TY - JOUR

T1 - Multimorbidity and mortality

T2 - A 15-year longitudinal registry-based nationwide Danish population study

AU - Willadsen, Tora Grauers

AU - Siersma, Volkert Dirk

AU - Nicolaisdottir, Dagny Ros

AU - Køster-Rasmussen, Rasmus

AU - Jarbøl, Dorte Ejg

AU - Reventlow, Susanne

AU - Mercer, Stewart

AU - Olivarius, Niels de Fine

PY - 2018

Y1 - 2018

N2 - Background: Knowledge about prevalent and deadly combinations of multimorbidity is needed.Objective: To determine the nationwide prevalence of multimorbidity and estimate mortality for the most prevalent combinations of 1-5 diagnosis groups. Furthermore, to assess the excess mortality of the combination of two groups compared to the product of mortality associated with the single groups. Design: A prospective cohort study using Danish registries and including 3 986 209 people aged ≥18 years on 1 January, 2000. Multimorbidity was defined as having diagnoses from at least two of ten diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. Logistic regression (odds ratios, OR) and Ratio of ORs (ROR) were used to study mortality and excess mortality.Results: Prevalence of multimorbidity was 7.1% in the Danish population. The most prevalent combination (0.4%) was the musculoskeletal-cardiovascular which had double the mortality (OR 2.03) compared to persons not belonging to any of the diagnosis groups but showed no excess mortality (ROR 0.97). The neurological-cancer combination had the highest mortality (OR 6.35), was less prevalent (0.07%), and had no excess mortality (ROR 0.94). Cardiovascular-lung was moderately prevalent (0.2%), had high mortality (OR 5.75), and had excess mortality (ROR 1.18). Endocrine-kidney had high excess mortality (ROR 1.81) and cancer-mental had low excess mortality (ROR 0.66). Mortality increased with the number of groups.Conclusions: All combinations had increased mortality risk with some of them having up to a six-fold increased risk. Mortality increased with the number of diagnosis groups. Most combinations did not increase mortality above that expected, i.e. were additive rather than synergistic.

AB - Background: Knowledge about prevalent and deadly combinations of multimorbidity is needed.Objective: To determine the nationwide prevalence of multimorbidity and estimate mortality for the most prevalent combinations of 1-5 diagnosis groups. Furthermore, to assess the excess mortality of the combination of two groups compared to the product of mortality associated with the single groups. Design: A prospective cohort study using Danish registries and including 3 986 209 people aged ≥18 years on 1 January, 2000. Multimorbidity was defined as having diagnoses from at least two of ten diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. Logistic regression (odds ratios, OR) and Ratio of ORs (ROR) were used to study mortality and excess mortality.Results: Prevalence of multimorbidity was 7.1% in the Danish population. The most prevalent combination (0.4%) was the musculoskeletal-cardiovascular which had double the mortality (OR 2.03) compared to persons not belonging to any of the diagnosis groups but showed no excess mortality (ROR 0.97). The neurological-cancer combination had the highest mortality (OR 6.35), was less prevalent (0.07%), and had no excess mortality (ROR 0.94). Cardiovascular-lung was moderately prevalent (0.2%), had high mortality (OR 5.75), and had excess mortality (ROR 1.18). Endocrine-kidney had high excess mortality (ROR 1.81) and cancer-mental had low excess mortality (ROR 0.66). Mortality increased with the number of groups.Conclusions: All combinations had increased mortality risk with some of them having up to a six-fold increased risk. Mortality increased with the number of diagnosis groups. Most combinations did not increase mortality above that expected, i.e. were additive rather than synergistic.

U2 - 10.1177/2235042X18804063

DO - 10.1177/2235042X18804063

M3 - Journal article

VL - 8

SP - 1

EP - 9

JO - Journal of Comorbidity

JF - Journal of Comorbidity

SN - 2235-042X

M1 - 8

ER -