Associations between multimorbidity and unintentional falls among older adults with coronary heart disease

Multimorbidity in individuals with coronary heart disease (CHD) is associated with an increased incidence of falls. We aimed to identify multimorbidity patterns and investigate the impact of different comorbidity patterns on fall and consequent fractures in older adults with CHD.

We identified 189,558 older adults (aged ≥ 60 years) with CHD between January 2015 and December 2021 from the Shandong Multicenter Healthcare Big Data Platform. Multimorbidity patterns were identified through latent class analysis (LCA). Fine and Gray competing risk regression models were used to assess the associations between multimorbidity pattern and falls and fall-related fractures.

Four distinct multimorbidity clusters were observed: a gastrointestinal-dominant pattern (Class 1, 49.34%), a core cardiovascular disease pattern (Class 2, 15.50%), a metabolic-cardiovascular disease pattern (Class 3, 19.00%), and a cerebrovascular-osteoarticular complex pattern (Class 4, 13.60%). Older adults in Class 3 (HR = 1.19, 95% CI: 1.02-1.39), and Class 4 (HR = 1.68, 95% CI: 1.46-1.95) had an increased fall risk after confounder adjustment compared with those in Class 1, with mild comorbidities. The highest risk of falls with fractures (especially for sternum fractures) was found in older adults in Class 4. The risks of falls and falls with fracture were greater for females and patients aged ≥ 80 years.

In this study, we analysis multimorbidity clusters among older patients with CHD and their association with fall and falls with fracture risk. We found that CHD patients with a cerebrovascular-osteoarticular complex pattern face the highest unintentional falls and fractures risk. Our findings can help stratify the risk of falls in older CHD patients and support precision public health initiatives.