All-Cause And Cardiovascular Mortality in Older Adults With Multimorbidity : 1999-2018 National Survey

TL;DR

This study finds that older adults with multiple chronic conditions face significantly higher risks of all-cause and cardiovascular mortality compared to those with fewer conditions.

Contribution

The study quantifies the increased mortality risk associated with multimorbidity in older U.S. adults using a large national dataset.

Findings

Multimorbidity is associated with a 43% higher all-cause mortality risk and 59% higher CVD mortality risk.

Each additional comorbidity increases all-cause and CVD mortality risks by 6% and 14%, respectively.

Integrated care models are recommended to address mortality risks in multimorbid older adults.

Abstract

Multimorbidity, the presence of two or more chronic conditions, is associated with premature mortality and decreasing life expectancy. Cardiovascular disease (CVD) remains a leading cause of death in the U.S. and is often final pathway to death among people living with multimorbidity. This study examined the association between multimorbidity and mortality, specifically CVD and all-cause mortality, among U.S. adults aged 50 years of age and older. Data from the 1999-2018 National Health Interview Survey linked with the National Death Index were analyzed. Primary outcomes were all-cause and CVD mortality (due to heart disease and cerebrovascular disease) years, measured from the interview to death or December 31, 2019. Cox regression models assessed mortality risk differences, adjusting for age, sex, marital status, poverty-income ratio, and education. Among 264,400 adults (39.02% with 0-1 chronic conditions; 60.98% with ≥2 conditions), the median follow-up was 7 years (IQR: 4-12). All-cause mortality was 30.65 per 1,000 person-years and CVD mortality was 9.91 per 1,000 person-years. Multimorbidity was linked to higher mortality rate (all-cause: 38.66 vs. 19.75 and CVD: 12.79 vs. 5.70, per 1,000 person-years). Fully adjusted models showed a 43% higher all-cause mortality risk (95% CI: 1.40-1.46) and 59% higher CVD mortality risk (95% CI: 1.52-1.65) for those with multimorbidity. Additionally, each additional comorbidity was associated with an increased risk in all-cause (aHR:1.06; 95% CI: 1.04–1.09) and CVD mortality (aHR: 1.14; 95% CI: 1.10–1.18). Integrated models of care considering multidisciplinary management is crucial to improve health outcomes and mitigate mortality risk among older adults with multimorbidity.