Multimorbidity and determinants for initiating outpatient trajectories: A population-based study

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  • Cathrine Bell
  • Anders Prior
  • Charlotte Weiling Appel
  • Frølich, Anne
  • Asger Roer Pedersen
  • Peter Vedsted

Introduction: Individuals with multimorbidity often receive high numbers of hospital outpatient services in concurrent trajectories. Nevertheless, little is known about factors associated with initiating new hospital outpatient trajectories; identified as the continued use of outpatient contacts for the same medical condition. Purpose: To investigate whether the number of chronic conditions and sociodemographic characteristics in adults with multimorbidity is associated with entering a hospital outpatient trajectory in this population. Methods: This population-based register study included all adults in Denmark with multimorbidity on January 1, 2018. The exposures were number of chronic conditions and sociodemographic characteristics, and the outcome was the rate of starting a new outpatient trajectory during 2018. Analyses were stratified by the number of existing outpatient trajectories. We used Poisson regression analysis, and results were expressed as incidence rates and incidence rate ratios with 95% confidence intervals. We followed the individuals during the entire year of 2018, accounting for person-time by hospitalization, emigration, and death. Results: Incidence rates for new outpatient trajectories were highest for individuals with low household income and ≥3 existing trajectories and for individuals with ≥3 chronic conditions and in no already established outpatient trajectory. A high number of chronic conditions and male gender were found to be determinants for initiating a new outpatient trajectory, regardless of the number of existing trajectories. Low educational level was a determinant when combined with 1, 2, and ≥3 existing trajectories, and increasing age, western ethnicity, and unemployment when combined with 0, 1, and 2 existing trajectories. Conclusion: A high number of chronic conditions, male gender, high age, low educational level and unemployment were determinants for initiation of an outpatient trajectory. The rate was modified by the existing number of outpatient trajectories. The results may help identify those with multimorbidity at greatest risk of having a new hospital outpatient trajectory initiated.

Original languageEnglish
Article number739
JournalBMC Public Health
Issue number1
Number of pages12
Publication statusPublished - Dec 2023

Bibliographical note

Funding Information:
This work was supported by the Novo Nordisk Foundation (Agreement Number: NNF18OC0052136 and NNF18OC0031194), Aarhus University, and the Toyota Foundation, Denmark. The authors have no affiliation with the funders, and the funders had no role in initiating or in carrying out this research.

Publisher Copyright:
© 2023, The Author(s).

    Research areas

  • Denmark, Healthcare utilization, Hospital, Multimorbidity, Outpatient, Trajectory

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