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


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.


CONCLUSIONS
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.
Primary Healthcare Department, Centre 'El Plà', DAP Metropolitana Sud ICS.
Assumpta
A
Ferrer
Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona; Bellvitge Biomedical Research Department Institute, IDIBELL, L'Hospitalet de Llobregat.
Francesc
F
Formiga
ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Barcelona University.
Héctor
H
Sanz
Support Unit Research for Primary Care, Primary Health Care Department of Costa Ponent, IDIAP, ICS; CIBER Department of Epidemiology Service (CIBERESP).
Jesús
J
Almeda
Clinical Laboratory Department, L'Hospitalet de Llobregat, Barcelona, Spain.
Glòria
G
Padrós
D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D000076322:Multimorbidity; D000071069:Multiple Chronic Conditions / Q000401:mortality*; D009369:Neoplasms / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D014786:Vision Disorders / Q000453:epidemiology
atrial fibrillation; chronic diseases; malignancy; mortality; multimorbidity; oldest old