Introduction
This study aimed to identify specific combinations of chronic conditions associated with increased risks of hospitalisation and mortality during the winter of 2021–22, a period that coincided with the third wave of the COVID-19 pandemic. Using comprehensive population-based data from England, the research aimed to inform health policies aimed at reducing pressures on the healthcare system during the winter.
Methods
Anonymised data from the General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), hospitalisation statistics and death records from the Office for National Statistics were used. The analysis included 48,253,125 adult individuals, monitored between 1 December 2021 and 31 March 2022.
• Main Exposure: Combinations of 59 chronic conditions were analyzed and subsequently reduced to 19 conditions considered most clinically relevant.
• Outcomes: All-cause hospitalizations and deaths during the study period.
• Analytical Models: Poisson regression models adjusted for age, sex, ethnicity and social deprivation index were used to calculate incidence ratios of hospitalization and mortality.
Results
1. Risk of Hospitalization:
• Individuals without chronic conditions had a hospitalization rate of 96.3 per 1,000 person-years.
• The highest rate of hospitalization was observed in people with cancer, chronic kidney disease, cardiovascular disease and type 2 diabetes, reaching 1,643 per 1,000 person-years.
• Cardiovascular diseases were present in almost all combinations of increased risk of hospitalization.
2. Mortality Risk:
• Individuals without chronic conditions had a mortality rate of 1 per 1,000 person-years.
• The combination of chronic kidney disease, cardiovascular disease, dementia and cancer was the most lethal, with a mortality rate of 346 per 1,000 person-years.
• Dementia associated with cardiovascular disease appeared in all combinations of increased mortality risk.
3. Demographic Inequalities:
• Individuals with multiple chronic conditions were generally older (mean age 61.4 years), predominantly female (61.3%), and predominantly white (88.7%).
Discussion
The study highlighted the critical impact of specific combinations of chronic conditions, especially those involving cardiovascular disease, kidney disease, and dementia. These conditions were associated with a substantial increase in demand for health services and mortality risk. The findings reinforce the need for targeted preventive interventions and integrated management for these high-risk populations, particularly during the winter months when pressure on the health system is most intense.
Practical Implications
• For policymakers: Prioritizing resources to prevent hospitalizations and deaths in populations with specific chronic conditions.
• For clinical practice: Integration of care for the management of conditions such as cardiovascular disease and dementia, in addition to monitoring programs for patients at risk.
Conclusion
Combinations of chronic conditions, such as cancer, cardiovascular disease, chronic kidney disease and dementia, are strong predictors of hospitalization and death during winter. These findings can guide policy decisions to allocate resources effectively, reduce pressure on health services and save lives.
Reference
Islam, N., Shabnam, S., Khan, N., & Gillies, C. (2024). Combinations of multiple long-term conditions and risk of hospital admission or death during winter 2021-22 in England: population based cohort study. BMJ Medicine, 3(1), e001016. Available at: https://bmjmedicine.bmj.com/content/3/1/e001016
