSIONS: this study quantifies the burden of chronic diseases in the population, which is useful information in epidemiology, in clinical practice, and in services management.

Postal screening can identify frailty and predict poor outcomes in older adults: longitudinal data from INTER-FRAIL study.

OBJECTIVE: identification of older individuals at risk for health-related adverse outcomes (HRAO) is necessary for population-based preventive interventions. Aim of this study was to improve a previously validated postal screening questionnaire for frailty in non-disabled older subjects and to test its prognostic validity in a vast sample of older community-dwellers. METHODS: individuals aged 70+ underwent a mass postal screening. Physical frailty phenotype (PFP) was assessed in the unselected subsample of the first responders. After a 1-year follow-up, HRAO were recorded in the whole sample, including survival, access to Emergency Department, hospitalisation and Long-Term Care admission. RESULTS: the questionnaire was mailed to 17,273 subjects, whose response rate was 55%. Among the first 1,037 responders without overt disability, the revised questionnaire was 75% sensitive and 69% specific for PFP (ROC 0.772). Non-disabled subjects who screened positive had a higher risk of HRAO in comparison with those who screened negative and similar to non-responders. Risk of adverse outcome was highest among disabled subjects. CONCLUSIONS: a simple questionnaire delivered by mail has good accuracy in detecting PFP in non-disabled older subjects and is able to predict HRAO.

[The study "Social health need of elderly people in Tuscany (Italy)": an example of epidemiology inside a regional programming cycle]. / Lo studio "Bisogno sociosanitario degli anziani in Toscana": un esempio di epidemiologia integrata in un ciclo di programmazione regionale.

OBJECTIVE: in 2008,Tuscany Region (Italy) allocated the "Regional Fund for Disabled Elderly People" to support a dedicated local welfare system mainly characterised by universal access and resource allocation proportional to assessed individuals' personal care needs. To assure sustainability, reliable estimates of disabled elderly people living in the Region, stratified by level of personal care needs, were needed. For such a purpose, in 2009, the Regional Health Agency of Tuscany conducted a survey called Bi.S.S. DESIGN: cross-sectional survey inside the resident population over 65 years. A structured questionnaire was used for detection: it contains the same multidimensional evaluation instruments used by Multidisciplinary Evaluation Units of the region. SETTING AND PARTICIPANTS: sample of Tuscany population over 65 years; stratified sampling by gender, age and residence zone (No. 2.551). Cases were extracted from the inhabitants registry of Tuscany. Evaluation data were collected only for the elderly who lived at home. MAIN OUTCOMEMEASURES: prevalence estimation and current and forecasted expected cases (by gender and age) of home resident disabled elderly people (according to inability to perform basic activities of daily living), by level of personal care needs (according to a pre-defined scale ranging 1-5, based on the level of dependence in performing basic activities of daily living, cognitive impairments and behaviour disorders). Expected cases were calculated on demographic data supplied by the Italian National Institute of Statistic (ISTAT). RESULTS: about 67,000 home resident disabled elderly people (49,000 women and 18,000 men) are currently expected to live in Tuscany, equal to 7.8% of the population aged 65 years and over. Of these, about 13,000 are classified at level of personal care needs 1; 7,500 at level 2; 15,500 at level 3; 24,000 at level 4; and 7,000 at level 5. By 2015, disabled elderly people living in Tuscany are expected to increase up to 80,500. CONCLUSIONS: on the basis of the available resources and of these results, amount of resources to be allocated for the personal care of the individual disabled people according to his/her level of care needs have been decided. Therefore, Bi.S.S. has been a good example of an epidemiological survey fully integrated in a regional programming plan. The expected increase in the next future of elderly disabled people calls for urgent prevention programmes and organization of cost-effective personal care services.

[A screening and comprehensive assessment programme aimed at secondary prevention of disability in community-dwelling frail older subjects: a pilot study]. / Screening della fragilità e valutazione multidimensionale degli anziani residenti a domicilio per la prevenzione secondaria della disabilità: risultati di uno studio pilota.

OBJECTIVE: to test a screening and comprehensive assessment procedures for frail elderly in Tuscany (Central Italy) in the perspective of interventions to prevent disability. DESIGN: two-phases feasibility study: a) screening phase, using a postal questionnaire and b) comprehensive assessment phase, aimed at identifying risk factors for disability that might be targeted by specific interventions. SETTING AND PARTICIPANTS: 11,589 individuals aged over 70, living at home, identified from residents registry of 2 health care districts in Tuscany, excluding subjects with recognized disability and those living in nursing home. Participants were sent a 7-item postal questionnaire (modified Sherbrooke Postal Questionnaire). Respondents with a score =3, suggestive of frailty, were offered an in-home comprehensive assessment performed by a nurse or social worker, oriented to ascertain independence in activities of daily living, lower limbs extremity function, mood status, malnutrition risk, cognitive level, visual acuity, hearing function, environmental risk and medications number. General practitioners, social workers or specific health care services were thereafter informed about results of the assessment with recommendations for specific interventions. RESULTS: among 6,629 respondents to the questionnaire, 52% (No. 3,432) scored =3, triggering the comprehensive assessment, which was performed in 66% of cases (No. 2,276). Out of them, 38% showed already a disability in basic activities of daily living. Of the remaining 1,411, 38% showed a disability in instrumental activities of daily living, 30% a reduced lower limb extremity function, 18% depressive symptoms, and 11% a cognitive impairment. Human resources used for the project were limited in relation to the extent of the involved population. CONCLUSIONS: postal screening of frailty in older subjects is feasible and is able to identify patients who might benefit from further assessment to address interventions for specific risk factors.

Screening for frailty in older adults using a postal questionnaire: rationale, methods, and instruments validation of the INTER-FRAIL study.

OBJECTIVES: To develop and test a postal screening questionnaire to intercept frailty in older community-dwelling individuals. DESIGN: A questionnaire was developed on the basis of expert consensus and preliminarily tested against the occurrence of incident disability, in secondary analyses of previous epidemiological studies. The questionnaire was then mailed and its concurrent validity, defined from the association between its individual items and summary score and the presence of the Fried frailty phenotype (FFP), was subsequently evaluated cross-sectionally with in-person examination of initial participants. SETTING: Community-based. PARTICIPANTS: Individuals aged 70 and older living in two communities near Florence, Italy. MEASUREMENTS: A home comprehensive geriatric assessment including the FFP was conducted in participants who screened positive for frailty and in a limited sample of negative responders. RESULTS: A 10-item questionnaire, developed based on expert consensus, was preliminarily tested on preexisting epidemiological data and showed an area under the receiver operating characteristic curve (AUC) of 0.716 versus incident disability. The questionnaire was then mailed to 15,774 subjects, whose response rate was 53.6%. Of the first 1,037 participants included in the concurrent validation study, 833 (80.3%) screened positive, and 380 (36.6%) were frail on assessment. The ability of the questionnaire summary score to predict frailty was adequate, with an AUC of 0.695, a sensitivity of 71%, and a specificity of 58%. CONCLUSION: A simple questionnaire delivered by mail was able to identify FFP in the community. This would facilitate large-scale screening for frailty in older persons.