Sarah Dorrington1,2, Ewan Carr1, Sharon A M Stevelink1,3, Alex Dregan1, Charlotte Woodhead1, Jayati Das-Munshi1, Mark Ashworth4, Matthew Broadbent2, Ira Madan5, Stephani L Hatch1, Matthew Hotopf1,2. 1. Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, LondonSE5 8AF, UK. 2. South London and Maudsley NHS Foundation Trust, London, UK. 3. King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 4. School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, LondonSE1 1UL, UK. 5. Department of Occupational Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Abstract
BACKGROUND: Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. METHODS: Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. RESULTS: We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73-12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60-4.87), chronic pain and depression (HR 4.14; 95% CI 3.69-4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36-4.95). CONCLUSIONS: Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.
BACKGROUND: Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. METHODS: Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. RESULTS: We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73-12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60-4.87), chronic pain and depression (HR 4.14; 95% CI 3.69-4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36-4.95). CONCLUSIONS: Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.
Entities:
Keywords:
comorbidity; depression; disability; fit note; health inequalities; multimorbidity; primary care; public health; sickness absence
Authors: Raquel Catalao; Sarah Dorrington; Megan Pritchard; Amelia Jewell; Matthew Broadbent; Mark Ashworth; Stephani Hatch; Louise Howard Journal: BMJ Open Date: 2022-07-15 Impact factor: 3.006
Authors: Sarah Dorrington; Ewan Carr; C Polling; Sharon Stevelink; Mark Ashworth; Emmert Roberts; Matthew Broadbent; Stephani Hatch; Ira Madan; Matthew Hotopf Journal: BMJ Open Date: 2021-03-26 Impact factor: 2.692