Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study

Ferrer, Assumpta; Formiga, Francesç; Sanz, Héctor; Almeda, Jesús; Padrós, Glòria

doi:10.2147/cia.s123173

Cited by 41 publications

(52 citation statements)

References 35 publications

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“…On the contrary, cancer–mental, followed by gastro–cardiovascular, had lower mortality in combination compared to the product of the single diagnoses. To the best of our knowledge, only one study has explored the interaction effect of pairs of diagnoses included in multimorbidity on mortality, finding excess mortality for combinations including cancer, 13 which is in contrast to our findings. Although somewhat speculative, the high mortality connected with the kidney–endocrine combination could be an accumulation of diabetes patients who are worse off in this combination compared to those in other combinations.…”

Section: Discussioncontrasting

confidence: 99%

“…The association between multimorbidity and mortality is known. 14 There exist some longitudinal studies exploring mortality in relation to multimorbidity with long, that is, 10 years or longer 12 , 19 , 20 and shorter, 13 , 21 , 22 follow-up times. One of the studies explored the most prevalent and the most lethal combinations of two to five diseases, respectively, 19 and one explored specific lethal combinations of two and three conditions.…”

Section: Introductionmentioning

confidence: 99%

“…One of the studies explored the most prevalent and the most lethal combinations of two to five diseases, respectively, 19 and one explored specific lethal combinations of two and three conditions. 13 However, all these studies included persons aged >65 years with the last study only including a limited number of persons aged 85 years or older. 13 Multimorbidity is not just an issue for older people 7 and to be able to intervene efficiently a focus on the general population is necessary.…”

Section: Introductionmentioning

confidence: 99%

“… 13 However, all these studies included persons aged >65 years with the last study only including a limited number of persons aged 85 years or older. 13 Multimorbidity is not just an issue for older people 7 and to be able to intervene efficiently a focus on the general population is necessary. This study investigates relevant combinations of multimorbidity, that is, prevalent combinations associated with high mortality.…”

Section: Introductionmentioning

confidence: 99%

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Multimorbidity and mortality

et al. 2018

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Background:Knowledge about prevalent and deadly combinations of multimorbidity is needed.Objective:To determine the nationwide prevalence of multimorbidity and estimate mortality for the most prevalent combinations of one to five diagnosis groups. Furthermore, to assess the excess mortality of the combination of two groups compared to the product of mortality associated with the single groups.Design:A prospective cohort study using Danish registries and including 3.986.209 people aged ≥18 years on 1 January, 2000. Multimorbidity was defined as having diagnoses from at least 2 of 10 diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. Logistic regression (odds ratios, ORs) and ratio of ORs (ROR) were used to study mortality and excess mortality.Results:Prevalence of multimorbidity was 7.1% in the Danish population. The most prevalent combination was the musculoskeletal–cardiovascular (0.4%), which had double the mortality (OR, 2.03) compared to persons not belonging to any of the diagnosis groups but showed no excess mortality (ROR, 0.97). The neurological–cancer combination had the highest mortality (OR, 6.35), was less prevalent (0.07%), and had no excess mortality (ROR, 0.94). Cardiovascular–lung was moderately prevalent (0.2%), had high mortality (OR, 5.75), and had excess mortality (ROR, 1.18). Endocrine–kidney had high excess mortality (ROR, 1.81) and cancer–mental had low excess mortality (ROR, 0.66). Mortality increased with the number of groups.Conclusions:All combinations had increased mortality risk with some of them having up to a six-fold increased risk. Mortality increased with the number of diagnosis groups. Most combinations did not increase mortality above that expected, that is, were additive rather than synergistic.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multimorbidity and mortality

et al. 2018

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“…A meta-analysis detected a positive association between the number of chronic conditions and risk of death 9. Studies that have evaluated multimorbidity patterns based on combinations of common conditions or factor analysis have found that health outcomes vary according to the patterns analysed 10. To our knowledge, no studies to date have evaluated survival in relation to multimorbidity patterns identified through cluster analysis, despite the potential of such an approach in guiding the design and implementation of population-based primary healthcare strategies.…”

Section: Introductionmentioning

confidence: 99%

Survival in relation to multimorbidity patterns in older adults in primary care in Barcelona, Spain (2010–2014): a longitudinal study based on electronic health records

Ibarra-Castillo

Guisado-Clavero

Violan-Fors

et al. 2018

J Epidemiol Community Health

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Impact of multimorbidity on mortality in heart failure with reduced ejection fraction: which comorbidities matter most? An analysis of PARADIGM‐HF and ATMOSPHERE

Dewan

Ferreira

Butt

et al. 2023

European J of Heart Fail

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Aims Multimorbidity, the coexistence of two or more chronic conditions, is synonymous with heart failure (HF). How risk related to comorbidities compares at individual and population levels is unknown. The aim of this study is to examine the risk related to comorbidities, alone and in combination, both at individual and population levels. Methods and results Using two clinical trials in HF – the Prospective comparison of ARNI (Angiotensin Receptor–Neprilysin Inhibitor) with ACEI (Angiotensin‐Converting Enzyme Inhibitor) to Determine Impact on Global Mortality and morbidity in HF trial (PARADIGM‐HF) and the Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure trials (ATMOSPHERE) – we identified the 10 most common comorbidities and examined 45 possible pairs. We calculated population attributable fractions (PAF) for all‐cause death and relative excess risk due to interaction with Cox proportional hazard models. Of 15 066 patients in the study, 14 133 (93.7%) had at least one and 11 867 (78.8%) had at least two of the 10 most prevalent comorbidities. The greatest individual risk among pairs was associated with peripheral artery disease (PAD) in combination with stroke (hazard ratio [HR] 1.73; 95% confidence interval [CI] 1.28–2.33) and anaemia (HR 1.71; 95% CI 1.39–2.11). The combination of chronic kidney disease (CKD) and hypertension had the highest PAF (5.65%; 95% CI 3.66–7.61). Two pairs demonstrated significant synergistic interaction (atrial fibrillation with CKD and coronary artery disease, respectively) and one an antagonistic interaction (anaemia and obesity). Conclusions In HF, the impact of multimorbidity differed at the individual patient and population level, depending on the prevalence of and the risk related to each comorbidity, and the interaction between individual comorbidities. Patients with coexistent PAD and stroke were at greatest individual risk whereas, from a population perspective, coexistent CKD and hypertension mattered most.

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Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study

Cited by 41 publications

References 35 publications

Multimorbidity and mortality

Multimorbidity and mortality

Survival in relation to multimorbidity patterns in older adults in primary care in Barcelona, Spain (2010–2014): a longitudinal study based on electronic health records

Impact of multimorbidity on mortality in heart failure with reduced ejection fraction: which comorbidities matter most? An analysis of PARADIGM‐HF and ATMOSPHERE

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