Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

Abstract

ObjectivesMultimorbidity is the coexistence of two or more health conditions in an individual. Multimorbidity in younger adults is increasingly recognised as an important challenge. We assessed the prevalence of secondary care multimorbidity in mid-life and its association with premature mortality over 15 years of follow-up, in the Aberdeen Children of the 1950s (ACONF) cohort.MethodA prospective cohort study using linked electronic health and mortality records. Scottish ACONF participants were linked to their Scottish Morbidity Record hospital episode data and mortality records. Multimorbidity was defined as two or more conditions and was assessed using healthcare records in 2001 when the participants were aged between 45 and 51 years. The association between multimorbidity and mortality over 15 years of follow-up (to ages 60–66 years) was assessed using Cox proportional hazards regression. There was also adjustment for key covariates: age, gender, social class at birth, intelligence at age 7, secondary school type, educational attainment, alcohol, smoking, body mass index and adult social class.ResultsOf 9625 participants (51% males), 3% had multimorbidity. The death rate per 1000 person-years was 28.4 (95% CI 23.2 to 34.8) in those with multimorbidity and 5.7 (95% CI 5.3 to 6.1) in those without. In relation to the reference group of those with no multimorbidity, those with multimorbidity had a mortality HR of 4.5 (95% CI 3.4 to 6.0) over 15 years and this association remained when fully adjusted for the covariates (HR 2.5 (95% CI 1.5 to 4.0)).ConclusionMultimorbidity prevalence was 3% in mid-life when measured using secondary care administrative data. Multimorbidity in mid-life was associated with premature mortality.

Patterns of multiple chronic conditions in pregnancy: Population‐based study using latent class analysis

“…The high prevalence of MCC observed in pregnant women in our study is concerning. In non‐pregnant populations, MCC is a strong contributor to hospitalisations and death 3,4 . Knowledge of such risks has led to the development of patient taxonomies and complex care strategies targeted at specific high‐risk groups 50 .…”

“…In non-pregnant populations, MCC is a strong contributor to hospitalisations and death. 3,4 Knowledge of such risks has led to the development of patient taxonomies and complex care strategies targeted at specific high-risk groups. 50 However, such efforts have largely focused on the elderly, 50 leaving unknown the characteristics and needs of reproductive-aged women with MCC, particularly, pregnant women with MCC.…”

“…2 MCC accounts for a disproportionate amount of healthcare use and related financial costs, with a dose-dependent relationship between the number of chronic conditions and corresponding rates of hospitalisation and premature mortality. 3,4 While traditionally considered an issue within the ageing population, MCC is now frequently recognised in younger adults, including in 18% of women of reproductive age. 2 Prior studies of chronic conditions in pregnancy have largely examined solitary chronic conditions rather than co-occurring MCC.…”

“…In Ontario, Canada, for example, the proportion of adults with MCC increased from 25% in 2003 to 32% in 2016 2 . MCC accounts for a disproportionate amount of healthcare use and related financial costs, with a dose‐dependent relationship between the number of chronic conditions and corresponding rates of hospitalisation and premature mortality 3,4 …”

Use of Drugs with Anticholinergic Properties at Hospital Admission Associated with Mortality in Older Patients: A Danish Nationwide Register-Based Cohort Study

“…Several other factors are associated with mortality in older people. Among important factors are multimorbidity and the individuals’ functional level expressed as activities of daily living (ADL) [ 27 – 30 ]. The aim of the present study was to examine the association between use of DAP at hospital admission and mortality in a nationwide cohort of acutely admitted geriatric patients when taking comorbidities and ADL into account.…”