Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study

Abstract

Assumpta Ferrer,1 Francesc Formiga,2,3 Héctor Sanz,4 Jesús Almeda,5,6 Glòria Padrós7 On behalf of the Octabaix Study Group 1Primary Healthcare Department, Centre ‘El Plà’, DAP Metropolitana Sud ICS, 2Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona, 3Bellvitge Biomedical Research Department Institute, IDIBELL, L’Hospitalet de Llobregat, 4ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic – Barcelona University, 5Support Unit Research for Primary Care, Primary Health Care Department of Costa Ponent, IDIAP, ICS, 6CIBER Department of Epidemiology Service (CIBERESP), 7Clinical Laboratory Department, L´Hospitalet de Llobregat, Barcelona, Spain Background: The population is aging and multimorbidity is becoming a common problem in the elderly.Objective: To explore the effect of multimorbidity patterns on mortality for all causes at 3- and 5-year follow-up periods.Materials and methods: A prospective community-based cohort (2009–2014) embedded within a randomized clinical trial was conducted in seven primary health care centers, including 328 subjects aged 85 years at baseline. Sociodemographic variables, sensory status, cardiovascular risk factors, comorbidity, and geriatric tests were analyzed. Multimorbidity patterns were defined as combinations of two or three of 16 specific chronic conditions in the same individual.Results: Of the total sample, the median and interquartile range value of conditions was 4 (3–5). The individual morbidities significantly associated with death were chronic obstructive pulmonary disease (COPD; hazard ratio [HR]: 2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy (HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95% CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the most associated with mortality at 5-year follow-up, after adjusting using Barthel functional index (BI). The two multimorbidity patterns most associated with death were AF, chronic kidney disease (CKD), and visual impairment (HR: 4.19; 95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension, CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years, after adjusting using BI.Conclusion: Multimorbidity as specific combinations of chronic conditions showed an effect on mortality, which would be higher than the risk attributable to individual morbidities. The most important predicting pattern for mortality was the combination of AF, CKD, and visual impairment after 3 years. These findings suggest that a new approach is required to target multimorbidity in octogenarians. Keywords: oldest old, multimorbidity, chronic diseases, mortality, atrial fibrillation, malignancy

Keywords

• Oldest old
• multimorbidity
• chronic diseases
• mortality