title: Multimorbidity in a marginalised, street-health Australian population: a retrospective cohort study.
abstract: OBJECTIVE
  Demographic and presentation profile of patients using an innovative mobile outreach clinic compared with mainstream practice.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Primary care mobile street health clinic and mainstream practice in Western Australia.
  
  
  METHODS
  2587 street health and 4583 mainstream patients.
  
  
  METHODS
  Prevalence and patterns of chronic diseases in anatomical domains across the entire age spectrum of patients and disease severity burden using Cumulative Illness Rating Scale (CIRS).
  
  
  RESULTS
  Multimorbidity (2+ CIRS domains) prevalence was significantly higher in the street health cohort (46.3%, 1199/2587) than age-sex-adjusted mainstream estimate (43.1%, 2000/4583), p=0.011. Multimorbidity prevalence was significantly higher in street health patients <45 years (37.7%, 615/1649) compared with age-sex-adjusted mainstream patients (33%, 977/2961), p=0.003 but significantly lower if 65+ years (62%, 114/184 vs 90.7%, 322/355, p<0.001). Controlling for age and gender, the mean CIRS Severity Index score for street health (M=1.4, SD=0.91) was significantly higher than for mainstream patients (M=1.1, SD=0.80), p<0.001. Furthermore, 44.2% (530/1199) of street health patients had at least one level 3 or 4 score across domains compared with 18.3% (420/2294) for mainstream patients, p<0.001. Street health population comprised 29.6% (766/2587) Aboriginal patients with 50.4% (386/766) having multimorbidity compared with 44.6% (813/1821) for non-Aboriginals, p=0.007. There were no comprehensive data on Indigenous status in the mainstream cohort available for comparison. Musculoskeletal, respiratory and psychiatric domains were most commonly affected with multimorbidity significantly associated with male gender, increasing age and Indigenous status.
  
  
  CONCLUSIONS
  Age-sex-adjusted multimorbidity prevalence and disease severity is higher in the street health cohort. Earlier onset (23-34 years) multimorbidity is found in the street health cohort but prevalence is lower in 65+ years than in mainstream patients. Multimorbidity prevalence is higher for Aboriginal patients of all ages.
authors.affiliation: General Practice and Primary Health Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Brett
authors.affiliation: General Practice and Primary Health Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia Centre for Health Services Research, School of Population Health, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Arnold-Reed
authors.affiliation: General Practice and Primary Health Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
authors.forename: Lakkhina
authors.initials: L
authors.lastname: Troeung
authors.affiliation: Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia.
authors.forename: Max K
authors.initials: MK
authors.lastname: Bulsara
authors.affiliation: Illawarra Shoalhaven Local Health District, Woolongong, New South Wales, Australia.
authors.forename: Annalisse
authors.initials: A
authors.lastname: Williams
authors.affiliation: School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Moorhead
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D062487:Social Marginalization; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: PRIMARY CARE; chronic disease; multimorbidity