1. J Browne, DA Edwards, KM Rhodes, DJ Brimicombe, RA Payne
The association of multimorbidity with health service utilisation among patients with dementia in the UK: a population-based study
J Browne, DA Edwards, KM Rhodes, DJ Brimicombe, RA Payne

2. Background Ageing population Increasing prevalence of dementia
Changing demands on healthcare and social care funding and service design
CSHA = Canadian Study of Health and Aging
Canadian Study of Health and Aging

3. Background It’s not just about “dementia patients”
Dementia is commonly associated with additional comorbidities
CSHA = Canadian Study of Health and Aging
Barnett, Lancet 2012

4. How do comorbidities impact upon health service utilisation in the dementia population?

5. Methods Retrospective cohort study CPRD
Incident dementia cases diagnosed 2008/9
65 Read codes, including any subtype and unspecified
5-year follow-up
minimum 3-months

6. Methods
Barnett, Lancet 2012

7. Methods Primary care consultations All hospital admissions
All primary care prescriptions
Time to death

8. Methods Association between comorbidity count and outcome
Negative binomial regression (service use)
Cox regression (death)
Adjustment for age, gender, practice, dementia treatment, deprivation

9. Baseline characteristics
Comorbidity count
0 or 1
2 or 3
4 or 5
6 or more
Number of patients
1071 (21%)
1691 (34%)
1391 (28%)
846 (17%)
Female (%)
67%
64%
61%
Age, mean (SD)
79.5 (9.2)
81.4 (7.8)
82.0 (7.8)
82.7 (7.0)
<80 years (%)
48%
38%
34%
31%
80-89 years (%)
42%
52%
53%
58%
≥90 years (%)
10%
11%
13%
Dementia Rx (%)
37%
33%
28%
24%

10. Prevalence of comorbidities

11. Primary care consultations
Service utilisation
Primary care consultations
Hospitalisations
Prescriptions
Comorbidity count
Annual rate
Rate ratio (95% CI)
0 or 1
15.9
0.81
( )
0.7
0.88
( ) 51
0.55
( )
2 or 3
18.4
Ref 85
4 or 5
19.9
1.13
( )
0.9
1.19
( )
107
1.34
( )
6 or more
21.3
1.31
( )
1.1
1.62
( )
122
1.68
( )
Mean follow-up 3.0 years

12. Survival Death rate 12.7 per 100 patient years
HR 1.56 (95% CI ), ≥6 vs. 2-3 comorbidities
p<0.001
Age and gender adjusted

13. Consequences
For a woman aged years with 6 or more comorbidities, over 3 years:
18 more consultations
131 more prescriptions
2 more hospitalisations
Additional cost £5137
(compared to similar individual with 2-3 comorbidities)

14. Strengths and limitations
First such study in UK
Large, representative sample
Range of relevant outcomes
Misclassification of comorbidities varying with health service contact
Crude measures of service use
Differential loss to follow-up

15. Conclusions Comorbidities are very common in the context of dementia
Comorbidities drive a substantial increase in health service utilisation
Multimorbidity must be considered when planning care services for people with dementia