Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark

Objective Patients with multimorbidity may carry a large symptom burden. Symptoms are often what drive patients to seek healthcare and they also assist doctors with diagnosis. We examined whether symptom burden is additive in people with multimorbidity compared with people with a single morbidity.De...

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Main Authors: Susanne Reventlow, Volkert Siersma, Dagný Rós Nicolaisdóttir, Rasmus Køster-Rasmussen, Tora Grauers Willadsen, Dorte Jarbol, Ann Dorrit Guassora
Format: Article
Language:English
Published: BMJ Publishing Group 2021-04-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/11/4/e041877.full
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author Susanne Reventlow
Volkert Siersma
Dagný Rós Nicolaisdóttir
Rasmus Køster-Rasmussen
Tora Grauers Willadsen
Dorte Jarbol
Ann Dorrit Guassora
author_facet Susanne Reventlow
Volkert Siersma
Dagný Rós Nicolaisdóttir
Rasmus Køster-Rasmussen
Tora Grauers Willadsen
Dorte Jarbol
Ann Dorrit Guassora
author_sort Susanne Reventlow
collection DOAJ
description Objective Patients with multimorbidity may carry a large symptom burden. Symptoms are often what drive patients to seek healthcare and they also assist doctors with diagnosis. We examined whether symptom burden is additive in people with multimorbidity compared with people with a single morbidity.Design This is a longitudinal cohort study drawing on questionnaire and Danish national registry data. Multimorbidity was defined as having diagnoses from at least two out of ten morbidity groups. Associations between morbidity groups and symptom burden were estimated with multivariable models.Participants In 2012, 47 452 participants from the Danish Symptom Cohort answered a questionnaire about symptoms (36 symptoms in total), including whether symptoms were affecting their daily activities (impairment score) and their worries about present symptoms (worry score) (the highest score among the 36 symptoms on a 0–4 scale).Main outcome measure The primary outcome was symptom burden.Results Participants without morbidity reported 4.77 symptoms (out of 36 possible). Participants with one, two or three morbidities reported more symptoms than patients without morbidity (0.95 (CI 0.86 to 1.03), 1.87 (CI 1.73 to 2.01) and 2.89 (CI 2.66 to 3.12), respectively). Furthermore, they reported a higher impairment score (0.36 (0.32 to 0.39), 0.65 (0.60 to 0.70) and 1.06 (0.98 to 1.14)) and a higher worry score (0.34 (0.31 to 0.37), 0.62 (0.57 to 0.66) and 1.02 (0.94 to 1.10)) than participants without morbidity. In 45 possible combinations of multimorbidity (participants with two morbidities), interaction effects were additive in 37, 41 and 36 combinations for the number of symptoms, impairment score and worry score, respectively.Conclusion Participants without morbidity reported a substantial number of symptoms. Having a single morbidity or multimorbidity resulted in approximately one extra symptom for each extra morbidity. In most combinations of multimorbidity, symptom burden was additive.
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spelling doaj-art-1a23deaaa29548bc8b621fa502dcebed2024-11-21T08:40:09ZengBMJ Publishing GroupBMJ Open2044-60552021-04-0111410.1136/bmjopen-2020-041877Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from DenmarkSusanne Reventlow0Volkert Siersma1Dagný Rós Nicolaisdóttir2Rasmus Køster-Rasmussen3Tora Grauers Willadsen4Dorte Jarbol5Ann Dorrit Guassora6Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, DenmarkCenter for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkCenter for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark1 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkResearch Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkThe Research Unit for General Practice, University of Southern Denmark, Odense, DenmarkDepartment of Public Health, University of Copenhagen, Copenhagen, DenmarkObjective Patients with multimorbidity may carry a large symptom burden. Symptoms are often what drive patients to seek healthcare and they also assist doctors with diagnosis. We examined whether symptom burden is additive in people with multimorbidity compared with people with a single morbidity.Design This is a longitudinal cohort study drawing on questionnaire and Danish national registry data. Multimorbidity was defined as having diagnoses from at least two out of ten morbidity groups. Associations between morbidity groups and symptom burden were estimated with multivariable models.Participants In 2012, 47 452 participants from the Danish Symptom Cohort answered a questionnaire about symptoms (36 symptoms in total), including whether symptoms were affecting their daily activities (impairment score) and their worries about present symptoms (worry score) (the highest score among the 36 symptoms on a 0–4 scale).Main outcome measure The primary outcome was symptom burden.Results Participants without morbidity reported 4.77 symptoms (out of 36 possible). Participants with one, two or three morbidities reported more symptoms than patients without morbidity (0.95 (CI 0.86 to 1.03), 1.87 (CI 1.73 to 2.01) and 2.89 (CI 2.66 to 3.12), respectively). Furthermore, they reported a higher impairment score (0.36 (0.32 to 0.39), 0.65 (0.60 to 0.70) and 1.06 (0.98 to 1.14)) and a higher worry score (0.34 (0.31 to 0.37), 0.62 (0.57 to 0.66) and 1.02 (0.94 to 1.10)) than participants without morbidity. In 45 possible combinations of multimorbidity (participants with two morbidities), interaction effects were additive in 37, 41 and 36 combinations for the number of symptoms, impairment score and worry score, respectively.Conclusion Participants without morbidity reported a substantial number of symptoms. Having a single morbidity or multimorbidity resulted in approximately one extra symptom for each extra morbidity. In most combinations of multimorbidity, symptom burden was additive.https://bmjopen.bmj.com/content/11/4/e041877.full
spellingShingle Susanne Reventlow
Volkert Siersma
Dagný Rós Nicolaisdóttir
Rasmus Køster-Rasmussen
Tora Grauers Willadsen
Dorte Jarbol
Ann Dorrit Guassora
Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark
BMJ Open
title Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark
title_full Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark
title_fullStr Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark
title_full_unstemmed Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark
title_short Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark
title_sort symptom burden in multimorbidity a population based combined questionnaire and registry study from denmark
url https://bmjopen.bmj.com/content/11/4/e041877.full
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