Association of Cardiometabolic Multimorbidity With Mortality
Creators: name: Di Angelantonio, Emanuele
name: Kaptoge, Stephen
name: Wormser, David
name: Willeit, Peter
name: Butterworth, Adam S.
name: Bansal, Narinder
name: O’Keeffe, Linda M.
name: Gao, Pei
name: Wood, Angela M.
name: Burgess, Stephen
name: Freitag, Daniel F.
name: Pennells, Lisa
name: Peters, Sanne A.
name: Hart, Carole L.
name: Haheim, Lise Lund
name: Gillum, Richard F.
name: Nordestgaard, Børge G.
name: Psaty, Bruce M.
name: Yeap, Bu B.
name: Knuiman, Matthew W.
name: Nietert, Paul J.
name: Kauhanen, Jussi
name: Salonen, Jukka T.
name: Kuller, Lewis H.
name: Simons, Leon A.
name: Van Der Schouw, Yvonne T.
name: Barrett-Connor, Elizabeth
name: Selmer, Randi
name: Crespo, Carlos J.
name: Rodriguez, Beatriz
name: Verschuren, W. M. Monique
name: Salomaa, Veikko
name: Svärdsudd, Kurt
name: Van Der Harst, Pim
name: Björkelund, Cecilia
name: Wilhelmsen, Lars
name: Wallace, Robert B.
name: Brenner, Hermann
name: Amouyel, Philippe
name: Barr, Elizabeth L. M.
name: Iso, Hiroyasu
name: Onat, Altan
name: Trevisan, Maurizio
name: D'Agostino Sr., Ralph B.
name: Cooper, Cyrus
name: Kavousi, Maryam
name: Welin, Lennart
name: Roussel, Ronan
name: Hu, Frank B.
name: Sato, Shinichi
name: Davidson, Karina W.
name: Howard, Barbara V.
name: Leening, Maarten J. G.
name: Rosengren, Annika
name: Dörr, Marcus
name: Deeg, Dorly J. H.
name: Kiechl, Stefan
name: Stehouwer, Coen D. A.
name: Nissinen, Aulikki
name: Giampaoli, Simona
name: Donfrancesco, Chiara
name: Kromhout, Daan
name: Price, Jackie F.
name: Peters, Annette
name: Meade, Tom W.
name: Casiglia, Edoardo
name: Lawlor, Debbie A.
name: Gallacher, John
name: Nagel, Dorothea
name: Franco, Oscar H.
name: Assmann, Gerd
name: Dagenais, Gilles R.
name: Jukema, J. Wouter
name: Sundström, Johan
name: Woodward, Mark
name: Brunner, Eric J.
name: Khaw, Kay-Tee
name: Wareham, Nicholas J.
name: Whitsel, Eric A.
name: Njølstad, Inger
name: Hedblad, Bo
name: Wassertheil-Smoller, Sylvia
name: Engström, Gunnar
name: Rosamond, Wayne D.
name: Selvin, Elizabeth
name: Sattar, Naveed
name: Thompson, Simon G.
name: Danesh, John
name: Emerging Risk Factors Collaboration
Publisher: name: Columbia University
Year: 2015
Subjects: Diabetes
Mortality
Cardiovascular system--Diseases
Medical sciences
Epidemiology

description: Importance  The prevalence of cardiometabolic multimorbidity is increasing.

Objective  To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.

Design, Setting, and Participants  Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.

Exposures  A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).

Main Outcomes and Measures  All-cause mortality and estimated reductions in life expectancy.

Results  In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.

Conclusions and Relevance  Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.