Association of Cardiometabolic Multimorbidity With Mortality.

MedStar author(s):
Citation: JAMA. 314(1):52-60, 2015 Jul 7.PMID: 26151266Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Diabetes Mellitus | *Life Expectancy | *Mortality | *Myocardial Infarction | *Stroke | Adult | Aged | Comorbidity | Diabetes Mellitus/ep [Epidemiology] | Female | Humans | Male | Middle Aged | Myocardial Infarction/ep [Epidemiology] | Risk Factors | Stroke/ep [Epidemiology]Local holdings: Available online from MWHC library: 1998 - present, Available in print through MWHC library: 1999 - presentISSN:
  • 0098-7484
Name of journal: JAMAAbstract: CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing.MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy.OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.All authors: Amouyel P, Assmann G, Bansal N, Barr EL, Barrett-Connor E, Bjorkelund C, Brenner H, Brunner EJ, Burgess S, Butterworth AS, Casiglia E, Cooper C, Crespo CJ, D'Agostino RB Sr, Dagenais GR, Danesh J, Davidson KW, Deeg DJ, Di Angelantonio E, Donfrancesco C, Dorr M, Emerging Risk Factors Collaboration, Engstrom G, Franco OH, Freitag DF, Gallacher J, Gao P, Giampaoli S, Gillum RF, Haheim LL, Hart CL, Hedblad B, Howard BV, Hu FB, Iso H, Jukema JW, Kaptoge S, Kauhanen J, Kavousi M, Khaw KT, Kiechl S, Knuiman MW, Kromhout D, Kuller LH, Lawlor DA, Leening M, Meade TW, Nagel D, Nietert PJ, Nissinen A, Njolstad I, Nordestgaard BG, O'Keeffe LM, Onat A, Pennells L, Peters A, Peters SA, Price JF, Psaty BM, Rodriguez B, Rosamond WD, Rosengren A, Roussel R, Salomaa V, Salonen JT, Sato S, Sattar N, Selmer R, Selvin E, Simons LA, Stehouwer CD, Sundstrom J, Svardsudd K, Thompson SG, Trevisan M, van der Harst P, van der Schouw YT, Verschuren WM, Wallace RB, Wareham NJ, Wassertheil-Smoller S, Welin L, Whitsel EA, Wilhelmsen L, Willeit P, Wood AM, Woodward M, Wormser D, Yeap BBDigital Object Identifier: Date added to catalog: 2016-01-13
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 26151266

Available online from MWHC library: 1998 - present, Available in print through MWHC library: 1999 - present

CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.

EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).

IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing.

MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy.

OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.

RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.

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