Relationship Between Multimorbidity, Combination and All-Cause Mortality Among Older Adults: A Retrospective Cohort Analysis

Abstract Background: Previous studies have evaluated the association of multimorbidity with higher mortality, but epidemiologic data on the association between the combination of multimorbidity and all-cause mortality risk are rare. We aimed to examine the relationship between multimorbidity (number/combination) and all-cause mortality in Chinese older adults. Methods: We conducted a population-based study of 50,100 Chinese participants. Cox regression models were used to estimate the impact of long-term conditions (LTCs) on all-cause mortality. Results: The prevalence of multimorbidity was 31.35% and all-cause mortality was 8.01% (50,100 participants). In adjusted Cox models, the hazard rations (HRs) and 95% confidence intervals (CIs) of all-cause mortality risk for those with 1, 2, and ≥ 3 LTCs compared with those with no LTCs was 1.10 (1.01-1.20), 1.21 (1.10-1.33), and 1.46 (1.27-1.67), respectively (Ptrend <0.001). In the LTCs ≥ 2 category, the combination of chronic diseases that included hypertension, diabetes, CHD, COPD, and stroke had the greatest impact on mortality. In the stratified model by age and sex, absolute all-cause mortality was higher among the ≥ 75 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 < 75 years.Conclusions: The risk of all-cause mortality is increased with the number of multimorbidity among Chinese older adults, particularly combinations.

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Relationship between multimorbidity, disease cluster and all-cause mortality among older adults: a retrospective cohort analysis

BMC Public Health ◽

10.1186/s12889-021-11108-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kun He ◽

Wenli Zhang ◽

Xueqi Hu ◽

Hao Zhao ◽

Bingxin Guo ◽

...

Keyword(s):

Older Adults ◽

Mortality Risk ◽

Cohort Analysis ◽

Multiple Logistic Regression Analysis ◽

Relative Effect ◽

Long Term Conditions ◽

Chinese Older Adults ◽

Disease Clusters ◽

All Cause Mortality ◽

The Impact

Abstract Background Previous studies have evaluated the association of multimorbidity with higher mortality, but epidemiologic data on the association between the disease clusters and all-cause mortality risk are rare. We aimed to examine the relationship between multimorbidity (number/ cluster) and all-cause mortality in Chinese older adults. Methods We conducted a population-based study of 50,100 Chinese participants. Multiple logistic regression analysis was used to estimate the impact of long-term conditions (LTCs) on all-cause mortality. Results The prevalence of multimorbidity was 31.35% and all-cause mortality was 8.01% (50,100 participants). In adjusted models, the odds ratios (ORs) and 95% confidence intervals (CIs) of all-cause mortality risk for those with 1, 2, and ≥ 3 LTCs compared with those with no LTCs was 1.45 (1.32–1.59), 1.72 (1.55–1.90), and 2.15 (1.85–2.50), respectively (Ptrend < 0.001). In the LTCs ≥2 category, the cluster of chronic diseases that included hypertension, diabetes, CHD, COPD, and stroke had the greatest impact on mortality. In the stratified model by age and sex, absolute all-cause mortality was higher among the ≥75 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 < 75 years. Conclusions The risk of all-cause mortality is increased with the number of multimorbidity among Chinese older adults, particularly disease clusters.

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Apolipoprotein E Genotype, Meat, Fish, and Egg Intake in Relation to Mortality Among Older Adults: A Longitudinal Analysis in China

Frontiers in Medicine ◽

10.3389/fmed.2021.697389 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xurui Jin ◽

Shangzhi Xiong ◽

Changzheng Yuan ◽

Enying Gong ◽

Xian Zhang ◽

...

Keyword(s):

Older Adults ◽

Apolipoprotein E ◽

Cox Regression ◽

Population Based ◽

Fish Intake ◽

Chinese Older Adults ◽

Healthy Longevity ◽

All Cause Mortality ◽

Diet Pattern ◽

Interactive Relationship

Introduction: The interactions between apolipoprotein E (APOE) genotype and diet pattern changes were found significant in several trials, implying that APOE gene may modify the effect of animal protein-rich food on health outcomes. We aim to study the interaction of APOE genotype with the effect of meat, fish and egg intake on mortality.Methods: This population-based study enrolled 8,506 older adults (mean age: 81.7 years, 52.3% female) from the Chinese Longitudinal Healthy Longevity Study. The intake frequency of meat, fish and egg was assessed by 3-point questions at baseline. Cox regression was conducted to calculate the hazard ratios for all-cause mortality of intake levels of meat, fish and egg. The analyses were stratified by APOE genotype and sex. The analyses were performed in 2020.Results: In the multivariable-adjusted models, meat and fish intake was associated with all-cause mortality (high vs. low intake: meat: HR: 1.14, 95% CI: 1.01, 1.28; fish: HR: 0.83, 95% CI: 0.73, 0.95). APOE genotype have significant interactions with meat and fish intake (Ps < 0.05). Compared with low fish intake, high fish intake was associated with lower risk of mortality (HR: 0.74, 95% CI: 0.56–0.98) only among the APOE ε4 carriers. High meat intake was significantly associated with higher risks of mortality (HR: 1.13, 95% CI: 1.04–1.25) only among the APOE ε4 non-carriers. The interactive relationship was restricted among the male. No significant findings were observed between egg and mortality among carriers or non-carriers.Conclusions: Among Chinese older adults, the significance of associations of mortality with reported meat or fish intake depended on APOE-E4 carriage status. If validated by other studies, our findings provide evidence for gene-based “precision” lifestyle recommendations.

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The Impact of Obesity and Adiposity on Mortality Risk in Older Adults: A Ten-year Survival Analysis

10.21203/rs.3.rs-777627/v1 ◽

2021 ◽

Author(s):

Letícia Almeida Nogueira Moura ◽

Valéria Pagotto ◽

Cristina Camargo Pereira ◽

Rômulo Roosevelt da Silva Filho ◽

César de Oliveira ◽

...

Keyword(s):

Older Adults ◽

Survival Analysis ◽

Mortality Risk ◽

Cancer Mortality ◽

Cox Regression ◽

Clinical History ◽

The Body ◽

Increased Risk ◽

Multifrequency Bioimpedance ◽

The Impact

Abstract There are not much information about the impact of obesity on all-cause, cardiovascular and cancer mortality in older adults. We have investigated the impact of obesity and adiposity on all-cause, cardiovascular and cancer mortality, in older adults after a 10-year follow-up. Prospective cohort study has been carried out with individuals ≥ 60 years. Sociodemographic characteristics, lifestyle, clinical history, laboratory tests and anthropometric data were collected. Adiposity was defined as tertiles of the percentage of body fat assessed by multifrequency bioimpedance. For obesity, three classifications were considered using the body mass index (BMI) as follows: ≥ 25.0 kg/m² in men and ≥ 26.6 kg/m² in women, ≥ 27.0 kg/m² and ≥ 30.0 kg/m². The BMI ≥ 30.0 kg/m² was associated a reduction in the all-cause mortality risk in non-ajusted Cox regression (HR: 0.65; 95% CI: 0.43 - 0.97) and in the Kaplan-Meier curves (p = 0.032). However, in multivariate Cox regression none of the diagnostic criteria for obesity and adiposity were significantly associated with all-cause, cardiovascular or cancer mortality. This 10-year survival analysis has showed that obesity and adiposity were not associated with an increased risk of all-cause, cardiovascular or cancer mortality in the older adults.

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Self-reported visual impairment, physical activity and all-cause mortality: The HUNT Study

Scandinavian Journal of Public Health ◽

10.1177/1403494816680795 ◽

2016 ◽

Vol 45 (1) ◽

pp. 33-41 ◽

Cited By ~ 4

Author(s):

Audun Brunes ◽

W. Dana Flanders ◽

Liv Berit Augestad

Keyword(s):

Physical Activity ◽

Visual Impairment ◽

Mortality Risk ◽

Cox Regression ◽

Age Groups ◽

Health Study ◽

Cox Models ◽

Hazard Ratios ◽

All Cause Mortality ◽

Hunt Study

Aims: To examine the associations of self-reported visual impairment and physical activity (PA) with all-cause mortality. Methods: This prospective cohort study included 65,236 Norwegians aged ⩾20 years who had participated in the Nord-Trøndelag Health Study (HUNT2, 1995−1997). Of these participants, 11,074 (17.0%) had self-reported visual impairment (SRVI). The participants’ data were linked to Norway’s Cause of Death Registry and followed throughout 2012. Hazard ratios and 95% confidence intervals (CI) were assessed using Cox regression analyses with age as the time-scale. The Cox models were fitted for restricted age groups (<60, 60−84, ⩾85 years). Results: After a mean follow-up of 14.5 years, 13,549 deaths were identified. Compared with adults with self-reported no visual impairment, the multivariable hazard ratios among adults with SRVI were 2.47 (95% CI 1.94–3.13) in those aged <60 years, 1.22 (95% CI 1.13–1.33) in those aged 60–84 years and 1.05 (95% CI 0.96–1.15) in those aged ⩾85 years. The strength of the associations remained similar or stronger after additionally controlling for PA. When examining the joint associations, the all-cause mortality risk of SRVI was higher for those who reported no PA than for those who reported weekly hours of PA. We found a large, positive departure from additivity in adults aged <60 years, whereas the departure from additivity was small for the other age groups. Conclusions: Adults with SRVI reporting no PA were associated with an increased all-cause mortality risk. The associations attenuated with age.

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The Association between Allostatic Load and Mortality among Chinese Older Adults: The Chinese Longitudinal Health and Longevity Study

10.21203/rs.3.rs-31124/v1 ◽

2020 ◽

Author(s):

Tianhang Zhang ◽

Lijing Yan ◽

Huashuai Chen ◽

Haiyu Jin ◽

Chenkai Wu

Keyword(s):

Older Adults ◽

Allostatic Load ◽

Adverse Outcomes ◽

Cox Models ◽

Chinese Older Adults ◽

Healthy Longevity ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality ◽

Wear And Tear

Abstract Background Allostatic load, as multiple biomarker measures of ‘wear and tear’ on physiological systems, has shown some promise that high burden of AL is associated with increased risk of adverse outcomes, but little attention has been paid to China with largest aging population in the world. This study is to examine the association between allostatic load (AL) and all-cause mortality among Chinese adults aged at least 60 years. Methods Data were from 2,439 participants in the Chinese Longitudinal Healthy Longevity Survey. The final analytic sample consisted of 1,519 participants. Cox models were used to examine the association between AL and mortality among men and women, separately. Analysis were also adjusted for potential confounders including age, ethnicity, education, and marital status, smoking and exercise. Results In the fully adjusted model, males with a medium AL burden (score: 2–4) and high AL burden (score: 5–9) had a 34% and 128% higher hazard of death, respectively, than those with a low AL burden (score: 0–1). We did not find significant difference between females with different levels of AL burden. Discussion Higher AL burden was associated with increased all-cause mortality among Chinese men aged at least 60 years. However, we did not find strong evidence about Allostatic load was associated with specific causes of death over the same follow-up period among women. In conclusion Intervention programs targeting modifiable components of the AL burden may help prolong lifespan for older adults, especially men, in China.

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Abstract P129: Biomarkers of Hyperglycemia With All-cause Mortality in Older Adults With and Without Diagnosed Diabetes

Circulation ◽

10.1161/circ.141.suppl_1.p129 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Mary R Rooney ◽

Olive Tang ◽

James S Pankow ◽

Elizabeth Selvin

Keyword(s):

Older Adults ◽

Cox Regression ◽

Glycated Albumin ◽

Cohort Analysis ◽

Undiagnosed Diabetes ◽

Atherosclerosis Risk In Communities ◽

All Cause Mortality ◽

Before And After ◽

Diagnosed Diabetes ◽

Glycemic Markers

Introduction: HbA1c is central to diagnosis and management of diabetes. However, our understanding of the associations of HbA1c with clinical outcomes is based primarily on studies of middle-aged adults. Objective: To characterize the associations between HbA1c and mortality among older adults with and without diabetes. We compared the HbA1c-mortality associations with those for alternative glycemic markers (fructosamine and glycated albumin). Methods: We conducted a prospective cohort analysis of 6370 participants (32% with diagnosed diabetes, mean age 76, 59% female, 23% black) in the Atherosclerosis Risk in Communities (ARIC) Study, baseline visit 5 (2011-13). We used Cox regression models to examine the association of each glycemic biomarker (modeled as a linear spline) with all-cause mortality through 2017, stratified by diagnosed diabetes. Model discrimination was tested using c-statistics. Results: There were 1022 deaths over 6 years of follow-up. In persons with diabetes, there was a J-shaped association between HbA1c and mortality ( Figure ). Associations were largely similar for fructosamine and glycated albumin. Among persons without diabetes, HbA1c was not strongly associated with mortality, but confidence intervals were wide for HbA1c <5.0% and ≥6.5% (undiagnosed diabetes); whereas, higher levels of fructosamine and glycated albumin were associated with an elevated mortality risk. Associations were similar before and after adjustment for cardiovascular risk factors. The addition of individual glycemic markers to the models modestly improved discrimination in both persons with and without diabetes. C-statistics were similar when the glycemic markers were added individually to the diabetes-stratified models (Figure). Conclusions: Among older adults, HbA1c and other glycemic markers tend to have similar associations with mortality. HbA1c, fructosamine, and glycated albumin, including low levels, may reflect common markers of risk in older adults, particularly in those with diabetes.

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The Non-linear Relationship Between Normal Range Systolic Blood Pressure and Cardiovascular or All-Cause Mortality Among Elderly Population

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.677189 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shuo Sun ◽

Xiao-cong Liu ◽

Guo-dong He ◽

Kenneth Lo ◽

Ying-qing Feng ◽

...

Keyword(s):

Older Adults ◽

Mortality Risk ◽

Elderly Population ◽

Cox Regression ◽

Cardiovascular Death ◽

Nutrition Examination Survey ◽

Normal Range ◽

Health And Nutrition ◽

All Cause Mortality ◽

Cardiovascular Mortality Risk

Purpose: The aim was to explore the association of normal range SBP with cardiovascular and all-cause mortality in older adults without hypertension.Methods: Participants aged ≥ 65 years without hypertension and those had an SBP level between 90 and 129 mmHg were included from the National Health and Nutrition Examination Survey (1999–2014). SBP was categorized into: 90–99, 100–109, 110–119, and 120–129 mmHg. Multivariate Cox regression was performed with hazard ratio (HR) and 95% confidence interval (CI).Results: Of the 1,074 participants, 584 were men (54.38%). Compared with participants with SBP level ranged 110 to 119 mmHg, the HRs for all-cause mortality risk was 1.83 (95% CI: 1.04, 3.23) for SBP level ranged 90 to 99 mm Hg, 0.87 (95% CI: 0.54, 1.41) for SBP level ranged 100 to 109 mmHg, and 1.30 (95% CI: 0.96, 1.75) for SBP level ranged 120 to 129 mmHg (P for trend = 0.448), and the HR for cardiovascular mortality risk was 3.30 (95% CI: 0.87, 12.54) for SBP level ranged 90 to 99 mmHg, 0.35(95% CI: 0.08, 1.56) for SBP level ranged 100 to 109 mmHg, and 1.75 (95% CI: 0.78, 3.94) for SBP level ranged 120 to 129 mm Hg (P for trend = 0.349) after confounders were adjusted.Conclusion: These were a nonlinear association of normal range SBP level with all-cause and cardiovascular death in older adults.

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Waist Circumference and All-Cause Mortality among Older Adults in Rural Indonesia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010116 ◽

2019 ◽

Vol 16 (1) ◽

pp. 116 ◽

Cited By ~ 5

Author(s):

Cahya Utamie Pujilestari ◽

Lennarth Nyström ◽

Margareta Norberg ◽

Nawi Ng

Keyword(s):

Older Adults ◽

Waist Circumference ◽

Abdominal Obesity ◽

Mortality Risk ◽

Cox Regression ◽

Public Health Intervention ◽

World Health ◽

Men And Women ◽

Cox Regression Analysis ◽

All Cause Mortality

Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

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Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glz045 ◽

2019 ◽

Vol 74 (12) ◽

pp. 1916-1921 ◽

Cited By ~ 1

Author(s):

Raya Elfadel Kheirbek ◽

Ali Fokar ◽

John T Little ◽

Marshall Balish ◽

Nawar M Shara ◽

...

Keyword(s):

Older Adults ◽

Mental Illness ◽

Mortality Risk ◽

Community Dwelling ◽

Department Of Veterans Affairs ◽

Cox Models ◽

Increased Risk ◽

All Cause Mortality ◽

Diagnosis Of Dementia ◽

Time Varying Covariates

Abstract Background Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia. Methods Data (2007–2015) were derived from Department of Veterans Affairs registries for 730,226 patients (≥65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics. Results The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotics had the highest risk of mortality (78.0%), followed by (73.0%) for patients with dementia alone and compared with patients without dementia or antipsychotics exposure who had the lowest mortality risk (42.0%). Exposure to typical antipsychotics was associated with (HR: 2.1, confidence interval [CI] 2.0–2.2) compared with atypical antipsychotics (HR: 1.5, CI 1.4–1.5, p = <.0001). Conclusion In a large cohort of older adults, antipsychotics were associated with an increased risk of all-cause mortality. While significant increase in mortality was attributable to the diagnosis of dementia, the addition of antipsychotics resulted in added mortality risk among all patients. Antipsychotic medications should be used cautiously in all older adults, not only those with dementia.

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Abstract P443: Association of Peripheral Neuropathy With All-cause and Cardiovascular Mortality in US Adults

Circulation ◽

10.1161/circ.141.suppl_1.p443 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Caitlin W Hicks ◽

Dan Wang ◽

B Gwen Windham ◽

Kunihiro Matsushita ◽

Elizabeth Selvin

Keyword(s):

Older Adults ◽

Peripheral Neuropathy ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Adult Population ◽

Cohort Analysis ◽

High Risk Population ◽

Cox Models ◽

Diabetes Status ◽

Nationally Representative

Background: Peripheral neuropathy (PN) is common in the general US adult population, especially in older adults even in the absence of diabetes. However, the clinical sequelae of PN have not been quantified in a nationally representative sample. We aimed to assess the associations of prevalent PN with all-cause and cardiovascular mortality using data from the National Health and Nutrition Examination Survey(NHANES). Methods: Prospective cohort analysis of 7,137 participants from NHANES (aged ≥40 yrs) who underwent standardized PN testing at baseline (1999-2004). We used survival analysis methods and Cox regression to evaluate the associations of PN with all-cause and cardiovascular mortality. Cox models were adjusted for demographic and cardiovascular risk factors. Results: The overall prevalence of PN was 17.7% (29.9% in adults with diabetes and 15.2% in adults without diabetes). In age-adjusted Kaplan-Meier analyses (median follow-up 13 yrs), the risk of all-cause and cardiovascular mortality was highest among adults with PN and diabetes, but PN was also associated with excess mortality risk in the absence of diabetes ( Figure ). After multivariable adjustment, PN remained significantly associated with all-cause and cardiovascular mortality in participants with diabetes ( Figure) , although the association of PN with cardiovascular mortality was largely driven by participants with long-standing diabetes ≥10 yrs (HR 4.53, 95%CI 2.34-8.78). In participants without diabetes, PN was moderately associated with both all-cause and cardiovascular mortality after adjustment ( Figure ). Conclusions: PN was associated with mortality in the US population regardless of diabetes status, suggesting that screening for PN may be important for older adults both with and without diabetes. Adults with long-standing diabetes and PN were at a substantially elevated risk of cardiovascular-related mortality, potentially reflecting a higher burden of concomitant diabetic autonomic neuropathy in this high-risk population.

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