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Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen, China
Fu-Rong Li1,2, Shuang Wang3, Xia Li1,2
1Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China.
Insights
Multimorbidity is highly prevalent in older Chinese adults with coronary heart disease (CHD), significantly increasing mortality risk. Managing conditions like cancer and heart failure is crucial for improving survival in these patients.
Area of Science:
- Gerontology
- Cardiology
- Public Health
Background:
- Multimorbidity's impact on older adults with coronary heart disease (CHD) in China is not well-understood.
- Assessing the association between multimorbidity and mortality in this population is crucial for public health initiatives.
Purpose of the Study:
- To evaluate the association between multimorbidity and all-cause and cardiovascular disease (CVD) mortality.
- To determine the population-attributable fractions (PAFs) of mortality linked to specific comorbidities in hospitalized older CHD patients in Shenzhen, China.
Main Methods:
- Retrospective cohort study involving older Chinese patients (≥ 65 years) diagnosed with CHD.
- Cox proportional hazards models were employed to analyze associations between multimorbidity and mortality outcomes.
- Population-attributable fractions (PAFs) were calculated to quantify the impact of specific conditions.
Main Results:
- A high prevalence of multimorbidity (91.9%) was observed among 76,455 older CHD patients.
- Cancer, hemorrhagic stroke, and chronic liver disease were associated with the highest all-cause mortality risk.
- Heart failure, ischemic stroke, and diabetes were identified as major contributors to cardiovascular disease mortality, with significant PAFs.
Conclusions:
- Multimorbidity is common and significantly elevates mortality risk in older Chinese CHD patients.
- Cancer, heart failure, ischemic stroke, and diabetes are key drivers of mortality, necessitating targeted management strategies.
- Prioritizing the treatment of these comorbidities is vital for enhancing survival and prognosis in CHD patients from a public health perspective.
Background:
The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease (CHD) is insufficient. We aimed to assess the association and population-attributable fractions (PAFs) between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen, China.
Methods:
We conducted a retrospective cohort study of older Chinese patients (aged ≥ 65 years) who were diagnosed with CHD. Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease (CVD) mortality. We also calculated the PAFs.
Results:
The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1, 2016, and August 31, 2022. Among them, 70,217 (91.9%) had multimorbidity, defined as the presence of at least one of the predefined 14 chronic conditions. Those with cancer, hemorrhagic stroke and chronic liver disease had the worst overall death risk, with adjusted HRs (95% CIs) of 4.05 (3.77, 4.38), 2.22 (1.94, 2.53), and 1.85 (1.63, 2.11), respectively. For CVD mortality, the highest risk was observed for hemorrhagic stroke, ischemic stroke, and chronic kidney disease; the corresponding adjusted HRs (95% CIs) were 3.24 (2.77, 3.79), 1.91 (1.79, 2.04), and 1.81 (1.64, 1.99), respectively. All-cause mortality was mostly attributable to cancer, heart failure and ischemic stroke, with PAFs of 11.8, 10.2, and 9.1, respectively. As for CVD mortality, the leading PAFs were heart failure, ischemic stroke and diabetes; the corresponding PAFs were 18.0, 15.7, and 6.1, respectively.
Conclusions:
Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen, China. Cancer, heart failure, ischemic stroke and diabetes are the primary contributors to PAFs. Therefore, prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.
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