Exploring measures of multimorbidity in predicting health and social care outcomes using administrative and survey data

Background: Multimorbidity is associated with adverse health and care outcomes, particularly in older populations. When quantifying multimorbidity, the appropriate measure varies by population, outcome under study and data available. Integrated health/social care, with a focus on the individual, improves patient satisfaction and health. In Scotland, clarity as to which measures/conditions are most strongly associated with health and care outcomes will help anticipate integrated care. Aim: To identify which multimorbidity measures, conditions and comorbidities predict health and care outcomes in an older Scottish population. Methods: Demographics, social care, admissions, and prescribing data for individuals 65+/resident in Scotland 2010-16 comprised three panel cohorts: for health (n=5,579,492), social (n=4,374,662) and informal care outcomes (n=2,449,229). Survey data linked to admissions were used for co-resident care (n=8,334). Panel logistic regression, using the receiver operating curve (ROC), identified the most predictive measures of multimorbidity for health/care. Further modelling was used to identify the strongest associated conditions/comorbidities, the impact of multimorbidity on social care by deprivation, and whether administrative outperforms survey data in predicting informal/co-resident care. Results: The Charlson Comorbidity Index (CCI) performed best (ROC >0.8) in predicting mortality, proxy measures for other health outcomes (ROC >0.7 and 0.7 and 0.8), and self-report measure (ROC >0.75) for co-resident care. Dementia is strongly associated with care, while comorbid interactions varied. An inverse effect between the relationship between multimorbidity and social care was found for local authority deprivation. Administrative data outperforms survey data at predicting informal care. Conclusions: The varying performance of multimorbidity measures highlight the importance of a wide range of data when predicting use of health and care services. A national index tailored to a Scottish population derived from both diagnosis-based and medication-based data may have better precision. This, and findings regarding individual and comorbid conditions, such as dementia, as well as macro- and micro-level effects of deprivation on the relationship between multimorbidity and care, have the potential to improve existing risk predicting algorithms within Scotland

Childhood attention-deficit hyperactivity disorder (ADHD): socio-economic inequalities in symptoms, impact, diagnosis and medication

Background Children from disadvantaged backgrounds are at greater risk of attention-deficit hyperactivity disorder (ADHD)-related symptoms, being diagnosed with ADHD, and being prescribed ADHD medications. We aimed to examine how inequalities manifest across the ‘patient journey’, from perceptions of impacts of ADHD symptoms on daily life, to the propensity to seek and receive a diagnosis and treatment. Methods We investigated four ‘stages’: (1) symptoms, (2) caregiver perception of impact, (3) diagnosis and (4) medication, in two data sets: UK Millennium Cohort Study (MCS, analytic n ~ 9,000), with relevant (parent-reported) information on all four stages (until 14 years); and a population-wide ‘administrative cohort’, which includes symptoms (child health checks) and prescriptions (dispensing records), born in Scotland, 2010–2012 (analytic n ~ 100,000), until ~6 years. We described inequalities according to maternal occupational status, with percentages and relative indices of inequality (RII). Results The prevalence of ADHD symptoms and medication receipt was considerably higher in the least compared to the most advantaged children in the administrative cohort (RIIs of 5.9 [5.5–6.4] and 8.1 [4.2–15.6]) and the MCS (3.08 [2.68–3.55], 3.75 [2.21–6.36]). MCS analyses highlighted complexities between these two stages, however, those from least advantaged backgrounds, with ADHD symptoms, were the least likely to perceive impacts on daily life (15.7% vs. average 19.5%) and to progress from diagnosis to medication (44.1% vs. average 72.5%). Conclusions Despite large inequalities in ADHD symptoms and medication, parents from the least advantaged backgrounds were less likely to report impacts of ADHD symptoms on daily life, and their children were less likely to have received medication postdiagnosis, highlighting how patient journeys differed according to socioeconomic circumstances

Association between multimorbidity and mortality in a cohort of patients admitted to hospital with COVID-19 in Scotland

Funding: BREATHE - The Health Data Research Hub for Respiratory Health, which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK (MC_PC_19004); CSO Rapid Research in Covid-19 Programme (COV/SAN/20/06); HDR UK Measuring and Understanding Multi-morbidity using Routine Data in the UK (MurMuRUK) (HDR-9006-9006; CFC0110); Medical Research Council (MR/R008345/1).Objectives We investigated the association between multimorbidity among patients hospitalised with COVID-19 and their subsequent risk of mortality. We also explored the interaction between the presence of multimorbidity and the requirement for an individual to shield due to the presence of specific conditions and its association with mortality. Design We created a cohort of patients hospitalised in Scotland due to COVID-19 during the first wave (between 28 February 2020 and 22 September 2020) of the pandemic. We identified the level of multimorbidity for the patient on admission and used logistic regression to analyse the association between multimorbidity and risk of mortality among patients hospitalised with COVID-19. Setting Scotland, UK. Participants Patients hospitalised due to COVID-19. Main outcome measures Mortality as recorded on National Records of Scotland death certificate and being coded for COVID-19 on the death certificate or death within 28 days of a positive COVID-19 test. Results Almost 58% of patients admitted to the hospital due to COVID-19 had multimorbidity. Adjusting for confounding factors of age, sex, social class and presence in the shielding group, multimorbidity was significantly associated with mortality (adjusted odds ratio 1.48, 95%CI 1.26–1.75). The presence of multimorbidity and presence in the shielding patients list were independently associated with mortality but there was no multiplicative effect of having both (adjusted odds ratio 0.91, 95%CI 0.64–1.29). Conclusions Multimorbidity is an independent risk factor of mortality among individuals who were hospitalised due to COVID-19. Individuals with multimorbidity could be prioritised when making preventive policies, for example, by expanding shielding advice to this group and prioritising them for vaccination.Publisher PDFPeer reviewe

Social media use and adolescent health-risk behaviours: a systematic review and meta-analysis

Objectives To examine the association between social media use and health risk behaviours in adolescents (defined as those 10-19 years). Design Systematic review and meta-analysis. Data sources EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXic, PsyArXiv, medRxiv, and Google Scholar (1 January 1997 to 6 June 2022). Methods Health risk behaviours were defined as use of alcohol, drugs, tobacco, electronic nicotine delivery systems, unhealthy dietary behaviour, inadequate physical activity, gambling, and anti-social, sexual risk, and multiple risk behaviours. Included studies reported a social media variable (ie, time spent, frequency of use, exposure to health risk behaviour content, or other social media activities) and one or more relevant outcomes. Screening and risk of bias assessments were completed independently by two reviewers. Synthesis without meta-analysis based on effect direction and random-effects meta-analyses was used. Effect modification was explored using meta-regression and stratification. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results Of 17 077 studies screened, 126 were included (73 included in meta-analyses). The final sample included 1 431 534 adolescents (mean age 15.0 years). Synthesis without meta-analysis indicated harmful associations between social media and all health risk behaviours in most included studies, except inadequate physical activity where beneficial associations were reported in 63.6% of studies. Frequent (v infrequent) social media use was associated with increased alcohol consumption (odds ratio 1.48 (95% confidence interval 1.35 to 1.62); n=383 068), drug use (1.28 (1.05 to 1.56); n=117 646), tobacco use (1.85, 1.49 to 2.30; n=424 326), sexual risk behaviours (1.77 (1.48 to 2.12); n=47 280), anti-social behaviour (1.73 (1.44 to 2.06); n=54 993), multiple risk behaviours (1.75 (1.30 to 2.35); n=43 571), and gambling (2.84 (2.04 to 3.97); n=26 537). Exposure to content showcasing health risk behaviours on social media (v no exposure) was associated with increased odds of use of electronic nicotine delivery systems (1.73 (1.34 to 2.23); n=721 322), unhealthy dietary behaviours (2.48 (2.08 to 2.97); n=9892), and alcohol consumption (2.43 (1.25 to 4.71); n=14 731). For alcohol consumption, stronger associations were identified for exposure to user generated content (3.21 (2.37 to 4.33)) versus marketer generated content (2.12 (1.06 to 4.24)). For time spent on social media, use for at least 2 h per day (v <2 h) increased odds of alcohol consumption (2.12 (1.53 to 2.95); n=12 390). GRADE certainty was moderate for unhealthy dietary behaviour, low for alcohol use, and very low for other investigated outcomes. Conclusions Social media use is associated with adverse health risk behaviours in young people, but further high quality research is needed to establish causality, understand effects on health inequalities, and determine which aspects of social media are most harmful

Study protocol: examining the impacts of COVID-19 mitigation measures on pregnancy and birth outcomes in Scotland: a linked administrative data study

No abstract available

The effect of growth conditions on the seed size/number trade-off

BACKGROUND: If the amount of resources allocated to reproduction (K) is fixed, then an increase in seed mass (S) can only be achieved by a decrease in seed number (n = K/S). Thus, log(n) = log(K)-log(S) producing a slope of -1 when seed mass and number are plotted on log-log axes. However, in comparative studies, empirical support for a slope of -1 is limited and contentious, leading some to question the utility of this concept. METHODOLOGY/PRINCIPAL FINDINGS: First, we show that the expected slope depends on whether genotypes and species producing seeds of different mass are expected to reach the same adult size and that this in turn depends partly on the nature of growth. Second, we present experimental results using a population of recombinant inbred lines (RILs) of Arabidopsis thaliana. When these RILs are grown in large pots with plentiful nutrients, they exhibit a trade-off between seed size and number with a slope of -1.68 (+/-0.18) on log-log axes. This occurs because of genetic correlations between seed mass and adult size so that, under the right growth conditions, lines producing lighter seeds have the genetic potential to produce larger rosettes and hence a greater total mass of seeds. We re-grew lines in small pots (10 and 40 mm diameter) in a nutrient-poor substrate so that final adult size was heavily restricted by pot size. CONCLUSIONS/SIGNIFICANCE: Under our growth conditions, small-seeded lines were unable to produce a greater total mass of seeds. Hence a trade-off emerged between seed mass and seed number with a slope of -1.166+/-0.319 on log-log axes in 40-mm diameter pots (close to the expected value of -1), although the slope was 0.132+/-0.263 in 10-mm diameter pots, demonstrating that the nature of the trade-off is sensitive to the growth conditions