Dataset Information

Multimorbidity, Mortality, and Long-Term Physical Functioning in 3 Prospective Cohorts of Community-Dwelling Adults.

ABSTRACT: Multimorbidity is prevalent, but its optimal quantification and associations with mortality rate and physical functioning in young through older adults are uncertain. We used data collected using the Short Form-36 in the Nurses' Health Study (enrollment started in 1976), Nurses' Health Study II (begun in 1989), and Health Professionals Follow-up Study (begun in 1986) to identify associations of a multimorbidity-weighted index (MWI) and common alternative indices with mortality and future physical functioning. We used Cox proportional hazard ratios to determine incident 10-year mortality and general linear models to obtain coefficients for the associations of MWI with 4- and 8-year physical functioning. At baseline, mean values for the 219,950 participants were 55.0 (standard deviation, 3.7) years for age; 3.8 (range, 0-51) for MWI; 2.7 (range, 0-23) for disease count, and 0.43 (range, 0-13) for Charlson Comorbidity Index (CCI). During follow-up, 23,709 deaths (10.8%) occurred. CCI, MWI, and disease count were 0 for 77%, 12%, and 19% of participants, respectively. When comparing persons in the highest quartiles with those in the lowest, the hazard ratios for mortality were 6.04 (95% confidence interval (CI): 6.00, 6.09; P for trend < 0.0001) for the MWI, 4.86 (95% CI: 4.81, 4.91; P for trend < 0.0001) for disease count, and 3.29 (95% CI: 3.26, 3.32; P for trend < 0.0001) for the CCI. For future physical functioning, MWI had the best model fit and explained the greatest variance. Multimorbidity has important associations with future physical functioning and mortality that are easily captured with a readily measured index.

SUBMITTER: Wei MY

PROVIDER: S-EPMC5860284 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Publications

Multimorbidity, Mortality, and Long-Term Physical Functioning in 3 Prospective Cohorts of Community-Dwelling Adults.

Wei Melissa Y MY Mukamal Kenneth J KJ

American journal of epidemiology 20180101 1

Multimorbidity is prevalent, but its optimal quantification and associations with mortality rate and physical functioning in young through older adults are uncertain. We used data collected using the Short Form-36 in the Nurses' Health Study (enrollment started in 1976), Nurses' Health Study II (begun in 1989), and Health Professionals Follow-up Study (begun in 1986) to identify associations of a multimorbidity-weighted index (MWI) and common alternative indices with mortality and future physica ...[more]

PMID: 29309518

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Project description:ImportanceHearing impairment, a common treatable condition, may contribute to poorer physical function with aging.ObjectiveTo assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function.Design, setting, and participantsIn this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US.ExposuresHearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment.Main outcomes and measuresPhysical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time.ResultsOf the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (β, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test.Conclusions and relevanceIn this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

Project description:ObjectivesHandgrip strength and physical activity are commonly used to evaluate physical frailty; however, their distribution varies worldwide. The thresholds that identify frail individuals have been established in high-income countries but not in low-income and middle-income countries. We created two adaptations of physical frailty to study how global versus regional thresholds for handgrip strength and physical activity affect frailty prevalence and its association with mortality in a multinational population.Design, setting and participantsOur sample included 137 499 adults aged 35-70 years (median age: 61 years, 60% women) from Population Urban Rural Epidemiology Studies community-dwelling prospective cohort across 25 countries, covering the following geographical regions: China, South Asia, Southeast Asia, Africa, Russia and Central Asia, North America/Europe, Middle East and South America.Primary and secondary outcome measuresWe measured and compared frailty prevalence and time to all-cause mortality for two adaptations of frailty.ResultsOverall frailty prevalence was 5.6% using global frailty and 5.8% using regional frailty. Global frailty prevalence ranged from 2.4% (North America/Europe) to 20.1% (Africa), while regional frailty ranged from 4.1% (Russia/Central Asia) to 8.8% (Middle East). The HRs for all-cause mortality (median follow-up of 9 years) were 2.42 (95% CI: 2.25 to 2.60) and 1.91 (95% CI: 1.77 to 2.06) using global frailty and regional frailty, respectively, (adjusted for age, sex, education, smoking status, alcohol consumption and morbidity count). Receiver operating characteristic curves for all-cause mortality were generated for both frailty adaptations. Global frailty yielded an area under the curve of 0.600 (95% CI: 0.594 to 0.606), compared with 0.5933 (95% CI: 0.587 to 5.99) for regional frailty (p=0.0007).ConclusionsGlobal frailty leads to higher regional variations in estimated frailty prevalence and stronger associations with mortality, as compared with regional frailty. However, both frailty adaptations in isolation are limited in their ability to discriminate between those who will die during 9 years' follow-up from those who do not.

Project description:BackgroundDietary protein may slow the decline in muscle mass and function with aging, making it a sensible candidate to prevent or modulate disability progression. At present, studies providing reliable estimates of the association between protein intake and physical function, and its interaction with physical activity (PA), in community-dwelling older adults are lacking.ObjectivesWe investigated the longitudinal relation between protein intake and physical function, and the interaction with PA.MethodsWe undertook a pooled analysis of individual participant data from cohorts in the PROMISS (PRevention Of Malnutrition In Senior Subjects in the European Union) consortium (the Health Aging and Body Composition Study, Quebec Longitudinal Study on Nutrition and Successful Aging, Longitudinal Aging Study Amsterdam, and Newcastle 85+) in which 5725 community-dwelling older adults were followed up to 8.5 y. The relation between protein intake and walking speed was determined using joint models (linear mixed-effects and Cox proportional hazards models) and the relation with mobility limitation was investigated using multistate models.ResultsHigher protein intake was modestly protective of decline in walking speed in a dose-dependent manner [e.g., protein intake ≥1.2 compared with 0.8 g/kg adjusted body weight (aBW)/d: β = 0.024, 95% CI: 0.009, 0.032 SD/y], with no clear indication of interaction with PA. Participants with protein intake ≥0.8 g/kg aBW/d had also a lower likelihood of incident mobility limitation, which was observed for each level of PA. This association seemed to be dose-dependent for difficulty walking but not for difficulty climbing stairs. No associations between protein intake and other mobility limitations transitions were observed.ConclusionsHigher daily protein intake can reduce physical function decline not only in older adults with protein intake below the current RDA of 0.8 g/kg BW/d, but also in those with a protein intake that is already considered sufficient. This dose-dependent association was observed for each level of PA, suggesting no clear synergistic association between protein intake and PA in relation to physical function.

Dataset Information

Multimorbidity, Mortality, and Long-Term Physical Functioning in 3 Prospective Cohorts of Community-Dwelling Adults.

Publications

Multimorbidity, Mortality, and Long-Term Physical Functioning in 3 Prospective Cohorts of Community-Dwelling Adults.

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