Department of Health & Human Services, University of Michigan, Dearborn, Michigan, USA.
Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA.
Gerontology. 2023;69(7):826-838. doi: 10.1159/000528648. Epub 2023 Mar 1.
Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear.
Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58% female, 25% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score.
Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95% CI = 1.01-1.20), diabetes (IRR = 1.19, 95% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95% CI = 1.02-1.11), hypertension (IRR = 1.06, 95% CI = 1.02-1.11), heart disease (IRR = 1.06, 95% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men.
The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.
特定的多种合并症组合，特别是包括关节炎、中风和认知障碍的组合，与老年人日常生活活动（ADL）-工具性日常生活活动（IADL）残疾的高负担有关。这些关联的生物学基础仍不清楚。
使用来自健康与退休研究（N=8618 人，平均年龄 74 岁，58%为女性，25%为非白人）的数据进行观察性纵向研究，并按性别分层使用负二项回归模型来评估炎症和血糖生物标志物（高敏 C 反应蛋白（hs-CRP）和 HbA1c）在特定多种合并症组合（围绕八种索引疾病之一分组：关节炎、癌症、认知障碍、糖尿病、心脏病、高血压、肺病和中风；在 2006 年至 2014 年之间评估）与前瞻性 ADL-IADL 残疾（2 年后，2008-2016 年）之间的相关性中的作用。结果根据社会人口统计学特征、体重指数、共存疾病数量和基线 ADL-IADL 评分进行调整。
男性中关节炎（IRR=1.1，95%CI=1.01-1.20）、糖尿病（IRR=1.19，95%CI=1.09-1.30）和认知障碍（IRR=1.11，95%CI=1.01-1.23）索引的多种合并症组合以及女性中糖尿病索引的多种合并症组合（IRR=1.07，95%CI=1.01-1.14）与 HbA1c 水平升高相关，ADL-IADL 评分较高。在较高水平的 hs-CRP 下，关节炎（IRR=1.06，95%CI=1.02-1.11）、高血压（IRR=1.06，95%CI=1.02-1.11）、心脏病（IRR=1.06，95%CI=1.01-1.12）和肺病（IRR=1.14，95%CI=1.07-1.23）索引的多种合并症组合与女性的 ADL-IADL 评分较高相关，而男性则没有显著相关性。
这些发现表明，对于这些特定的多种合并症组合，老年女性可能需要进行抗炎治疗，老年男性则需要进行最佳血糖控制，作为维持功能健康的治疗/预防选择的重点。
