The Prevalence of Metabolic Disease Multimorbidity and Its Associations With Spending and Health Outcomes in Middle-Aged and Elderly Chinese Adults

Zhao, Yang; Zhang, Puhong; Lee, John Tayu; Oldenburg, Brian; Heusden, Alexander van; Haregu, Tilahun Nigatu; Wang, Haipeng

doi:10.3389/fpubh.2021.658706

Cited by 18 publications

(10 citation statements)

References 44 publications

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“…Our findings suggest that the growing burden of cardiometabolic disease contributed most significantly to the risk of disability. This is consistent with previous studies showing a positive association of metabolic multimorbidity with a higher risk of disability [ 42 ], cardiovascular outcomes, and mortality [ 43 ]. Similar to our findings, a recent study based on the CHARLS suggested that the older adults who exhibited the “cardiometabolic” and the “stomach/arthritis” patterns of multimorbidity were at greater risk of function decline when developing a new chronic disease.…”

Section: Discussionsupporting

confidence: 93%

Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study

et al. 2022

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Background Although multimorbidity is a risk factor for disability, the relationship between the accumulative patterns of multimorbidity and disability remains poorly understood. The objective of this study was to identify the latent groups of multimorbidity trajectories among mid to older age adults and to examine their associations with incident disability. Methods We included 5,548 participants aged ≥ 45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2018 and had no multimorbidity (≥ 2 chronic conditions) at baseline. The group-based multi-trajectory modeling was used to identify distinct trajectory groups of multimorbidity based on the latent dimensions underlying 13 chronic conditions. The association between multimorbidity trajectories and incident disability was analyzed using the generalized estimating equation model adjusting for potential confounders. Results Of the 5,548 participants included in the current analysis, 2,407 (43.39%) developed multimorbidity during the follow-up. Among participants with new-onset multimorbidity, four trajectory groups were identified according to the combination of newly diagnosed diseases: “Cardiometabolic” (N = 821, 34.11%), “Digestive-arthritic” (N = 753, 31.28%), “Cardiometabolic/Brain” (N = 618, 25.68%), and “Respiratory” (N = 215, 8.93%). Compared to participants who did not develop multimorbidity, the risk of incident disability was most significantly increased in the “Cardiometabolic/Brain” trajectory group (OR = 2.05, 95% CI: 1.55–2.70), followed by the “Cardiometabolic” (OR = 1.96, 95% CI: 1.52 –2.53) and “Digestive-arthritic” (OR = 1.70, 95% CI: 1.31–2.20) trajectory groups. Conclusions The growing burden of multimorbidity, especially the comorbid of cardiometabolic and brain diseases, may be associated with a significantly increased risk of disability for mid to older age adults. These findings improve our understanding of multimorbidity patterns that affect the independence of living and inform the development of strategies for the primary prevention of disability.

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Section: Discussionsupporting

confidence: 93%

Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study

et al. 2022

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“…A few of studies have suggested that multiple chronic diseases have a significant impact on health related outcomes and mortality (10,(16)(17)(18). These findings are consistent with our previous studies in China (16,(19)(20)(21), United States (10,42,43), Japan (44), and Europe (45), where multimorbidity presented in healthrelated outcomes and deaths (10,16). Cardiovascular and metabolic diseases have been revealed by several studies to play a dominant role in multiple multimorbidity patterns (41).…”

Section: Discussionsupporting

confidence: 87%

“…There is limited evidence on the long-term changes of health related outcomes in individuals who are suffering from cardiometabolic multimorbidity (3)(4)(5). In China, there is no study focusing on females and estimated the impact of cardiometabolic multimorbidity on long-term mortality using nationally representative data (17)(18)(19)(20)(21). Therefore, the objective of this research is to investigate the prevalence of cardiometabolic multimorbidity among Chinese women and the association of cardiometabolic multimorbidity with all-cause mortality, using nationally representative populationbased cohort data.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of cardiometabolic multimorbidity and its associations with health outcomes among women in China

Zhao

Zhang²,

Liu³

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveIn China, a limited number of studies focus on women and examine the effect of cardiometabolic multimorbidity (defined as the presence of two or more cardiometabolic diseases) on health outcomes. This research aims to investigate the epidemiology of cardiometabolic multimorbidity and the association of cardiometabolic multimorbidity with long-term mortality.MethodsThis study used data from the China Health and Retirement Longitudinal Study between 2011 and 2018, which includes 4,832 women aged 45 years and older in China. Poisson-distributed Generalized Linear Models (GLM) were applied to examine the association of cardiometabolic multimorbidity with all-cause mortality.ResultsOverall, the prevalence of cardiometabolic multimorbidity was 33.1% among the total sample of 4,832 Chinese women, and increased with age, ranging from 28.5% (22.1%) for those aged 45–54 years to 65.3% (38.2%) for those aged ≥75 years in urban (rural) areas. Compared with the group of none and single disease, cardiometabolic multimorbidity was positively associated with all-cause death (RR = 1.509, 95% CI = 1.130, 2.017), after adjusting socio-demographic and lifestyle behavioral covariates. Stratified analyses revealed that the association between cardiometabolic multimorbidity and all-cause death was only statistically significant (RR = 1.473, 95% CI = 1.040, 2.087) in rural residents, but not significant in urban residents.ConclusionCardiometabolic multimorbidity is common among women in China and has been associated with excess mortality. Targeted strategies and people-centered integrated primary care models must be considered to more effectively manage the cardiometabolic multimorbidity shift from focusing on single-disease.

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“…15 Second, evidence of multimorbidity in patients with diabetes has mainly come from high-income countries, with little data for low-income and middle-income countries. In addition, there is no standardised definition and measure of multimorbidity, 34 which could explain the variable prevalence of multimorbidity across different studies. 7 In the base case analysis, we found that the prevalence of CHE was 56.6% at the 20% threshold.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Multimorbidity and catastrophic health expenditure among patients with diabetes in China: a nationwide population-based study

Chen

Liu

2022

BMJ Glob Health

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IntroductionMultimorbidity is common among patients with diabetes and can lead to catastrophic health expenditure (CHE) for their families. This study aims to investigate the prevalence of multimorbidity and CHE among people with diabetes in China, and the association between multimorbidity and CHE and whether this is influenced by socioeconomic status and health insurance type.MethodsA national survey was conducted in China in 2013 that included 8471 people aged ≥18 years who were living with diabetes. The concentration curve and concentration index were used to measure socioeconomic-related inequalities. Factors influencing CHE and the impact of multimorbidity on CHE according to socioeconomic status and health insurance type were examined by logistic regression.ResultsThere were 5524 (65.2%) diabetes patients with multimorbidity. The prevalence of CHE was 56.6%, with a concentration index of −0.030 (95% CI −0.035 to –0.026). For each additional chronic disease, the probability of CHE increased by 39% (OR=1.39, 95% CI 1.31 to 1.47). Factors that were positively associated (p<0.05) with CHE included older age; male sex; lower educational level; being retired, unemployed or jobless; being a non-smoker and non-drinker; having had no physical examination; lower socioeconomic status; being in an impoverished family; and residing in the central or western regions. Among participants with Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical Scheme, the probability of CHE increased by 32% (OR=1.32, 95% CI 1.23 to 1.43), 43% (OR=1.43, 95% CI 1.24 to 1.65) and 47% (OR=1.47, 95% CI 1.33 to 1.63), respectively, with each additional chronic disease. The association between multimorbidity and CHE was observed across all health insurance types irrespective of socioeconomic status.ConclusionsMultimorbidity affects about two-thirds of Chinese patients with diabetes. Current health insurance schemes offer limited protection against CHE to patients’ families.

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The Prevalence of Metabolic Disease Multimorbidity and Its Associations With Spending and Health Outcomes in Middle-Aged and Elderly Chinese Adults

Cited by 18 publications

References 44 publications

Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study

Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study

The prevalence of cardiometabolic multimorbidity and its associations with health outcomes among women in China

Multimorbidity and catastrophic health expenditure among patients with diabetes in China: a nationwide population-based study

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