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The Factors Associated with 3-Year Mortality Stratified by Physical and Mental Multimorbidity and Area of Residence Deprivation in Primary Care Community-Living Older Adults.

ABSTRACT: Objectives: To examine the risk factors of mortality stratified by physical and mental multimorbidity (PMM) and area socioeconomic status. Methods: Cox regression analyses were used to study 3-year all-cause mortality in primary care older adults stratified by PMM status, and area of residence material and social deprivation. Results: There were socioeconomic differences in the associations between PMM and mortality. Continuity of care decreased mortality risk in moderately and most deprived areas. Satisfaction with medical consultations decreased mortality risk in moderately deprived areas. Current smoking increased mortality in those living in moderately and most deprived areas. Physical activity reduced mortality only in individuals without PMM. Higher cognition was associated with reduced mortality in individuals living in moderately deprived areas. Discussion: Public health policies should be further encouraged in primary care, aiming at increased continuity of care, quality of interactions with patients, and prevention strategies including smoking cessation programs and physical activity promotion.

SUBMITTER: Vasiliadis HM

PROVIDER: S-EPMC8236670 | biostudies-literature | 2021 Aug-Sep

REPOSITORIES: biostudies-literature

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The Factors Associated with 3-Year Mortality Stratified by Physical and Mental Multimorbidity and Area of Residence Deprivation in Primary Care Community-Living Older Adults.

Vasiliadis Helen-Maria HM Gontijo Guerra Samantha S Berbiche Djamal D Pitrou Isabelle E IE

Journal of aging and health 20210327 7-8

Objectives: To examine the risk factors of mortality stratified by physical and mental multimorbidity (PMM) and area socioeconomic status. Methods: Cox regression analyses were used to study 3-year all-cause mortality in primary care older adults stratified by PMM status, and area of residence material and social deprivation. Results: There were socioeconomic differences in the associations between PMM and mortality. Continuity of care decreased mortality risk in moderately ...[more]

PMID: 33779356

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Project description:BackgroundThe burden of chronic diseases in China is substantial now. Data on patterns of chronic diseases and multimorbidity among older adults, especially among those living in rural areas, are sparse.ObjectiveWe aim to investigate the prevalence and patterns of chronic disease pairs and multimorbidity in elderly people living in rural China.MethodsThis population-based study included 1480 adults aged 60 years and over (mean age 68.5 years, 59.4% women) living in a rural community. Data were derived from the Confucius Hometown Aging Project in Shandong, China (June 2010-July 2011). Chronic diseases were diagnosed through face-to-face interviews, clinical examinations, and laboratory tests. Patterns of chronic disease pairs and multimorbidity were explored using logistic regression and exploratory factor analyses.ResultsThe prevalence of individual chronic diseases ranged from 3.0% for tumor to 76.4% for hypertension, and each disease was often accompanied with three or more other chronic diseases. The observed prevalence of pairs of chronic conditions exceeded the expected prevalence for several conditions, such as cardiovascular diseases and metabolic disorders, as well as pulmonary diseases and degenerative disorders. Chronic multimorbidity (≥2 chronic diseases) affected more than 90% of subjects, and two patterns of chronic multimorbidity were identified: cardiopulmonary-mental-degenerative disorder pattern (overall prevalence, 58.2%), and cerebrovascular-metabolic disorder pattern (62.6%). Prevalence of the cardiopulmonary-mental-degenerative disorder pattern increased with age, and was higher in men than women; whereas prevalence of the cerebrovascular-metabolic disorder pattern was higher in women than in men but did not vary by age.ConclusionChronic multimorbidity was highly prevalent among older Chinese adults living in rural areas, and there were specific patterns of the co-occurrence of chronic diseases. Effort is needed to identify possible preventative strategies based on the potential clustering of chronic diseases.

Project description:Background: Evidence on the association between physical performance and multimorbidity is scarce in Asia. This study aimed to identify multimorbidity patterns and their association with physical performance among older Chinese adults. Methods: Individuals aged ≥60 years from the China Health and Retirement Longitudinal Study 2011-2015 (N = 10,112) were included. Physical performance was measured by maximum grip strength (kg) and average gait speed (m/s) categorized as fast (>0.8 m/s), median (>0.6-0.8 m/s), and slow (≤0.6 m/s). Multimorbidity patterns were explored using exploratory factor analysis. Generalized estimating equation was conducted. Results: Four multimorbidity patterns were identified: cardio-metabolic, respiratory, mental-sensory, and visceral-arthritic. An increased number of chronic conditions was associated with decreased normalized grip strength (NGS). Additionally, the highest quartile of factor scores for cardio-metabolic (β = -0.06; 95% Confidence interval (CI) = -0.07, -0.05), respiratory (β = -0.03; 95% CI = -0.05, -0.02), mental-sensory (β = -0.04; 95% CI = -0.05, -0.03), and visceral-arthritic (β = -0.04; 95% CI = -0.05, -0.02) patterns were associated with lower NGS compared with the lowest quartile. Participants with ≥4 chronic conditions were 2.06 times more likely to have a slow gait speed. Furthermore, the odds ratios for the highest quartile of factor scores of four patterns with slow gait speed compared with the lowest quartile ranged from 1.26-2.01. Conclusion: Multimorbidity was related to worse physical performance, and multimorbidity patterns were differentially associated with physical performance. A shift of focus from single conditions to the requirements of a complex multimorbid population was needed for research, clinical guidelines, and health-care services. Grip strength and gait speed could be targeted to routinely measure clinical performance among older adults with multimorbidity, especially mental-sensory disorders, in clinical settings.

Dataset Information

The Factors Associated with 3-Year Mortality Stratified by Physical and Mental Multimorbidity and Area of Residence Deprivation in Primary Care Community-Living Older Adults.

Publications

The Factors Associated with 3-Year Mortality Stratified by Physical and Mental Multimorbidity and Area of Residence Deprivation in Primary Care Community-Living Older Adults.

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