Yang Liu, Sun Jiahong, Zhao Min, Magnussen Costan G, Xi Bo
Department of Epidemiology/Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, School of Public Health/Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Front Cardiovasc Med. 2021 Dec 9;8:731240. doi: 10.3389/fcvm.2021.731240. eCollection 2021.
Several prospective cohort studies have assessed the association between multimorbidity and all-cause mortality, but the findings have been inconsistent. In addition, limited studies have assessed the association between multimorbidity and cause-specific mortality. In this study, we used the population based cohort study of National Health Interview Survey (1997-2014) with linkage to the National Death Index records to 31 December 2015 to examine the trends in prevalence of multimorbidity from 1997 to 2014, and its association with the risk of all-cause and cause-specific mortality in the U.S. population. A total of 372,566 adults aged 30-84 years were included in this study. From 1997 to 2014, the age-standardized prevalence of specific chronic condition and multimorbidity increased significantly ( < 0.0001). During a median follow-up of 9.0 years, 50,309 of 372,566 participants died from all causes, of which 11,132 (22.1%) died from CVD and 13,170 (26.2%) died from cancer. Compared with participants without the above-mentioned chronic conditions, those with 1, 2, 3, and ≥4 of chronic conditions had 1.41 (1.37-1.45), 1.94 (1.88-2.00), 2.64 (2.54-2.75), and 3.68 (3.46-3.91) higher risk of all-cause mortality after adjustment for important covariates. Similarly, a higher risk of CVD-specific and cancer-specific mortality was observed as the number of chronic conditions increased, with the observed risk stronger for CVD-mortality compared with cancer-specific mortality. Given the prevalence of multimorbidity tended to increase from 1997 to 2014, our data suggest effective prevention and intervention programs are necessary to limit the increased mortality risk associated with multimorbidity.
几项前瞻性队列研究评估了多种疾病并存与全因死亡率之间的关联，但研究结果并不一致。此外，评估多种疾病并存与特定病因死亡率之间关联的研究有限。在本研究中，我们利用基于人群的队列研究（1997 - 2014年国家健康访谈调查）与截至2015年12月31日的国家死亡指数记录相链接，以研究1997年至2014年多种疾病并存患病率的趋势，及其与美国人群全因死亡率和特定病因死亡率风险的关联。本研究共纳入了372,566名年龄在30 - 84岁的成年人。从1997年到2014年，特定慢性病和多种疾病并存的年龄标准化患病率显著增加（<0.0001）。在中位随访9.0年期间，372,566名参与者中有50,309人死于各种原因，其中11,132人（22.1%）死于心血管疾病（CVD），13,170人（26.2%）死于癌症。与没有上述慢性病的参与者相比，患有1种、2种、3种和≥4种慢性病的参与者在调整重要协变量后，全因死亡风险分别高1.41（1.37 - 1.45）、1.94（1.88 - 2.00）、2.64（2.54 - 2.75）和3.68（3.46 - 3.91）倍。同样，随着慢性病数量的增加，观察到CVD特异性和癌症特异性死亡风险更高，与癌症特异性死亡率相比，观察到的CVD死亡率风险更强。鉴于从1997年到2014年多种疾病并存的患病率趋于上升，我们的数据表明，有必要制定有效的预防和干预计划，以限制与多种疾病并存相关的死亡风险增加。
