{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T02:43:23Z","timestamp":1777517003497,"version":"3.51.4"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"BMS, Gilead Sciences, Janssen, Merck and ViiV Healthcare","award":["2012- 003581-40"],"award-info":[{"award-number":["2012- 003581-40"]}]},{"name":"BMS, Gilead Sciences, Janssen, Merck and ViiV Healthcare","award":["CRO1992"],"award-info":[{"award-number":["CRO1992"]}]},{"name":"Gilead Sciences, ViiV Healthcare and Merck Sharp & Dohme (UK) Limited","award":["19SM5112"],"award-info":[{"award-number":["19SM5112"]}]},{"name":"National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infection","award":["NIHR200911"],"award-info":[{"award-number":["NIHR200911"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Multimorbidity and Comorbidity"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    There is no consensus definition for multimorbidity. We explored how different frameworks affect multimorbidity patterns and their associations with patient-reported outcomes using the prospective, observational Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) Study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Sixty-four conditions were classified into three frameworks: Framework-D (diseases), Framework-DCI (diseases and clinical indicators) and Framework-DCIS (diseases, clinical indicators and symptoms). Principal component analysis (PCA) identified five comparable patterns:\n                    <jats:italic toggle=\"yes\">Cardiovascular disease (CVD)<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Sexually transmitted diseases<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Metabolic\/AIDS-related<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Mental health\/Other<\/jats:italic>\n                    , and\n                    <jats:italic toggle=\"yes\">Cancer<\/jats:italic>\n                    . A sixth pattern was identified using Framework-D (\n                    <jats:italic toggle=\"yes\">Infections\/Skin)<\/jats:italic>\n                    and Framework-DCI\/DCIS (\n                    <jats:italic toggle=\"yes\">Cardiometabolic)<\/jats:italic>\n                    . Using PCA loadings, burden z-scores were calculated for each individual\/pattern, and their associations with functional impairment (Lawton Instrumental Activities of Daily Living &lt;8), hospitalisation and SF-36 physical and mental health scores were assessed using logistic or linear regression.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    The analyses included 1073 people with HIV (median [interquartile range; IQR] age 52 [47 - 59] years; 85% male; 97% on ART). Clinical indicators and symptoms were correlated with the\n                    <jats:italic toggle=\"yes\">CVD<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">Cardiometabolic<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">Mental health\/Other<\/jats:italic>\n                    patterns. While differences were marginal, Framework-DCI showed slightly stronger relationships between\n                    <jats:italic toggle=\"yes\">CVD<\/jats:italic>\n                    and functional impairment, hospitalisation and physical health compared to Framework-D. Similarly, Framework-DCIS demonstrated somewhat stronger associations between\n                    <jats:italic toggle=\"yes\">Metabolic\/AIDS-related<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">Mental health\/Other<\/jats:italic>\n                    patterns with certain outcomes.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    The inclusion of clinical indicators and symptoms were associated with some changes in the strength of associations between certain multimorbidity patterns and outcomes. Our findings suggest that their inclusion in multimorbidity frameworks should be guided by the specific research context and question, rather than solely by effect size on patient-important outcomes.\n                  <\/jats:p>","DOI":"10.1177\/26335565251331732","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T06:04:03Z","timestamp":1743746643000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Multimorbidity frameworks impact the composition of patterns and their associations with patient-reported outcomes among people with HIV"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6182-2126","authenticated-orcid":false,"given":"Luxsena","family":"Sukumaran","sequence":"first","affiliation":[{"name":"University College London"},{"name":"National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College London"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Winston","sequence":"additional","affiliation":[{"name":"Imperial College London"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Anderson","sequence":"additional","affiliation":[{"name":"Homerton University Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Boffito","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Healthcare NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank A.","family":"Post","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Memory","family":"Sachikonye","sequence":"additional","affiliation":[{"name":"UK Community Advisory Board (UK-CAB)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick W. G.","family":"Mallon","sequence":"additional","affiliation":[{"name":"University College Dublin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Waters","sequence":"additional","affiliation":[{"name":"University College London"},{"name":"Central and North West London NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime","family":"Vera","sequence":"additional","affiliation":[{"name":"Brighton and Sussex Medical School"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Burns","sequence":"additional","affiliation":[{"name":"University College London"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline A.","family":"Sabin","sequence":"additional","affiliation":[{"name":"University College London"},{"name":"National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College London"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu869"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12683"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir627"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/qco.0000000000000890"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.2217\/1745509x.4.6.615"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32835584ea"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2017.1246185"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2012.0329"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/geriatrics5040085"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp12X659295"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/coh.0000000000000595"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1370\/AFM.1337"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glq208"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.3109\/02813432.2016.1153242"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15921"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glq208"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.15256\/joc.2017.7.122"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyy072"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_3_8_21_2","volume-title":"Health survey for England\u201996","author":"P P-C","year":"1998","unstructured":"P P-C, P. 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