Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study

Abstract

Objectives: The evolution of multimorbidity describes the continuum from a healthy status to the development of a single disease and further progression to multimorbidity with additional diseases. We investigated the evolution of cardiometabolic multimorbidity and risk for mortality in a Chinese population.

Design: Longitudinal cohort study using data from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study, with 5.43 million person-years follow-up (median 5.16 years).

Participants: Data for 1 038 704 adults (total 22 750 deaths) were analysed.

Exposure: Cardiometabolic multimorbidity was defined as ever being diagnosed with two or more of three diseases: hypertension, diabetes and cardiovascular disease (CVD).

Primary and secondary outcome measures: Age-adjusted and sex-adjusted HRs were calculated for all-cause mortality.

Results: The cardiometabolic disease status of 105 209 (10.1%) individuals changed during the follow-up. The prevalence of cardiometabolic multimorbidity increased from 2.41% (95% CI: 2.38% to 2.44%) to 5.94% (95% CI: 5.90% to 5.99%). Baseline multimorbidity status showed the HR (95% CI) was 1.37 (1.33 to 1.42) in those with one disease, 1.71 (1.64 to 1.79) in those with two diseases and 2.22 (2.00 to 2.46) in those with three diseases. The highest HRs were observed for CVD only (3.31, 95% CI: 3.05 to 3.59) or diabetes and CVD (3.12, 95% CI: 2.37 to 4.11). Those with hypertension only had the lowest HR (1.26, 95% CI: 1.22 to 1.30). Longitudinal data showed the HRs (95% CI) in patients with one, two and three diseases were 1.36 (1.32 to 1.41), 2.03 (1.96 to 2.10) and 2.16 (2.05 to 2.29), respectively.

Conclusions: The prevalence of cardiometabolic multimorbidity in a general Chinese population increased more than doubled over 5 years, indicating rapid evolution of cardiometabolic multimorbidity. A history of CVD dominates the risk for mortality. A complementary strategy for primary and secondary prevention of cardiometabolic diseases is needed in China.

Keywords: cardiovascular disease; diabetes; hypertension; longitudinal; multimorbidity.

Figure 1

Prevalence of cardiometabolic disease according to age groups. CVD, cardiovascular disease; DM, diabetes mellitus; HT, hypertension.

Figure 2

Evolution of cardiometabolic disease status during follow-up. Note: *Crude prevalence. CVD, cardiovascular disease; DM, diabetes mellitus; HT, hypertension.

Figure 3

Age-adjusted and sex-adjusted HRs (95%) for all-cause mortality by cardiometabolic disease status. CVD, cardiovascular disease; DM, diabetes mellitus; HT, hypertension.