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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.
- GERIATRIC MEDICINE
- Adult intensive & critical care
- INTERNAL MEDICINE
- EPIDEMIOLOGY
- PRIMARY CARE
- PUBLIC HEALTH
Data availability statement
No data are available. Data that support the findings of this study are available from the Sax Institute, but restrictions apply to the availability of these data, which were used under licence for the current study and so are not publicly available. The data, however, are available from the authors upon reasonable request and with permission from the Sax Institute.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- GERIATRIC MEDICINE
- Adult intensive & critical care
- INTERNAL MEDICINE
- EPIDEMIOLOGY
- PRIMARY CARE
- PUBLIC HEALTH
Data availability statement
No data are available. Data that support the findings of this study are available from the Sax Institute, but restrictions apply to the availability of these data, which were used under licence for the current study and so are not publicly available. The data, however, are available from the authors upon reasonable request and with permission from the Sax Institute.
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Footnotes
Contributors All authors substantially contributed to this article and met the authorship criteria. AK, AT, SA and MB conceived the study. AK, AT, SA, DPC and MB contributed to the design, analysis and interpreting the results. AK drafted the manuscript and coordinated its revision, and all authors critically reviewed the manuscript. All authors read and approved the final version of the manuscript. AK acts as the guarantor for the overall content.
Funding This research was funded by Sydney Local Health District, South Eastern Sydney Local Health District and the South and Eastern Sydney Primary Health Network.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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