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Research

Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan

Takayuki Ando, Takashi Sasaki, Yukiko Abe, Yoshinori Nishimoto, Takumi Hirata, Takayuki Tajima, Yuko Oguma, Junji Haruta and Yasumichi Arai
BJGP Open 2024; 8 (3): BJGPO.2024.0016. DOI: https://doi.org/10.3399/BJGPO.2024.0016
Takayuki Ando
1 Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Japan
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  • For correspondence: takayuki.ando{at}keio.jp
Takashi Sasaki
2 Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Japan
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Yukiko Abe
2 Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Japan
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Yoshinori Nishimoto
2 Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Japan
3 Department of Neurology, Keio University School of Medicine, Shinjuku-ku, Japan
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Takumi Hirata
4 Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Japan
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Takayuki Tajima
5 Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Japan
6 Sports Medicine Research Center, Keio University, Yokohama, Japan
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Yuko Oguma
6 Sports Medicine Research Center, Keio University, Yokohama, Japan
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Junji Haruta
1 Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Japan
7 Medical Education Center, Keio University School of Medicine, Shinjuku-ku, Japan
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Yasumichi Arai
2 Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Japan
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Article Figures & Data

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    Figure 1. Kaplan–Meier estimates of all-cause mortality according to RVF. RVF = regularly visited facilities
  • Figure 2.
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    Figure 2. Kaplan–Meier estimates of all-cause mortality, according to the Fragmentation of Care Index (FCI). The 'Q' in Q1, Q2, Q3, and Q4 represents the 'quartile', indicating the first through fourth FCI quartiles.

Tables

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    Table 1. Description of the characteristics of participants
    By MFVF typeTotal
    ClinicHospitalBothNone
    Number (%)715 (73.9)172 (17.8)26 (2.7)55 (5.7)968
    Median age, years (IQR)86 (85, 88)86 (85, 87)86 (86, 88)87 (85, 88)86 (85, 88)
    Male (%)375 (52.4)67 (39.0)14 (53.8)31 (56.4)487 (50.3)
    Higher education (%)322 (45.0)80 (46.5)10 (38.5)24 (43.6)436 (45.0)
    Drinks alcohol (%)287 (40.1)71 (41.3)10 (38.5)20 (36.4)388 (40.1)
    Smokes (%)24 (3.4)6 (3.5)1 (3.8)6 (10.9)37 (3.8)
    Independent IADL (%)617 (86.3)148 (86.0)23 (88.5)47 (85.5)835 (86.3)
    Frailty (%)a
     Robust112 (16.0)19 (11.3)5 (19.2)5 (9.3)141 (14.9)
     Prefrail417 (59.7)113 (67.3)15 (57.7)29 (53.7)574 (60.6)
     Frail170 (24.3)36 (21.4)6 (23.1)20 (37.0)232 (24.5)
    Mean number of chronic conditions (SD)4.75 (1.81)4.71 (1.71)5.19 (1.70)3.69 (1.40)4.70 (1.78)
    Median FCI (IQR)0.66 (0.52, 0.75)0.54 (0.29, 0.70)0.70 (0.65, 0.78)0.00 (0.00, 0.80)0.65 (0.48, 0.74)
    Mean RVF (SD)2.39 (1.25)1.72 (0.88)3.08 (1.38)0.00 (0.00)2.15 (1.30)
     00 (0.0)0 (0.0)0 (0.0)55 (100.0)55 (5.7)
     1193 (27.0)88 (51.2)0 (0.0)0 (0.0)281 (29.0)
     2228 (31.9)54 (31.4)10 (38.5)0 (0.0)292 (30.2)
     ≥3294 (41.1)30 (17.4)16 (61.5)0 (0.0)340 (35.1)
    Number of deaths (%)105 (14.7)32 (18.6)6 (23.1)15 (27.3)158 (16.3)
    • FCI = Fragmentation of Care Index. IADL = instrumental activity of daily living. IQR = interquartile range. MFVF = most frequently visited facility. RVF = regularly visited facilities. SD = standard deviation

    • aFrailty percentages are calculated based on the following denominators: Clinic (n = 699), Hospital (n = 168), Both (n = 54), and Total (n = 947) due to missing data on frailty.

    • View popup
    Table 2. Cross-tabulation of regularly visited facilities (RVF) and the number of chronic comorbid conditions identified in study participants
    Chronic conditions2–4 (n = 463)≥5 (n = 505)
    RVF
     03817
     1175106
     2133159
     ≥3117223
    • RVF = regularly visited facilities

    • View popup
    Table 3. Adjusted associations between regularly visited facilities (RVF) and all-cause mortality
    Chronic conditions2–4 (n = 463)≥5 (n = 505)
    HR (95% CI) P valueHR (95% CI) P value
    RVF
     01.97 (0.91 to 4.27)0.0852.68 (1.05 to 6.84)0.039
     1Reference–Reference–
     21.51 (0.86 to 2.64)0.1480.84 (0.46 to 1.55)0.578
     ≥30.43 (0.18 to 0.99)0.0480.92 (0.52 to 1.63)0.774
    Sex (male)0.91 (0.56 to 1.47)0.6870.70 (0.45 to 1.08)0.107
    Age (per 1 year)0.97 (0.82 to 1.16)0.7711.05 (0.90 to 1.22)0.533
    Frailty (yes)0.98 (0.55 to 1.75)0.9502.20 (1.43 to 3.39)<0.001
    FCI
     Q1Reference–Reference–
     Q20.90 (0.49 to 1.65)0.7390.68 (0.35 to 1.33)0.257
     Q30.45 (0.21 to 0.96)0.0400.85 (0.45 to 1.62)0.623
     Q40.84 (0.43 to 1.66)0.6210.92 (0.50 to 1.69)0.779
    Sex (male)0.92 (0.57 to 1.51)0.7500.77 (0.50 to 1.20)0.245
    Age (per 1 year)1.00 (0.84 to 1.19)1.0001.06 (0.90 to 1.24)0.488
    Frailty (yes)1.00 (0.56 to 1.78)0.9942.22 (1.43 to 3.45)<0.001
    • Multivariate Cox proportional hazard analysis results adjusted for sex, age, and frailty. Participants were stratified into two groups by the median number of comorbid chronic conditions. FCI = Fragmentation of Care Index. HR = hazard ratio. Q = quartile. RVF = regularly visited facilities

Supplementary Data

  • TA_10.3399BJGPO.2024.0016_supp.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy. 

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Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan
Takayuki Ando, Takashi Sasaki, Yukiko Abe, Yoshinori Nishimoto, Takumi Hirata, Takayuki Tajima, Yuko Oguma, Junji Haruta, Yasumichi Arai
BJGP Open 2024; 8 (3): BJGPO.2024.0016. DOI: 10.3399/BJGPO.2024.0016

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Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan
Takayuki Ando, Takashi Sasaki, Yukiko Abe, Yoshinori Nishimoto, Takumi Hirata, Takayuki Tajima, Yuko Oguma, Junji Haruta, Yasumichi Arai
BJGP Open 2024; 8 (3): BJGPO.2024.0016. DOI: 10.3399/BJGPO.2024.0016
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Keywords

  • care fragmentation
  • multimorbidity
  • polydoctoring
  • aged
  • cohort studies
  • Primary healthcare

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