• Paolo Fraccaro, Evangelos Kontopantelis, Matthew Sperrin, Niels Peek, Christian Mallen, Philip Urban, Iain E Buchan, and Mamas A Mamas.
• Health eResearch Centre, Farr Institute for Health Informatics Research NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health NIHR School for Primary Care Research, University of Manchester, Manchester Research Institute for Primary Care & Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom Cardiovascular Department, Hôpital de La Tour, Geneva, Switzerland Keele Cardiovascular Research Group, Keele University Stoke-on-Trent and Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom.
• Medicine (Baltimore). 2016 Oct 1; 95 (43): e4973e4973.

AbstractMultimorbidity is common among older people and presents a major challenge to health systems worldwide. Metrics of multimorbidity are, however, crude: focusing on measuring comorbid conditions at single time-points rather than reflecting the longitudinal and additive nature of chronic conditions. In this paper, we explore longitudinal comorbidity metrics and their value in predicting mortality.Using linked primary and secondary care data, we conducted a retrospective cohort study on adults in Salford, UK from 2005 to 2014 (n = 287,459). We measured multimorbidity with the Charlson Comorbidity Index (CCI) and quantified its changes in various time windows. We used survival models to assess the relationship between CCI changes and mortality, controlling for gender, age, baseline CCI, and time-dependent CCI. Goodness-of-fit was assessed with the Akaike Information Criterion and discrimination with the c-statistic.Overall, 15.9% patients experienced a change in CCI after 10 years, with a mortality rate of 19.8%. The model that included gender and time-dependent age, CCI, and CCI change across consecutive time windows had the best fit to the data but equivalent discrimination to the other time-dependent models. The absolute CCI score gave a constant hazard ratio (HR) of around 1.3 per unit increase, while CCI change afforded greater prognostic impact, particularly when it occurred in shorter time windows (maximum HR value for the 3-month time window, with 1.63 and 95% confidence interval 1.59-1.66).Change over time in comorbidity is an important but overlooked predictor of mortality, which should be considered in research and care quality management.

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