Trajectories in Outpatient Care for People with Multimorbidity: A Population-Based Register Study in Denmark

Figures & data

Figure 1 This example illustrates how the contact pattern might have been for an individual with multimorbidity in 2018: 6 contacts, 3 trajectories, 5 trajectory contacts, and 2 concurrent trajectories within 6 weeks from the most recent outpatient contact. The colored lines represent different trajectories, a green cross represents contact to outpatient clinic, and the gray vertical lines represent the number of weeks since the most recent outpatient contact in 2018.

Table 1 Chronic Conditions^a in Individuals with Multimorbidity in Denmark, 1 January 2019

Conditions:	N	%
All individuals with multimorbidity	1,339,840	100
Circulatory	1,037,764	77.5
Hypertension	808,172	60.3
Dyslipidaemia	389,954	29.1
Ischemic heart disease	226,712	16.9
Atrial fibrillation	145,897	10.9
Heart failure	66,640	5.0
Peripheral artery occlusive disease	86,773	6.5
Stroke	133,783	10.0
Endocrine	392,976	29.3
Diabetes mellitus	242,207	18.1
Thyroid disorder	131,518	9.8
Gout	59,401	4.4
Pulmonary and allergy	307,091	22.9
Chronic pulmonary disease	212,376	15.9
Allergy	146,313	10.9
Urogenital	137,371	10.3
Chronic kidney disease	36,213	2.7
Prostate disorder	107,175	8.0
Gastrointestinal	234,865	17.5
Ulcer/chronic gastritis	77,727	5.8
Chronic liver disease	34,643	2.6
Inflammatory bowel disease	36,801	2.8
Diverticular disease of intestine	108,651	8.1
Musculoskeletal	484,373	36.2
Connective tissue disorders	82,816	6.2
Osteoporosis	139,526	10.4
Painful condition	353,324	26.4
Hematologic	94,783	7.1
HIV/AIDS	4836	0.4
Anemias	90,067	6.7
Neurological	456,686	34.1
Vision problems	202,180	15.1
Hearing problems	202,107	15.1
Migraine	42,186	3.2
Epilepsy	39,271	2.9
Parkinson’s disease	8478	0.6
Multiple sclerosis	10,721	0.8
Neuropathies	30,128	2.3
Cancer  Cancer	115,463	8.6
Mental health	314,006	23.4
Mood, stress-related, or anxiety disorders	48,919	3.7
Psychological distress	190,548	14.2
Alcohol problems	19,500	1.5
Substance abuse	5087	0.4
Anorexia/bulimia	1462	0.1
Bipolar affective disorder	20,247	1.5
Schizophrenia or schizoaffective disorder	21,387	1.6
Dementia	34,582	2.6

Notes: ^aDiseases according to the International Classification of Diseases, 10^th revision. See the appendix containing the algorithm.

Abbreviations: HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome.

Table 2 Characteristics of All Individuals with Multimorbidity (≥2 Conditions) Living in Denmark on 1 January 2019

	N	%
All individuals with multimorbidity	1,339,840	100.0
Gender
Men	612,722	45.7
Women	727,118	54.3
Age, Median 68 (IQI^1, 57: 76)
<50	186,382	13.9
50-59	223,707	16.7
60-69	321,847	24.0
70-79	380,239	28.4
≥80	227,665	17.0
Ethnicities
Western	1,271,952	94.9
Non-western	67,349	5.0
Missing	539	0.0
Population density
<5,000	602,630	45.0
5,000-99,999	498,076	37.2
≥100,000	239,134	17.9
Educational level^2
<10 years	457,748	34.2
10-15 years	785,228	58.6
>15 years	69,837	5.2
Missing	27,027	2.0
Civil status
Living with partner	788,460	58,9
Living alone	551,380	41,2
Work force attachment
Employed	426,791	31.9
Unemployed	887,675	66.3
Student	25,206	1.9
Missing	168	0.0
Household income, EUR^3
<25,000	85,726	6.4
25,000-49,999	593,574	44.3
50,000-74,999	286,651	21.4
≥75,000	373,889	27.9

Notes: ¹IQI, Interquartile interval; ²International Standard Classification of Education 2011; ³Gross income in 2018 summed for all household members.

Table 3 Hospital Outpatient Trajectories and Related Trajectory Contacts from Individuals with Multimorbidity in 2018

Individuals in Outpatient Trajectories			Number of Trajectory Contacts
Trajectories	N	%	N	%	Median per patient	IQI
0	992,861	74.1	–		–	–
≥1	346,979	25.9	1,954,802	100	3	2: 5
1	298,901	22.3	1,413,746	72.3	3	2: 4
2	42,821	3.2	444,549	22.7	6	4: 10
3	4776	0.4	84,835	4.3	10	8: 16
≥4	481	0.04	11,672	0.6	15	11: 24

Abbreviation: IQI, interquartile interval.

Table 4 Outpatient Trajectories According to Disease System Categories in Adults with Multimorbidity in 2018

Disease System Categories	N, Trajectories	%	Trajectories, Per Individual, Median	IQI	N, Trajectory Contacts	%	Trajectory Contacts per Individual, Median	IQI
Cancers	73,447	18.3	1	1:1	620,187	31.7	4	2:10
Circulatory	67,592	16.9	1	1:2	258,877	13.2	3	2:4
Endocrine	62,723	15.7	1	1:2	217,670	11.1	3	2.4
Gastrointestinal	19,625	4.9	1	1:1	70,143	3.6	3	2:4
Hematologic	9189	2.3	1	1:2	30,310	1.6	2	2.4
Musculoskeletal	38,197	9.5	1	1:2	139,264	7.1	2	2:5
Neurological	89,151	22.2	1	1:1	289,889	14.8	3	2:4
Pulmonary and allergy	25,283	6.3	1	1:2	71,670	3,7	2	2:3
Urogenital	15,618	4.0	1	1:2	256,792	13.1	3	2:5
Total	400,825	100	1	1:2	1,954,802	100	3	2:5

Abbreviation: IQI, interquartile interval.

Figure 2 Lorenz diagram of the cumulated proportion of individuals with multimorbidity on 1 January 2019 according to the cumulated proportion of trajectory-related contacts in 2018.

Figure 3 Histogram displaying the number of individuals in concurrent trajectories in 2018 according to different observation times, stratified by the number of concurrent trajectories.

Figure 4 Bar plot of concurrent trajectories for 2018 according to different observation times, stratified by disease system category and the number of weeks since the most recent contact.