Dataset Information

Association of Cardiometabolic Multimorbidity With Mortality.

ABSTRACT:

Importance

The prevalence of cardiometabolic multimorbidity is increasing.

Objective

To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.

Design, setting, and participants

Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.

Exposures

A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).

Main outcomes and measures

All-cause mortality and estimated reductions in life expectancy.

Results

In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.

Conclusions and relevance

Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

SUBMITTER: Emerging Risk Factors Collaboration

PROVIDER: S-EPMC4664176 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

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Publications

Association of Cardiometabolic Multimorbidity With Mortality.

Di Angelantonio Emanuele E Kaptoge Stephen S Wormser David D Willeit Peter P Butterworth Adam S AS Bansal Narinder N O'Keeffe Linda M LM Gao Pei P Wood Angela M AM Burgess Stephen S Freitag Daniel F DF Pennells Lisa L Peters Sanne A SA Hart Carole L CL Håheim Lise Lund LL Gillum Richard F RF Nordestgaard Børge G BG Psaty Bruce M BM Yeap Bu B BB Knuiman Matthew W MW Nietert Paul J PJ Kauhanen Jussi J Salonen Jukka T JT Kuller Lewis H LH Simons Leon A LA van der Schouw Yvonne T YT Barrett-Connor Elizabeth E Selmer Randi R Crespo Carlos J CJ Rodriguez Beatriz B Verschuren W M Monique WM Salomaa Veikko V Svärdsudd Kurt K van der Harst Pim P Björkelund Cecilia C Wilhelmsen Lars L Wallace Robert B RB Brenner Hermann H Amouyel Philippe P Barr Elizabeth L M EL Iso Hiroyasu H Onat Altan A Trevisan Maurizio M D'Agostino Ralph B RB Cooper Cyrus C Kavousi Maryam M Welin Lennart L Roussel Ronan R Hu Frank B FB Sato Shinichi S Davidson Karina W KW Howard Barbara V BV Leening Maarten J G MJ Leening Maarten M Rosengren Annika A Dörr Marcus M Deeg Dorly J H DJ Kiechl Stefan S Stehouwer Coen D A CD Nissinen Aulikki A Giampaoli Simona S Donfrancesco Chiara C Kromhout Daan D Price Jackie F JF Peters Annette A Meade Tom W TW Casiglia Edoardo E Lawlor Debbie A DA Gallacher John J Nagel Dorothea D Franco Oscar H OH Assmann Gerd G Dagenais Gilles R GR Jukema J Wouter JW Sundström Johan J Woodward Mark M Brunner Eric J EJ Khaw Kay-Tee KT Wareham Nicholas J NJ Whitsel Eric A EA Njølstad Inger I Hedblad Bo B Wassertheil-Smoller Sylvia S Engström Gunnar G Rosamond Wayne D WD Selvin Elizabeth E Sattar Naveed N Thompson Simon G SG Danesh John J

JAMA 20150701 1

<h4>Importance</h4>The prevalence of cardiometabolic multimorbidity is increasing.<h4>Objective</h4>To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.<h4>Design, setting, and participants</h4>Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; ...[more]

PMID: 26151266

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Project description:ImportanceLimited knowledge about interactions among health disorders impedes optimal patient care. Because comorbidities are common among patients 50 years and older with fractures, these fractures provide a useful setting for studying interactions among disorders.ObjectiveTo define multimorbidity clusters at the time of fracture and quantify the interaction between multimorbidity and fracture in association with postfracture excess mortality.Design, setting, and participantsThis nationwide cohort study included 307 870 adults in Denmark born on or before January 1, 1951, who had an incident low-trauma fracture between January 1, 2001, and December 31, 2014, and were followed up through December 31, 2016. Data were analyzed from February 1 to March 31, 2022.Main outcomes and measuresFracture and 32 predefined chronic diseases recorded within 5 years before the index fracture were identified from the Danish National Hospital Discharge Register. Death was ascertained from the Danish Register on Causes of Death. Latent class analysis was conducted to identify multimorbidity clusters. Relative survival analysis was used to quantify excess mortality associated with the combination of multimorbidity and fractures at specific sites.ResultsAmong the 307 870 participants identified with incident fractures, 95 372 were men (31.0%; mean [SD] age at fracture, 72.3 [11.2] years) and 212 498 were women (69.0%; mean [SD] age at fracture, 74.9 [11.2] years). During a median of 6.5 (IQR, 3.0-11.0) years of follow-up, 41 017 men (43.0%) and 81 727 women (38.5%) died. Almost half of patients with fractures (42.9%) had at least 2 comorbidities. Comorbidities at fracture were categorized as low-multimorbidity (60.5% in men and 66.5% in women), cardiovascular (23.7% in men and 23.5% in women), diabetic (5.6% in men and 5.0% in women), malignant (5.1% in men and 5.0% in women), and mixed hepatic and/or inflammatory (5.1% in men only) clusters. These clusters distinguished individuals with advanced, complex, or late-stage disease from those with earlier-stage disease. Multimorbidity and proximal or lower leg fractures were associated with increased mortality risk, with the highest excess mortality found in patients with hip fracture in the malignant cluster (1-year excess mortality: 40.8% [95% CI: 38.1%-43.6%]). The combination of multimorbidity and fracture compounded the association with mortality, conferring much greater risk than either alone.Conclusions and relevanceConcomitant illnesses were common and clustered into distinct multimorbidity clusters that were associated with excess postfracture mortality. The compound contribution of multimorbidity to postfracture excess mortality highlights the need for more comprehensive approaches in these high-risk patients. The analytical approach applied to fracture could also be used to examine other sentinel health events.

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Dataset Information

Association of Cardiometabolic Multimorbidity With Mortality.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Conclusions and relevance

Publications

Association of Cardiometabolic Multimorbidity With Mortality.

Similar Datasets

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