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Prev Chronic Dis. 2015 Apr 23;12:E55. doi: 10.5888/pcd12.140478.

Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions.

Author information

1
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, Ohio 44106-4945. Email: skoroukian@case.edu.
2
Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska.
3
Department of Internal Medicine, Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, Ohio.
4
Department of Family Medicine, Michigan State University, East Lansing, Michigan. Drs. Koroukian and Owusu are also affiliated with the Case Comprehensive Cancer Center, Cleveland, Ohio.

Abstract

INTRODUCTION:

Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS:

We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS:

All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION:

Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

PMID:
25906436
PMCID:
PMC4415428
DOI:
10.5888/pcd12.140478
[Indexed for MEDLINE]
Free PMC Article

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