Abstract
Background:
Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population. We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.
Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years. Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline. Multimorbidity patterns were identified using hierarchical cluster analysis. Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.
Results:Overall, 15.8% of participants had multimorbidity. The prevalence of multimorbidity increased with age and was higher in urban than rural participants. Four multimorbidity patterns were identified, including cardiometabolic multimorbidity (diabetes, coronary heart disease, stroke, and hypertension), respiratory multimorbidity (tuberculosis, asthma, and chronic obstructive pulmonary disease), gastrointestinal and hepatorenal multimorbidity (gallstone disease, chronic kidney disease, cirrhosis, peptic ulcer, and cancer), and mental and arthritis multimorbidity (neurasthenia, psychiatric disorder, and rheumatoid arthritis). During a median of 10.8 years of follow-up, 49,371 deaths occurred. Compared with participants without multimorbidity, cardiometabolic multimorbidity (hazard ratios [HR] = 2.20, 95% confidence intervals [CI]: 2.14 − 2.26) and respiratory multimorbidity (HR = 2.13, 95% CI:1.97 − 2.31) demonstrated relatively higher risks of mortality, followed by gastrointestinal and hepatorenal multimorbidity (HR = 1.33, 95% CI:1.22 − 1.46). The mortality risk increased by 36% (HR = 1.36, 95% CI: 1.35 − 1.37) with every additional disease.
Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.
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1 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
2 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing 100191, China
3 National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
4 China Kadoorie Biobank National Coordination Centre, Chinese Academy of Medical Sciences, Beijing 100730, China
5 Nuffield Department of Population Health, Medical Research Council Population Health Research Unit, University of Oxford, Oxford OX3 7LF, United Kingdom; Nuffield Department of Population Health, University of Oxford, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Oxford OX3 7LF, United Kingdom
6 Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu 215004, China
7 Nuffield Department of Population Health, University of Oxford, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Oxford OX3 7LF, United Kingdom
8 China National Center for Food Safety Risk Assessment, Beijing 100022, China
9 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing 100191, China; Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing 100191, China