Journal Article

Multimorbidity patterns and their relationship to mortality in the US older adult population

Lee, David J., Feaster, Daniel J., Curiel-Cid, Rosie E., Loewenstein, David A., Christ, Sharon L., McCollister, Kathryn E., Lam, Byron L., Zheng, D. Diane

2021

Overview

Understanding patterns of multimorbidity in the US older adult population and their relationship with mortality is important for reducing healthcare utilization and improving health. Previous investigations measured multimorbidity as counts of conditions rather than specific combination of conditions. This cross-sectional study with longitudinal mortality follow-up employed latent class analysis (LCA) to develop clinically meaningful subgroups of participants aged 50 and older with different combinations of 13 chronic conditions from the National Health Interview Survey 2002-2014. Mortality linkage with National Death Index was performed through December 2015 for 166,126 participants. Survival analyses were conducted to assess the relationships between LCA classes and all-cause mortality and cause specific mortalities. LCA identified five multimorbidity groups with primary characteristics: \"healthy\" (51.5%), \"age-associated chronic conditions\" (33.6%), \"respiratory conditions\" (7.3%), \"cognitively impaired\" (4.3%) and \"complex cardiometabolic\" (3.2%). Covariate-adjusted survival analysis indicated \"complex cardiometabolic\" class had the highest mortality with a Hazard Ratio (HR) of 5.30, 99.5% CI [4.52, 6.22]; followed by \"cognitively impaired\" class (3.34 [2.93, 3.81]); \"respiratory condition\" class (2.14 [1.87, 2.46]); and \"age-associated chronic conditions\" class (1.81 [1.66, 1.98]). Patterns of multimorbidity classes were strongly associated with the primary underlying cause of death. The \"cognitively impaired\" class reported similar number of conditions compared to the \"respiratory condition\" class but had significantly higher mortality (3.8 vs 3.7 conditions, HR = 1.56 [1.32, 1.85]). We demonstrated that LCA method is effective in classifying clinically meaningful multimorbidity subgroup. Specific combinations of conditions including cognitive impairment and depressive symptoms have a substantial detrimental impact on the mortality of older adults. The numbers of chronic conditions experienced by older adults is not always proportional to mortality risk. Our findings provide valuable information for identifying high risk older adults with multimorbidity to facilitate early intervention to treat chronic conditions and reduce mortality.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Aged, 80 and over / Aging / Angina pectoris / Arthritis / Asthma / Behavioral sciences / Biology and Life Sciences / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - epidemiology / Cardiovascular Diseases - mortality / Chronic conditions / Chronic Disease - epidemiology / Chronic Disease - mortality / Chronic illnesses / Chronic obstructive pulmonary disease / Cognitive ability / Cognitive Dysfunction - epidemiology / Cognitive Dysfunction - mortality / Comorbidity / Coronary artery / Coronary artery disease / Coronary vessels / Cross-Sectional Studies / Depressive Disorder - epidemiology / Depressive Disorder - mortality / Diabetes mellitus / Diabetes Mellitus - epidemiology / Diabetes Mellitus - mortality / Editing / Emphysema / Family studies / Female / Follow-Up Studies / Funding / Health aspects / Health care policy / Health risks / Health sciences / Heart diseases / Hepatitis / Hispanic people / Humans / Hypertension / Kidney diseases / Life expectancy / Life span / Low income groups / Male / Marital status / Medical research / Medicine / Medicine and Health Sciences / Medicine, Experimental / Methodology / Middle Aged / Morbidity / Mortality / Multimorbidity / Neurosciences / Older people / People and Places / Population / Psychiatry / Public health / Reviews / Signs and symptoms / Statistical analysis / Statistics / Subgroups / Survival Rate / United States