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Simard M, Rahme E, Dubé M, Boiteau V, Talbot D, Mésidor M, Chiu YM, Sirois C. 10-Year Multimorbidity Trajectories in Older People Have Limited Benefit in Predicting Short-Term Health Outcomes in Comparison to Standard Multimorbidity Thresholds: A Population-Based Study. Clin Epidemiol 2024; 16:345-355. [PMID: 38798914 PMCID: PMC11128253 DOI: 10.2147/clep.s456004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose To identify multimorbidity trajectories among older adults and to compare their health outcome predictive performance with that of cross-sectional multimorbidity thresholds (eg, ≥2 chronic conditions (CCs)). Patients and Methods We performed a population-based longitudinal study with a random sample of 99,411 individuals aged >65 years on April 1, 2019. Using health administrative data, we calculated for each individual the yearly CCs number from 2010 to 2019 and constructed the trajectories with latent class growth analysis. We used logistic regression to determine the increase in predictive capacity (c-statistic) of multimorbidity trajectories and traditional cross-sectional indicators (≥2, ≥3, or ≥4 CCs, assessed in April 2019) over that of a baseline model (including age, sex, and deprivation). We predicted 1-year mortality, hospitalization, polypharmacy, and frequent general practitioner, specialist, or emergency department visits. Results We identified eight multimorbidity trajectories, each representing between 3% and 25% of the population. These trajectories exhibited trends of increasing, stable, or decreasing number of CCs. When predicting mortality, the 95% CI for the increase in the c-statistic for multimorbidity trajectories [0.032-0.044] overlapped with that of the ≥3 indicator [0.037-0.050]. Similar results were observed when predicting other health outcomes and with other cross-sectional indicators. Conclusion Multimorbidity trajectories displayed comparable health outcome predictive capacity to those of traditional cross-sectional multimorbidity indicators. Given its ease of calculation, continued use of traditional multimorbidity thresholds remains relevant for population-based multimorbidity surveillance and clinical practice.
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Affiliation(s)
- Marc Simard
- Institut national de santé publique du Québec, Québec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marjolaine Dubé
- Institut national de santé publique du Québec, Québec, QC, Canada
| | | | - Denis Talbot
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Miceline Mésidor
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Yohann Moanahere Chiu
- Institut national de santé publique du Québec, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Faculty of de Pharmacy, Université Laval, Québec, QC, Canada
| | - Caroline Sirois
- Institut national de santé publique du Québec, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
- VITAM-Centre de recherche en santé durable, Québec, QC, Canada
- Faculty of de Pharmacy, Université Laval, Québec, QC, Canada
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Liu H, Zhang M, Zhang X, Zhao X. Exposure to early-life adversity and long-term trajectories of multimorbidity among older adults in China: analysis of longitudinal data from the China Health and Retirement Longitudinal Study. BMJ Open 2024; 14:e075834. [PMID: 38485180 PMCID: PMC10941172 DOI: 10.1136/bmjopen-2023-075834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES This study aimed to identify long-term distinct trajectories of multimorbidity with ageing from 50 to 85 years among Chinese older adults and examine the relationship between exposure to early-life adversity (ELA; including specific types of adversity and accumulation of different adversities) and these long-term multimorbidity trajectories. DESIGN The group-based trajectory models identified long-term multimorbidity trajectories. Multinomial logistic regression models were used to examine the relationship between ELA and the identified multimorbidity trajectories. SETTING This study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) and the 2014 Life History Survey. PARTICIPANTS We used data from 9112 respondents (aged 60 and above) of the 2018 wave of CHARLS. OUTCOME MEASURES Each respondent's history of chronic conditions and experiences of ELA were collected from the 2011-2018 waves of CHARLS and the 2014 Life History Survey. RESULTS Four heterogeneous long-term trajectories of multimorbidity development were identified: 'maintaining-low' (19.1%), 'low onset-rapidly increasing' (23.3%), 'middle onset-moderately increasing' (41.5%) and 'chronically-high' (16.2%). Our findings indicated that the heterogeneity can be explained by ELA experiences. Across various types of different ELA experiences, exposure to food insufficiency (relative risk ratios from 1.372 (95% CI 1.190 to 1.582) to 1.780 (95% CI 1.472 to 2.152)) and parental quarrel/divorce (relative risk ratios from 1.181 (95% CI 1.000 to 1.394) to 1.262 (95% CI 1.038 to 1.536)) had the most prominent associations with health deterioration. The accumulation of more different ELA experiences was associated with a higher relative risk of developing more severe multimorbidity trajectories (relative risk ratio for five to seven ELAs and chronically high trajectory: 7.555, 95% CI 4.993 to 11.431). CONCLUSIONS There are heterogeneous long-term trajectories of multimorbidity in Chinese older adults, and the risk of multimorbidity associated with ELA accumulates over the lifespan. Our findings highlight the role of a supportive early-life family environment in promoting health development across the lifespan, advocating for the integration of life-course approaches to implementing health disparity interventions.
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Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, China
| | - Mi Zhang
- Department of Sociology, Central South University, Changsha, China
| | - Xinyan Zhang
- Department of Sociology, Central South University, Changsha, China
| | - Xinyi Zhao
- School of Health Humanities, Peking University, Beijing, China
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Han EJ, Song MK, Lee Y. The 10-year multimorbidity trajectory and mortality risk in older people with long-term care needs. Arch Gerontol Geriatr 2022; 103:104775. [PMID: 35843024 DOI: 10.1016/j.archger.2022.104775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND This study aimed to identify trajectories of multimorbidity in older adults prior to receiving long-term care benefits and to demonstrate their value in predicting mortality. METHODS This study included 1,004,924 Korean beneficiaries who completed the National Long-Term Care Insurance (NLTCI) eligibility assessment between 2010 and 2016. Multimorbidity was defined as the coexistence of 2 or more out of 23 chronic diseases related to disability in the 10 years before transitioning to long-term care. Mortality was defined as all-cause deaths after the date of the NLTCI needs assessment. Latent class growth modeling was performed to identify groups that exhibited similar trajectory patterns over time. Sex, age, and long-term care grade were used as covariates. Cox proportional hazards models were used to analyze the mortality rates by trajectories. RESULTS Three patterns emerged in the multimorbidity trajectory in the 10 years prior to entering the long-term care system: consistently low morbidity ("consistently low"), an abrupt increase in morbidity in less than one year ("catastrophic"), and an increment in morbidity over a longer period ("progressive"). In multiple Cox regression adjusting for covariates, the hazard ratios (95% confidence interval) of 1-year mortality for the catastrophic and progressive groups were 1.38 (1.36-1.39) and 1.43 (1.41-1.45), respectively, compared to the consistently low group. CONCLUSIONS This study identified distinct trajectories of multimorbidity in older people accessing the long-term care system and demonstrated their prognostic value for the survival of those with long-term care needs. Treatment and management strategies targeting individuals with a high-risk trajectory are warranted.
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Affiliation(s)
- Eun-Jeong Han
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea
| | - Mi Kyung Song
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164 World cup-ro, Youngtong-gu, Suwon 16499, South Korea..
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Cezard G, McHale CT, Sullivan F, Bowles JKF, Keenan K. Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence. BMJ Open 2021; 11:e048485. [PMID: 34810182 PMCID: PMC8609933 DOI: 10.1136/bmjopen-2020-048485] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/20/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Multimorbidity-the co-occurrence of at least two chronic diseases in an individual-is an important public health challenge in ageing societies. The vast majority of multimorbidity research takes a cross-sectional approach, but longitudinal approaches to understanding multimorbidity are an emerging research area, being encouraged by multiple funders. To support development in this research area, the aim of this study is to scope the methodological approaches and substantive findings of studies that have investigated longitudinal multimorbidity trajectories. DESIGN We conducted a systematic search for relevant studies in four online databases (Medline, Scopus, Web of Science and Embase) in May 2020 using predefined search terms and inclusion and exclusion criteria. The search was complemented by searching reference lists of relevant papers. From the selected studies, we systematically extracted data on study methodology and findings and summarised them in a narrative synthesis. RESULTS We identified 35 studies investigating multimorbidity longitudinally, all published in the last decade, and predominantly in high-income countries from the Global North. Longitudinal approaches employed included constructing change variables, multilevel regression analysis (eg, growth curve modelling), longitudinal group-based methodologies (eg, latent class modelling), analysing disease transitions and visualisation techniques. Commonly identified risk factors for multimorbidity onset and progression were older age, higher socioeconomic and area-level deprivation, overweight and poorer health behaviours. CONCLUSION The nascent research area employs a diverse range of longitudinal approaches that characterise accumulation and disease combinations and to a lesser extent disease sequencing and progression. Gaps include understanding the long-term, life course determinants of different multimorbidity trajectories, and doing so across diverse populations, including those from low-income and middle-income countries. This can provide a detailed picture of morbidity development, with important implications from a clinical and intervention perspective.
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Affiliation(s)
- Genevieve Cezard
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | | | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
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