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. 2018 Feb 19;8(1):1-8.
doi: 10.15256/joc.2018.8.129. eCollection 2018.

Risk factors and mortality associated with multimorbidity in people with stroke or transient ischaemic attack: a study of 8,751 UK Biobank participants

Katie I Gallacher  1 , Ross McQueenie  1 , Barbara Nicholl  1 , Bhautesh D Jani  1 , Duncan Lee  2 , Frances S Mair  1
Affiliations

Risk factors and mortality associated with multimorbidity in people with stroke or transient ischaemic attack: a study of 8,751 UK Biobank participants

Katie I Gallacher et al. J Comorb. .

Abstract

Background: Multimorbidity is common in stroke, but the risk factors and effects on mortality remain poorly understood.

Objective: To examine multimorbidity and its associations with sociodemographic/lifestyle risk factors and all-cause mortality in UK Biobank participants with stroke or transient ischaemic attack (TIA).

Design: Data were obtained from an anonymized community cohort aged 40-72 years. Overall, 42 comorbidities were self-reported by those with stroke or TIA. Relative risk ratios demonstrated associations between participant characteristics and number of comorbidities. Hazard ratios demonstrated associations between the number and type of comorbidities and all-cause mortality. Results were adjusted for age, sex, socioeconomic status, smoking, and alcohol intake. Data were linked to national mortality data. Median follow-up was 7 years.

Results: Of 8,751 participants (mean age 60.9±6.7 years) with stroke or TIA, the all-cause mortality rate over 7 years was 8.4%. Over 85% reported ≥1 comorbidities. Age, socioeconomic deprivation, smoking and less frequent alcohol intake were associated with higher levels of multimorbidity. Increasing multimorbidity was associated with higher all-cause mortality. Mortality risk was double for those with ≥5 comorbidities compared to those with none. Having cancer, coronary heart disease, diabetes, or chronic obstructive pulmonary disease significantly increased mortality risk. Presence of any cardiometabolic comorbidity significantly increased mortality risk, as did any non-cardiometabolic comorbidity.

Conclusions: In stroke survivors, the number of comorbidities may be a more helpful predictor of mortality than type of condition. Stroke guidelines should take greater account of comorbidities, and interventions are needed that improve outcomes for people with multimorbidity and stroke.

Keywords: comorbidity; mortality; multimorbidity; risk factors; stroke.

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Conflict of interest statement

BN, DL, FM and KG received grants from the Chief Scientist Office (CSO), Scottish Government Health Directorates’, during the conduct of the study. KG also received a grant from the Carnegie Trust for the Universities of Scotland during the conduct of the study. RM and BJ have nothing to declare.

Figures

Figure 1
Figure 1
Fully adjusted hazards ratios for mortality in relation to the number of comorbidities.
Figure 2
Figure 2
Kaplan–Meier graph of death proportion versus comorbidities (n=8,751).
See this image and copyright information in PMC

References

    1. Barnett K Mercer SW Norbury M Watt G Wyke S Guthrie B Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study Lancet 2012; 380:37–43. - PubMed
    1. Gallacher KI Batty GD McLean G Mercer SW Guthrie B May CR et al. Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden BMC Med 2014; 12:151. - PMC - PubMed
    1. Payne RA Avery AJ Duerden M Saunders CL Simpson CR Abel GA Prevalence of polypharmacy in a Scottish primary care population Eur J Clin 2014; 70:575–81. - PubMed
    1. Dumbreck S Flynn A Nairn M Wilson M Treweek S Mercer SW et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines Br Med J 2015; 350:h949. - PMC - PubMed
    1. Guthrie B Makubate B Hernandez-Santiago V Dreischulte T The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010 BMC Med 2015; 13:74. - PMC - PubMed

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