Associations between multiple long-term conditions and mortality in diverse ethnic groups.
<h4>Background</h4>Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple co...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0266418 |
| _version_ | 1811245276868902912 |
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| author | Mai Stafford Hannah Knight Jay Hughes Anne Alarilla Luke Mondor Anna Pefoyo Kone Walter P Wodchis Sarah R Deeny |
| author_facet | Mai Stafford Hannah Knight Jay Hughes Anne Alarilla Luke Mondor Anna Pefoyo Kone Walter P Wodchis Sarah R Deeny |
| author_sort | Mai Stafford |
| collection | DOAJ |
| description | <h4>Background</h4>Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England.<h4>Methods and findings</h4>A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Long-term conditions were counted from a list of 32 that have previously been associated with greater primary care, hospital admissions, or mortality risk. Cox regression models were used to estimate mortality by count of conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional condition at baseline was associated with increased mortality. The direction of the interaction of number of conditions with ethnicity showed a statistically higher mortality rate associated with long-term conditions in Pakistani, Black African, Black Caribbean and Other Black ethnic groups. In ethnicity-stratified models, the mortality rate per additional condition at age 50 was 1.33 (95% CI 1.31,1.35) for White ethnicity, 1.43 (95% CI 1.26,1.61) for Black Caribbean ethnicity and 1.78 (95% CI 1.41,2.24) for Other Black ethnicity.<h4>Conclusions</h4>The higher mortality rate associated with having multiple conditions is greater in minoritised compared with White ethnic groups. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups. |
| first_indexed | 2024-04-12T14:38:17Z |
| format | Article |
| id | doaj.art-a63626ab6e40419dbc4e541dfc4f2d83 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T14:38:17Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a63626ab6e40419dbc4e541dfc4f2d832022-12-22T03:29:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01174e026641810.1371/journal.pone.0266418Associations between multiple long-term conditions and mortality in diverse ethnic groups.Mai StaffordHannah KnightJay HughesAnne AlarillaLuke MondorAnna Pefoyo KoneWalter P WodchisSarah R Deeny<h4>Background</h4>Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England.<h4>Methods and findings</h4>A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Long-term conditions were counted from a list of 32 that have previously been associated with greater primary care, hospital admissions, or mortality risk. Cox regression models were used to estimate mortality by count of conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional condition at baseline was associated with increased mortality. The direction of the interaction of number of conditions with ethnicity showed a statistically higher mortality rate associated with long-term conditions in Pakistani, Black African, Black Caribbean and Other Black ethnic groups. In ethnicity-stratified models, the mortality rate per additional condition at age 50 was 1.33 (95% CI 1.31,1.35) for White ethnicity, 1.43 (95% CI 1.26,1.61) for Black Caribbean ethnicity and 1.78 (95% CI 1.41,2.24) for Other Black ethnicity.<h4>Conclusions</h4>The higher mortality rate associated with having multiple conditions is greater in minoritised compared with White ethnic groups. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.https://doi.org/10.1371/journal.pone.0266418 |
| spellingShingle | Mai Stafford Hannah Knight Jay Hughes Anne Alarilla Luke Mondor Anna Pefoyo Kone Walter P Wodchis Sarah R Deeny Associations between multiple long-term conditions and mortality in diverse ethnic groups. PLoS ONE |
| title | Associations between multiple long-term conditions and mortality in diverse ethnic groups. |
| title_full | Associations between multiple long-term conditions and mortality in diverse ethnic groups. |
| title_fullStr | Associations between multiple long-term conditions and mortality in diverse ethnic groups. |
| title_full_unstemmed | Associations between multiple long-term conditions and mortality in diverse ethnic groups. |
| title_short | Associations between multiple long-term conditions and mortality in diverse ethnic groups. |
| title_sort | associations between multiple long term conditions and mortality in diverse ethnic groups |
| url | https://doi.org/10.1371/journal.pone.0266418 |
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