Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study

Alamgir Kabir; An Tran; Sameera Ansari; Damian P Conway; Margo Barr

doi:10.1136/bmjopen-2021-060001

Impact of multimorbidity and complex multimorbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study

BMJ Open. 2022 Jul 26;12(7):e060001. doi: 10.1136/bmjopen-2021-060001.

Authors

Alamgir Kabir¹, An Tran², Sameera Ansari^{3

4}, Damian P Conway^{5

6}, Margo Barr²

Affiliations

¹ Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia a.kabir@unsw.edu.au.
² Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia.
³ School of Population Health, University of New South Wales, Sydney, NSW, Australia.
⁴ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia.
⁵ The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
⁶ Population and Community Health Directorate, South Eastern Sydney Local Health District, Sydney, NSW, Australia.

Abstract

Objectives: Multimorbidity (MM, co-occurrence of two or more chronic conditions) and complex multimorbidity (CMM, three or more chronic conditions affecting three or more different body systems) are used in the assessment of complex healthcare needs and their impact on health outcomes. However, little is known about the impacts of MM and CMM on mortality in Australia.

Design: Community-based prospective cohort study.

Setting: New South Wales, Australia.

Participants: People aged 45 years and over who completed the baseline survey of the 45 and Up Study.

Measures: Baseline survey data from the 45 and Up Study were linked with deaths registry data. Deaths that occurred within 8 years from the baseline survey date were the study outcome. Eleven self-reported chronic conditions (cancer, heart disease, diabetes, stroke, Parkinson's disease, depression/anxiety, asthma, allergic rhinitis, hypertension, thrombosis and musculoskeletal conditions) from the baseline survey were included in the MM and CMM classifications. Cox proportional hazard models were used to estimate adjusted and unadjusted 8-year mortality hazard ratios (HRs).

Results: Of 251 689 people (53% female and 54% aged ≥60 years) in the cohort, 111 084 (44.1%) were classified as having MM and 39 478 (15.7%) as having CMM. During the 8-year follow-up, there were 25 891 deaths. Cancer (34.7%) was the most prevalent chronic condition and the cardiovascular system (50.9%) was the body system most affected by a chronic condition. MM and CMM were associated with a 37% (adjusted HR 1.36, 95% CI 1.32 to 1.40) and a 22% (adjusted HR 1.22, 95% CI 1.18 to 1.25) increased risk of death, respectively. The relative impact of MM and CMM on mortality decreased as age increased.

Conclusion: MM and CMM were common in older Australian adults; and MM was a better predictor of all-cause mortality risk than CMM. Higher mortality risk in those aged 45-59 years indicates tailored, person-centred integrated care interventions and better access to holistic healthcare are needed for this age group.

Keywords: Adult intensive & critical care; EPIDEMIOLOGY; GERIATRIC MEDICINE; INTERNAL MEDICINE; PRIMARY CARE; PUBLIC HEALTH.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Australia / epidemiology
Chronic Disease
Female
Humans
Male
Multimorbidity*
Neoplasms*
Prospective Studies
Risk Factors