Multimorbidity among patients with digestive cancers patients in Chile: a nationwide database study

Abstract

Background
Multimorbidity, the presence of two or more chronic diseases in one individual, affects an increasing number of patients worldwide, creating one of the main challenges in global public health. Multimorbidity results in higher mortality, lower quality of life, and individual risks, such as polypharmacy and exposure to complex therapeutic regimens. In Chile, five of the top ten cancers with the highest mortality rates affect the digestive system. To our knowledge, this is the first study based on a national-wide database focused on multimorbidity in patients with cancer in Chile. Our objective was to characterise multimorbidity and establish the chronic diseases and combinations thereof that most contribute to multimorbidity in patients with digestive cancers in Chile.

Methods
Hospital discharge data for this study were taken from a national database based on Diagnosis-Related Groups through International Classification of Diseases, 10th revision (ICD-10) codes. Multimorbidity was defined as the presence of two or more (from a list of 45 chronic diseases) in addition to digestive cancer. Frequencies of chronic diseases were calculated and the patterns of multimorbidity in patients with multimorbidity and in different digestive cancers were described.

Findings
The hospital discharge records of 1 464 884 patients, with a total of 1 933 386 hospitalisation events (defined as admission and discharge from the hospital), were screened. Hospital admissions between Nov 1, 2018, and Dec 31, 2020 were considered. We found 18 678 patients aged 15 years or older and diagnosed with digestive cancers as per ICD-10 codes (colorectal [C18–C19.0, C20, and C21–C21.8], stomach [C16–C16.9], pancreatic [C25–C25.9], liver [C22–C22.4 and C22.7–C22.9], oesophageal [C15–C15.9], gallbladder and biliary tract cancers [C23–C24.9], or small intestine [C17]). 7861 (42·1%) of 18 678 patients had colorectal cancer, 5917 (31·7%) had stomach cancer, 1727 (9·2%) had pancreatic cancer, 1663 (8·9%) had liver cancer, 1162 (6·2%) had oesophageal cancer, 515 (2·8%) had gallbladder and biliary tract cancer, and 28 (0·1%) had small intestine cancer. We found that 9391 (50·3%) of all patients with digestive cancers were affected by multimorbidity (3770 [47·9%] of 7861 patients with colorectal cancer, 2860 [48·3%] of 5917 patients with stomach cancer, 903 [52·3%] of 1727 patients with pancreatic cancer, 1132 [68·1%] of 1663 patients with liver cancer, 516 [44·4%] of 1162 patients with oesophageal cancer, 284 [55·1%] of 515 patients with gallbladder and biliary tract cancer, and 14 [50·0%] of 28 patients with small intestine cancer). Frequency of multimorbidity increases with age. High blood pressure (in 8306 [44·5%] of 18678 patients), diabetes (in 4084 [21·9%] of 18678 patients), non-malignant thyroid disease (in 3773 [20·2%] of 18678 patients), anaemia (in 2653 [14·2%] of 18678 patients), and liver disease (in 2454 [13·1%] of 18678 patients) were the five most frequent chronic diseases identified. Chronic conditions affecting patients with cancer was highly variable with cancer type: for example, the diagnosis of diabetes was found to be more common in all patients diagnosed with liver cancer (594 [35·7%] of 1663) than in patients diagnosed with stomach cancer (1162 [19·1%] of 5917); the diagnosis of anaemia was more common in all patients diagnosed with stomach cancer (1096 [18·5%] of 5917) that in all patients diagnosed with oesophageal cancer (87 [7·5%] of 1162) or that in all patients diagnosed with gallbladder and biliary tract cancer (45 [8·7%] of 515); and the diagnosis of dementia (68 [13·2%] of 515) and thyroid disease (115 [22·3%] of 515) were more common in all patients diagnosed with gallbladder and biliary tract cancer than in patients with other digestive cancers. The most frequent multimorbidity pattern in all patients with digestive cancers was high blood pressure and diabetes (in 1308 [13·9%] of 9391 multimorbidity patients).

Interpretation
This study is, to the best of our knowledge, the first characterisation of multimorbidity in Chilean patients with digestive cancers. The presentation of chronic diseases in patients with digestive cancers is heterogeneous and varies with the digestive organ affected by cancer. Protocols that include the evaluation of multimorbidity during primary and hospital care of patients with cancer need to be developed. Patient-centred approaches that can manage and respond to the needs of patients with complex health conditions while contributing to comprehensive care are necessary to improve outcomes in patients with cancer.

Funding
National Agency for Research and Development (reference 21210439).

Full text

Abstracts
30
www.thelancet.com/oncology
Published Online
July 13, 2022
Centro de Genética y Genómica,
Instituto de Ciencias e
Innovación (Y A Bernal MSc)
and Centro de Epidemiología y
Políticas de Salud
(Iris Delgado PhD), Medicina
Facultad de Medicina, Clínica
Alemana, Universidad del
Desarrollo, Santiago, Chile
Correspondence to:
Ms Yanara A Bernal, Centro de
Genética y Genómica, Instituto
de Ciencias e Innovación,
Medicina Facultad de Medicina,
Clínica Alemana, Universidad del
Desarrollo, Santiago 7550000,
Chile
ybernalg@udd.cl
Multimorbidity among patients with digestive cancers
patients in Chile: a nationwide database study
Yanara A Bernal, Iris Delgado
Abstract
Background Multimorbidity, the presence of two or more chronic diseases in one individual, aects an increasing
number of patients worldwide, creating one of the main challenges in global public health. Multimorbidity results in
higher mortality, lower quality of life, and individual risks, such as polypharmacy and exposure to complex therapeutic
regimens. In Chile, five of the top ten cancers with the highest mortality rates aect the digestive system. To our
knowledge, this is the first study based on a national-wide database focused on multimorbidity in patients with cancer
in Chile. Our objective was to characterise multimorbidity and establish the chronic diseases and combinations
thereof that most contribute to multimorbidity in patients with digestive cancers in Chile.
Methods Hospital discharge data for this study were taken from a national database based on Diagnosis-Related
Groups through International Classification of Diseases, 10th revision (ICD-10) codes. Multimorbidity was defined as
the presence of two or more (from a list of 45 chronic diseases) in addition to digestive cancer. Frequencies of chronic
diseases were calculated and the patterns of multimorbidity in patients with multimorbidity and in dierent digestive
cancers were described.
Findings The hospital discharge records of 1 464 884 patients, with a total of 1 933 386 hospitalisation events (defined as
admission and discharge from the hospital), were screened. Hospital admissions between Nov 1, 2018, and Dec 31, 2020
were considered. We found 18 678 patients aged 15 years or older and diagnosed with digestive cancers as per ICD-10
codes (colorectal [C18–C19.0, C20, and C21–C21.8], stomach [C16–C16.9], pancreatic [C25–C25.9], liver [C22–C22.4 and
C22.7–C22.9], oesophageal [C15–C15.9], gallbladder and biliary tract cancers [C23–C24.9], or small intestine [C17]).
7861 (42·1%) of 18 678 patients had colorectal cancer, 5917 (31·7%) had stomach cancer, 1727 (9·2%) had pancreatic
cancer, 1663 (8·9%) had liver cancer, 1162 (6·2%) had oesophageal cancer, 515 (2·8%) had gallbladder and biliary tract
cancer, and 28 (0·1%) had small intestine cancer. We found that 9391 (50·3%) of all patients with digestive cancers were
aected by multimorbidity (3770 [47·9%] of 7861 patients with colorectal cancer, 2860 [48·3%] of 5917 patients with
stomach cancer, 903 [52·3%] of 1727 patients with pancreatic cancer, 1132 [68·1%] of 1663 patients with liver cancer,
516 [44·4%] of 1162 patients with oesophageal cancer, 284 [55·1%] of 515 patients with gallbladder and biliary tract
cancer, and 14 [50·0%] of 28 patients with small intestine cancer). Frequency of multimorbidity increases with age.
High blood pressure (in 8306 [44·5%] of 18678 patients), diabetes (in 4084 [21·9%] of 18678 patients), non-malignant
thyroid disease (in 3773 [20·2%] of 18678 patients), anaemia (in 2653 [14·2%] of 18678 patients), and liver disease (in
2454 [13·1%] of 18678 patients) were the five most frequent chronic diseases identified. Chronic conditions aecting
patients with cancer was highly variable with cancer type: for example, the diagnosis of diabetes was found to be more
common in all patients diagnosed with liver cancer (594 [35·7%] of 1663) than in patients diagnosed with stomach
cancer (1162 [19·1%] of 5917); the diagnosis of anaemia was more common in all patients diagnosed with stomach
cancer (1096 [18·5%] of 5917) that in all patients diagnosed with oesophageal cancer (87 [7·5%] of 1162) or that in all
patients diagnosed with gallbladder and biliary tract cancer (45 [8·7%] of 515); and the diagnosis of dementia (68 [13·2%]
of 515) and thyroid disease (115 [22·3%] of 515) were more common in all patients diagnosed with gallbladder and
biliary tract cancer than in patients with other digestive cancers. The most frequent multimorbidity pattern in all
patients with digestive cancers was high blood pressure and diabetes (in 1308 [13·9%] of 9391 multimorbidity patients).
Interpretation This study is, to the best of our knowledge, the first characterisation of multimorbidity in Chilean
patients with digestive cancers. The presentation of chronic diseases in patients with digestive cancers is heterogeneous
and varies with the digestive organ aected by cancer. Protocols that include the evaluation of multimorbidity during
primary and hospital care of patients with cancer need to be developed. Patient-centred approaches that can manage
and respond to the needs of patients with complex health conditions while contributing to comprehensive care are
necessary to improve outcomes in patients with cancer.
Funding National Agency for Research and Development (reference 21210439).
Copyright © 2022 Published by Elsevier Ltd. All rights reserved.
Declaration of interests
We declare no competing interests.