Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study
Objectives Multimorbidity (MM, co-occurrence of two or more chronic conditions) and complex multimorbidity (CMM, three or more chronic conditions affecting three or more different body systems) are used in the assessment of complex healthcare needs and their impact on health outcomes. However, littl...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060001.full |
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| author | Alamgir Kabir An Tran Sameera Ansari Damian P Conway Margo Barr |
| author_facet | Alamgir Kabir An Tran Sameera Ansari Damian P Conway Margo Barr |
| author_sort | Alamgir Kabir |
| collection | DOAJ |
| description | Objectives Multimorbidity (MM, co-occurrence of two or more chronic conditions) and complex multimorbidity (CMM, three or more chronic conditions affecting three or more different body systems) are used in the assessment of complex healthcare needs and their impact on health outcomes. However, little is known about the impacts of MM and CMM on mortality in Australia.Design Community-based prospective cohort study.Setting New South Wales, Australia.Participants People aged 45 years and over who completed the baseline survey of the 45 and Up Study.Measures Baseline survey data from the 45 and Up Study were linked with deaths registry data. Deaths that occurred within 8 years from the baseline survey date were the study outcome. Eleven self-reported chronic conditions (cancer, heart disease, diabetes, stroke, Parkinson’s disease, depression/anxiety, asthma, allergic rhinitis, hypertension, thrombosis and musculoskeletal conditions) from the baseline survey were included in the MM and CMM classifications. Cox proportional hazard models were used to estimate adjusted and unadjusted 8-year mortality hazard ratios (HRs).Results Of 251 689 people (53% female and 54% aged ≥60 years) in the cohort, 111 084 (44.1%) were classified as having MM and 39 478 (15.7%) as having CMM. During the 8-year follow-up, there were 25 891 deaths. Cancer (34.7%) was the most prevalent chronic condition and the cardiovascular system (50.9%) was the body system most affected by a chronic condition. MM and CMM were associated with a 37% (adjusted HR 1.36, 95% CI 1.32 to 1.40) and a 22% (adjusted HR 1.22, 95% CI 1.18 to 1.25) increased risk of death, respectively. The relative impact of MM and CMM on mortality decreased as age increased.Conclusion MM and CMM were common in older Australian adults; and MM was a better predictor of all-cause mortality risk than CMM. Higher mortality risk in those aged 45–59 years indicates tailored, person-centred integrated care interventions and better access to holistic healthcare are needed for this age group. |
| format | Article |
| id | doaj-art-4075cd65c0684126a3c43d5b37339ff2 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4075cd65c0684126a3c43d5b37339ff22025-01-31T13:20:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-060001Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage studyAlamgir Kabir0An Tran1Sameera Ansari2Damian P Conway3Margo Barr4The George Institute for Global Health, Sydney, NSW, AustraliaCentre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, AustraliaFaculty of Health Sciences and Medicine, Bond University, Robina, Queensland, AustraliaUniversity of New South Wales, Sydney, New South Wales, AustraliaUniversity of New South Wales, Sydney, New South Wales, AustraliaObjectives Multimorbidity (MM, co-occurrence of two or more chronic conditions) and complex multimorbidity (CMM, three or more chronic conditions affecting three or more different body systems) are used in the assessment of complex healthcare needs and their impact on health outcomes. However, little is known about the impacts of MM and CMM on mortality in Australia.Design Community-based prospective cohort study.Setting New South Wales, Australia.Participants People aged 45 years and over who completed the baseline survey of the 45 and Up Study.Measures Baseline survey data from the 45 and Up Study were linked with deaths registry data. Deaths that occurred within 8 years from the baseline survey date were the study outcome. Eleven self-reported chronic conditions (cancer, heart disease, diabetes, stroke, Parkinson’s disease, depression/anxiety, asthma, allergic rhinitis, hypertension, thrombosis and musculoskeletal conditions) from the baseline survey were included in the MM and CMM classifications. Cox proportional hazard models were used to estimate adjusted and unadjusted 8-year mortality hazard ratios (HRs).Results Of 251 689 people (53% female and 54% aged ≥60 years) in the cohort, 111 084 (44.1%) were classified as having MM and 39 478 (15.7%) as having CMM. During the 8-year follow-up, there were 25 891 deaths. Cancer (34.7%) was the most prevalent chronic condition and the cardiovascular system (50.9%) was the body system most affected by a chronic condition. MM and CMM were associated with a 37% (adjusted HR 1.36, 95% CI 1.32 to 1.40) and a 22% (adjusted HR 1.22, 95% CI 1.18 to 1.25) increased risk of death, respectively. The relative impact of MM and CMM on mortality decreased as age increased.Conclusion MM and CMM were common in older Australian adults; and MM was a better predictor of all-cause mortality risk than CMM. Higher mortality risk in those aged 45–59 years indicates tailored, person-centred integrated care interventions and better access to holistic healthcare are needed for this age group.https://bmjopen.bmj.com/content/12/7/e060001.full |
| spellingShingle | Alamgir Kabir An Tran Sameera Ansari Damian P Conway Margo Barr Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study BMJ Open |
| title | Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study |
| title_full | Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study |
| title_fullStr | Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study |
| title_full_unstemmed | Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study |
| title_short | Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study |
| title_sort | impact of multimorbidity and complex multimorbidity on mortality among older australians aged 45 years and over a large population based record linkage study |
| url | https://bmjopen.bmj.com/content/12/7/e060001.full |
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