Multimorbidity & health in immigrants: The need for person-centered research

Transcription

1 Multimorbidity & health in immigrants: The need for person-centered research Amaia Calderón-Larrañaga, PhD MPH Aging Research Center Karolinska Institutet, Sweden EpiChron Research Group on Chronic Diseases IACS, Spain

2 Multimorbidity What is it?

3 Shift in the causes of death and disease burden Communicable, maternal, perinatal, nutritional causes Noncommunicable causes Mathers C et al, 2006

4 Definition Multimorbidity the simultaneous presence of two or more chronic diseases in one same individual van den Akker et al, 1996 Comorbidity a distinct additional clinical entity occurred during the clinical course of a patient having an index disease Feinstein et al, 1970

5 Frequency The most common chronic condition Tinetti et al, 2012 Suffered by 9 out of 10 people over 65 years Marengoni et al, 2008 A higher than expected prevalence among younger age groups Barnett et al, 2012

6

7 Multimorbidity in Sweden % Marengoni et al, 2009

8 Multimorbidity and age Fortin et al, 2012

9 Multimorbidity and socio-economic status It is strongly related to deprivation Salisbury et al, 2011 It occurs years earlier in people living in most deprived areas Barnett et al, 2012 Differential increase from early ages Mc Lean et al, 2014

10 Multimorbidity Why do we care about it?

11 Triple crisis Health system Multimorbidity Clinicians Medicine Adapted from José R Repullo, 2012

12 An example Mrs F: 79-year-old woman with COPD, diabetes, osteoporosis, hypertension, and osteoarthritis Evidence-based treatment: 12 drugs, 19 doses/day, 5 times/day 14 nonpharmacological recommendations: energy conservation, exercise, footwear, avoid environmental exposures, etc. Nutritional recommendations: NA, K, fat, colesterol, Mg, Ca, calories and alcohol, etc. 5 programmed visits/year Boyd et al, 2005

13 Multimorbidity and health services use Wolff et al, 2002

14 Multimorbidity and quality of life Fortin et al, 2006

15 Multimorbidity and physical function Tinetti et al, 2011

16 Multimorbidity and death Caughey et al, 2010

17 In brief, we are facing a situation that is likely to become even more common with relevant negative consequences entailing important future challenges

18 Multimorbidity What do we know of its epidemiology in immigrants?

19 One out of ten are immigrants in the EU Foreign-borns resident in Europe 2014 Statistics Norway

20 Few previous studies on multimorbidity in immigrants Carried out in Australia (Jatrana et al, 2014) and Switzerland (Pache et al, 2001; Pfortmueller et al, 2013) Two posible theories: Healthy migrant effect (+) Stress linked to migration (-) Are there geographical variations across Europe?

21 EpiChron (SPAIN) - NAKMI (NORWAY) collaboration Is there an association between multimorbidity and immigrant status beyond socio-economic factors? How do age, sex, area of origin and reason for migration mediate this association? Do patterns of multimorbidity differ among natives and immigrants?

22 EpiChron (SPAIN) NAKMI (NORWAY) Study year Healthcare system Used data Definition of immigrant Universal coverage Primary care physicians as gatekeeperers Primary care electronic health records Foreign birth of place Foreign birth of place (both parents also) Inhabitants 1.3 millions 5 millions % of immigrants 13% 15%

23 Chronic disease prevalence Spain Gimeno-Feliu et al, 2015

24 Chronic disease prevalence Spain Gimeno-Feliu et al, 2015

25 Prevalence of multimorbidity Norway Diaz et al, 2015

26 Risk of multimorbidity Norway Reference: Norwegian-born Diaz et al, 2015

27 Prevalence of multimorbidity according to length of stay Spain Gimeno-Feliu et al, submitted

28 Risk of multimorbidity according to length of stay Spain (adjustment by age and sex) Reference: Spanish-born Reference: length of stay <5 years Gimeno-Feliu et al, submitted

29 Risk of multimorbidity according to reason for migration Norway (adjustment by age, income, civil status and length of stay) Reference: family reunification Diaz et al, 2015

30 Risk of multimorbidity according to reason for migration Norway (adjustment by age, sex, income, civil status and length of stay) Reference: <5 years Reference: males Diaz et al, 2015

31 Some take-away notes The most prevalent chronic conditions are similar among natives and immigrants. The prevalence of multimorbidty is lower among immigrants. Multimorbidty becomes more prevalent with longer length of stay, although its impact varies by area of origin. The reason for migration explains variations in multimorbdity rates better than the area of origin.

32 Food for thought Why is the prevalence of multimorbdity lower among immigrants? (underdiagnosis, low medicalization, healthy migration effect, life style habits, inverse care law?) Why is length of stay a risk factor? How can pre-migration and post-migration experiences help in the design of tailored healthcare? Are European health systems prepared to respond to immigrant patients with multiple chronic conditions?

33 The paradigm shift When individuals rather than diseases are the focus of health care, better health outcomes, lower incidence of adverse events and costs, and improved population health is achieved Starfield, 2005

34 EpiChron Research Group on Chronic Diseases THANKS FOR YOUR ATTENTION!