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JAMA. 2015 Jul 7;314(1):52-60. doi: 10.1001/jama.2015.7008.

Association of Cardiometabolic Multimorbidity With Mortality.

Author information

1
University of Cambridge, Cambridge, England.
2
University Medical Center Utrecht, Utrecht, the Netherlands.
3
University of Glasgow, Glasgow, Scotland.
4
University of Oslo, Oslo, Norway.
5
Howard University College of Medicine, Washington, DC.
6
Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark.
7
University of Washington, Seattle.
8
University of Western Australia, Perth.
9
Department of Public Health Sciences, Medical University of South Carolina, Charleston.
10
University of Eastern Finland, Kuopio.
11
Metabolic Analytical Services Inc, Helsinki, Finland.
12
University of Pittsburgh, Pittsburgh, Pennsylvania.
13
University of New South Wales, New South Wales, Australia.
14
University of California-San Diego, La Jolla.
15
Norwegian Institute of Public Health, Oslo, Norway.
16
Portland State University, Portland, Oregon.
17
University of Hawaii, Honolulu.
18
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
19
National Institute for Health and Welfare, Helsinki, Finland.
20
Uppsala University, Uppsala, Sweden.
21
University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
22
University of Gothenburg, Gothenburg, Sweden.
23
Department of Epidemiology, University of Iowa, Iowa City.
24
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
25
Institut Pasteur de Lille, Lille, France.
26
Baker IDI Heart and Diabetes Institute, Victoria, Australia.
27
Osaka University, Suita, Japan.
28
Istanbul University, Istanbul, Turkey.
29
City College of New York, New York, New York.
30
Boston University, Boston, Massachusetts.
31
University of Southampton, Southampton, England32University of Oxford, Oxford, England.
32
Erasmus Medical Center, Rotterdam, the Netherlands.
33
Lidköping Hospital, Lidköping, Sweden.
34
INSERM, Centre de Recherche des Cordeliers, Paris, France36Université Paris Diderot, Paris, France37Diabétologie, AP-HP, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France.
35
Harvard School of Public Health, Boston, Massachusetts.
36
Osaka Medical Center for Health Science and Promotion/Chiba Prefectural Institute of Public Health, Suita, Japan.
37
Columbia University Medical Center, New York, New York.
38
MedStar Health Research Institute, Hyattsville, Maryland.
39
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
40
University Medicine Greifswald, Greifswald, Germany44DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
41
Vrije Universiteit Medical Center, Amsterdam, the Netherlands.
42
Medical University Innsbruck, Innsbruck, Austria.
43
Maastricht University Medical Centre, Maastricht, the Netherlands.
44
Istituto Superiore di Sanità, Rome, Italy.
45
Wageningen University, Wageningen, the Netherlands.
46
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland.
47
Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany52German Research Center for Cardiovascular Research (DZHK eV), Partner-Site Munich, Munich, Germany.
48
London School of Hygiene and Tropical Medicine, London, England.
49
University of Padova, Padova, Italy.
50
University of Bristol, Bristol, England.
51
Cardiff University, Cardiff, England.
52
Klinikum der Universität München LMU, München, Germany.
53
Assmann-Stiftung für Prävention, Munster, Germany.
54
Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec, Canada.
55
Leiden University Medical Center, Leiden, the Netherlands.
56
University of Sydney, Sydney, Australia.
57
University College London, London, England.
58
Medical Research Council Epidemiology Unit, Cambridge, England.
59
Department of Medicine, University of North Carolina, Chapel Hill65Department of Epidemiology, University of North Carolina, Chapel Hill.
60
University of Tromsø, Tromsø, Norway.
61
Lund University, Lund, Sweden.
62
Albert Einstein College of Medicine, New York, New York.
63
University of North Carolina, Chapel Hill.
64
Johns Hopkins University, Baltimore, Maryland.

Abstract

IMPORTANCE:

The prevalence of cardiometabolic multimorbidity is increasing.

OBJECTIVE:

To estimate reductions in life expectancy associated with cardiometabolic 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).

MAIN OUTCOMES AND MEASURES:

All-cause mortality and estimated reductions in life expectancy.

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.

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.

PMID:
26151266
PMCID:
PMC4664176
DOI:
10.1001/jama.2015.7008
[Indexed for MEDLINE]
Free PMC Article
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