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Open Access 01-12-2019 | Research article

Relationship between multimorbidity, demographic factors and mortality: findings from the UK Biobank cohort

Authors: Bhautesh Dinesh Jani, Peter Hanlon, Barbara I. Nicholl, Ross McQueenie, Katie I. Gallacher, Duncan Lee, Frances S. Mair

Published in: BMC Medicine | Issue 1/2019

Abstract

Background

Multimorbidity is associated with higher mortality, but the relationship with cancer and cardiovascular mortality is unclear. The influence of demographics and type of condition on the relationship of multimorbidity with mortality remains unknown. We examine the relationship between multimorbidity (number/type) and cause of mortality and the impact of demographic factors on this relationship.

Methods

Data source: the UK Biobank; 500,769 participants; 37-73 years; 53.7% female. Exposure variables: number and type of long-term conditions (LTCs) (N = 43) at baseline, modelled separately. Cox regression models were used to study the impact of LTCs on all-cause/vascular/cancer mortality during median 7-year follow-up. All-cause mortality regression models were stratified by age/sex/socioeconomic status.

Results

All-cause mortality is 2.9% (14,348 participants). Of all deaths, 8350 (58.2%) were cancer deaths and 2985 (20.8%) vascular deaths. Dose-response relationship is observed between the increasing number of LTCs and all-cause/cancer/vascular mortality. A strong association is observed between cardiometabolic multimorbidity and all three clinical outcomes; non-cardiometabolic multimorbidity (excluding cancer) is associated with all-cause/vascular mortality. All-cause mortality risk for those with ≥ 4 LTCs was nearly 3 times higher than those with no LTCs (HR 2.79, CI 2.61–2.98); for ≥ 4 cardiometabolic conditions, it was > 3 times higher (HR 3.20, CI 2.56–4.00); and for ≥ 4 non-cardiometabolic conditions (excluding cancer), it was 50% more (HR 1.50, CI 1.36–1.67). For those with ≥ 4 LTCs, morbidity combinations that included cardiometabolic conditions, chronic kidney disease, cancer, epilepsy, chronic obstructive pulmonary disease, depression, osteoporosis and connective tissue disorders had the greatest impact on all-cause mortality. In the stratified model by age/sex, absolute all-cause mortality was higher among the 60–73 age group with an increasing number of LTCs; however, the relative effect size of the increasing number of LTCs on higher mortality risk was larger among those 37–49 years, especially men. While socioeconomic status was a significant predictor of all-cause mortality, mortality risk with increasing number of LTCs remained constant across different socioeconomic gradients.

Conclusions

Multimorbidity is associated with higher all-cause/cancer/vascular mortality. Type, as opposed to number, of LTCs may have an important role in understanding the relationship between multimorbidity and mortality. Multimorbidity had a greater relative impact on all-cause mortality in middle-aged as opposed to older populations, particularly males, which deserves exploration.

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Academy of Medical Sciences. Multimorbidity: a priority for global health research. 2018. https://acmedsci.ac.uk/file-download/82222577. Accessed 18 Mar 2019.

Violan C, Foguet-Boreu Q, Flores-Mateo G, Salisbury C, Blom J, Freitag M, et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLoS One. 2014;9:e102149.CrossRef

Arokiasamy P, Uttamacharya U, Jain K, Biritwum RB, Yawson AE, Wu F, et al. The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal? BMC Med. 2015;13:178. https://doi.org/10.1186/s12916-015-0402-8.CrossRefPubMedPubMedCentral

Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–5. https://doi.org/10.1007/s11606-007-0322-1.CrossRefPubMedPubMedCentral

Wallace E, Stuart E, Vaughan N, Bennett K, Fahey T, Smith SM. Risk prediction models to predict emergency hospital admission in community-dwelling adults. Med Care. 2014;52:751–65. https://doi.org/10.1097/MLR.0000000000000171.CrossRefPubMedPubMedCentral

Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2016;67:130–8. https://doi.org/10.1016/j.archger.2016.07.008.CrossRefPubMed

Department of Health UK. Living well for longer: progress 1 year on. 2015. https://www.gov.uk/government/publications/living-well-for-longer-progress-1-year-on. Accessed 18 Mar 2019.

Dugoff EH, Canudas-Romo V, Buttorff C, Leff B, Anderson GF. Multiple chronic conditions and life expectancy: a life table analysis. Med Care. 2014;52:688–94.CrossRef

Marengoni A, Von Strauss E, Rizzuto D, Winblad B, Fratiglioni L. The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med. 2009;265:288–95.CrossRef

10.

St John PD, Tyas SL, Menec V, Tate R. Multimorbidity, disability, and mortality in community-dwelling older adults. Can Fam Physician 2014;60:e272–e280. http://www.ncbi.nlm.nih.gov/pubmed/24829022. Accessed 26 July 2018.

11.

Landi F, Calvani R, Tosato M, Martone AM, Bernabei R, Onder G, et al. Impact of physical function impairment and multimorbidity on mortality among community-living older persons with sarcopaenia: results from the ilSIRENTE prospective cohort study. BMJ Open. 2016;6:e008281. https://doi.org/10.1136/bmjopen-2015-008281.CrossRefPubMedPubMedCentral

12.

Zeng C, Ellis JL, Steiner JF, Shoup JA, McQuillan DB, Bayliss EA. Assessment of morbidity over time in predicting health outcomes. Med Care. 2014;52:S52–9. https://doi.org/10.1097/MLR.0000000000000033.CrossRefPubMed

13.

Bannay A, Chaignot C, Blotière P-O, Basson M, Weill A, Ricordeau P, et al. The best use of the Charlson Comorbidity Index with electronic health care database to predict mortality. Med Care. 2016;54:188–94. https://doi.org/10.1097/MLR.0000000000000471.CrossRefPubMed

14.

Brilleman SL, Salisbury C. Comparing measures of multimorbidity to predict outcomes in primary care: a cross sectional study. Fam Pract. 2013;30:172–8.CrossRef

15.

Quail JM, Lix LM, Osman BA, Teare GF. Comparing comorbidity measures for predicting mortality and hospitalization in three population-based cohorts. BMC Health Serv Res. 2011;11:146. https://doi.org/10.1186/1472-6963-11-146.CrossRefPubMedPubMedCentral

16.

Lane NE, Maxwell CJ, Gruneir A, Bronskill SE, Wodchis WP. Absence of a socioeconomic gradient in older adults’ survival with multiple chronic conditions. EBioMedicine. 2015;2:2094–100. https://doi.org/10.1016/J.EBIOM.2015.11.018.CrossRefPubMedPubMedCentral

17.

Jensen NL, Pedersen HS, Vestergaard M, Mercer SW, Glümer C, Prior A. The impact of socioeconomic status and multimorbidity on mortality: a population-based cohort study. Clin Epidemiol. 2017;9:279–89. https://doi.org/10.2147/CLEP.S129415.CrossRef

18.

Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet (London, England). 2017;389:941–50. https://doi.org/10.1016/S0140-6736(17)30003-X.CrossRef

19.

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet (London, England). 2012;380:37–43. https://doi.org/10.1016/S0140-6736(12)60240-2.CrossRef

20.

Nicholl BI, Mackay D, Cullen B, Martin DJ, Ul-Haq Z, Mair FS, et al. Chronic multisite pain in major depression and bipolar disorder: cross-sectional study of 149,611 participants in UK Biobank. BMC Psychiatry. 2014;14:350. https://doi.org/10.1186/s12888-014-0350-4.CrossRefPubMedPubMedCentral

21.

Townsend P. Deprivation. J Soc Policy. 1987;16:125.CrossRef

22.

Celis-Morales CA, Lyall DM, Anderson J, Iliodromiti S, Fan Y, Ntuk UE, et al. The association between physical activity and risk of mortality is modulated by grip strength and cardiorespiratory fitness: evidence from 498 135 UK-Biobank participants. Eur Heart J. 2016;7:ehw249.CrossRef

23.

WHO. WHO BMI Classification. 2004. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed 18 Mar 2019.

24.

WHO. International Statistical Classification of Diseases and Related Health Problems (International Classification of Diseases)(ICD) 10th Revision - Version:2010. 2010. http://apps.who.int/classifications/icd10/browse/2010/en. Accessed 18 Mar 2019.

25.

Austin PC, Lee DS, Fine JP. Introduction to the analysis of survival data in the presence of competing risks. Circulation. 2016;133:601–9. https://doi.org/10.1161/CIRCULATIONAHA.115.017719.CrossRefPubMedPubMedCentral

26.

Hogarty KY, Hines CV, Kromrey JD, Ferron JM, Mumford KR. The quality of factor solutions in exploratory factor analysis: the influence of sample size, communality, and overdetermination; 2005. https://doi.org/10.1177/0013164404267287.CrossRef

27.

Team RC. R Core Team (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org/. 2018. http://www.r-project.org/. Accessed 18 Mar 2019.

28.

Fry A, Littlejohns T, Sudlow C, Doherty N, Allen N. OP41 The representativeness of the UK biobank cohort on a range of sociodemographic, physical, lifestyle and health-related characteristics. J Epidemiol Community Health. 2016;70(Suppl 1):A26.1–A26. https://doi.org/10.1136/jech-2016-208064.41.CrossRef

29.

Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Pub Health. 2018. https://doi.org/10.1093/eurpub/cky098.CrossRef

30.

Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, et al. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet (London, England). 2017;389:1229–37. https://doi.org/10.1016/S0140-6736(16)32380-7.CrossRef

31.

WHO, World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. 2013.

32.

Islam KMM, Jiang X, Anggondowati T, Lin G, Ganti AK. Comorbidity and survival in lung cancer patients. Cancer Epidemiol Biomark Prev. 2015;24:1079–85. https://doi.org/10.1158/1055-9965.EPI-15-0036.CrossRef

33.

Tetsche MS, Dethlefsen C, Pedersen L, Sorensen HT, Norgaard M. The impact of comorbidity and stage on ovarian cancer mortality: a nationwide Danish cohort study. BMC Cancer. 2008;8:31.CrossRef

34.

Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291:2441. https://doi.org/10.1001/jama.291.20.2441.CrossRefPubMed

35.

Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard M. The impact of comorbidity on cancer survival: a review. Clin Epidemiol. 2013;5(Suppl 1):3–29. https://doi.org/10.2147/CLEP.S47150.CrossRefPubMedPubMedCentral

36.

Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, Bansal N, et al. Association of cardiometabolic multimorbidity with mortality. JAMA - J Am Med Assoc. 2015;314:52–60. https://doi.org/10.1001/jama.2015.7008.CrossRef

37.

Gallacher K, McQueenie R, Nicole B, Jani B, Lee D, Mair F. Risk factors and mortality associated with multimorbidity in people with stroke or transient ischaemic attack: a study of 8,751 UK Biobank participants. J Comorbidity. 2018;8:1–8. https://doi.org/10.15256/joc.2018.8.129.CrossRef

38.

Hall M, Dondo TB, Yan AT, Mamas MA, Timmis AD, Deanfield JE, et al. Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: latent class analysis of a nationwide population-based cohort. PLoS Med. 2018;15:e1002501. https://doi.org/10.1371/journal.pmed.1002501.CrossRefPubMedPubMedCentral

39.

(UK) NGC. Multimorbidity: assessment, prioritisation and management of care for people with commonly occurring multimorbidity. 2016. https://www.ncbi.nlm.nih.gov/pubmed/27683922. Accessed 18 Mar 2019.

40.

Bleich SN, Sherrod C, Chiang A, Boyd C, Wolff J, Chang E, et al. Systematic review of programs treating high-need and high-cost people with multiple chronic diseases or disabilities in the United States, 2008–2014. Prev Chronic Dis. 2015;12:150275. https://doi.org/10.5888/pcd12.150275.CrossRef

41.

Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012;345:e5205. https://doi.org/10.1136/bmj.e5205.CrossRefPubMedPubMedCentral

Title: Relationship between multimorbidity, demographic factors and mortality: findings from the UK Biobank cohort
Authors: Bhautesh Dinesh Jani
Peter Hanlon
Barbara I. Nicholl
Ross McQueenie
Katie I. Gallacher
Duncan Lee
Frances S. Mair
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2019
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-019-1305-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Relationship between multimorbidity, demographic factors and mortality: findings from the UK Biobank cohort

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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