Prevalence and pairs of long-term conditions in new presentations of breathlessness in primary care: a preliminary descriptive assessment using UK CPRD GOLD from 2007- 2017

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

3B.5

Presenter:

Harini Sathanapally

Co-authors:

Urvee Karsanji, Claire Lawson, Michael Steiner, Rachael Evans, Jennifer Creese, Anvesha Singh

Author institutions:

University of Leicester

Problem

Breathlessness is a complex symptom, with multifactorial aetiologies and associated with a high prevalence of underlying multiple long-term conditions (MLTC). Both breathlessness and MLTC have in turn been associated with increased health service utilisation and increased risk of adverse health outcomes. However, little is understood about the compounding effect of patterns of underlying MLTC’s in patients presenting with breathlessness in primary care.

Approach

UK CPRD GOLD was used to identify adults with a first-recorded code for breathlessness (index) between 2007-17, and no known cardio-respiratory conditions (Asthma, COPD, Interstitial Lung Disease and Heart failure). To identify patients with non-infective causes of breathlessness only, patients who had a coded diagnosis of acute respiratory infection on the same date as their coded presentation with breathlessness were excluded. We sought to describe the prevalence of MLTC’s (defined as the coexistence of two or more long-term conditions in the same individual) and the top five most prevalent pairs of pre-existing long-term conditions at index. Coded diagnoses of long-term conditions from CPRD with matched coded data from HES, were identified in accordance with those listed in the Cambridge Multimorbidity Score (CMS).

Findings

There were 101,369 patients with a first-recorded code of breathlessness; mean age 58.1 years, 55.3% female, 22.7% from the least deprived (IMD= 5) and 16.5% from the most deprived areas (IMD =1). Hypertension (30.8%) was the most prevalent condition at the time of presentation, followed by depression (29.5%). 56.4% of patients suffered with 2 or more LTC’s. The top five most prevalent pairs of long-term conditions were:1. Depression & Anxiety (13.7%)2. Depression & Hypertension (8.5%)3. Depression & Psoriasis/Eczema (7.6%)4. Hypertension & Psoriasis/Eczema (7.3%)5. Hypertension & Anxiety (6.3%)Depression and Anxiety were the most prevalent pair of LTC’s (13.7%) in our cohort, and affected a higher proportion of female patients (17.3%) compared to male patients (9.3%) .

Consequences

Our preliminary descriptive findings reiterate the significant burden of MLTC’s in this group, and suggest there may be patterns of pre-existing MLTC’s amongst patients presenting with breathlessness. Further work using latent class analysis is planned to identify any patterns in how MLTC’s cluster together with interplay of individual demographic factors including ethnicity with intersectionality in this patient group, and identify any differences in diagnostic pathways, health service utilisation and outcomes.

Submitted by:

Harini Sathanapally

Funding acknowledgement:

This work is supported by the Wellcome Trust as part of the Leicestershire Health Inequalities Improvement Doctoral Training Programme [223512/Z/21/Z] and the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.