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. 2020 May 5;10(5):e033622.
doi: 10.1136/bmjopen-2019-033622.

Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

Marjorie C Johnston  1 , Corrinda Black  2   3 , Stewart W Mercer  4 , Gordon J Prescott  5 , Michael A Crilly  3   6
Affiliations

Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study

Marjorie C Johnston et al. BMJ Open. .

Abstract

Objectives: Multimorbidity is the coexistence of two or more health conditions in an individual. Multimorbidity in younger adults is increasingly recognised as an important challenge. We assessed the prevalence of secondary care multimorbidity in mid-life and its association with premature mortality over 15 years of follow-up, in the Aberdeen Children of the 1950s (ACONF) cohort.

Method: A prospective cohort study using linked electronic health and mortality records. Scottish ACONF participants were linked to their Scottish Morbidity Record hospital episode data and mortality records. Multimorbidity was defined as two or more conditions and was assessed using healthcare records in 2001 when the participants were aged between 45 and 51 years. The association between multimorbidity and mortality over 15 years of follow-up (to ages 60-66 years) was assessed using Cox proportional hazards regression. There was also adjustment for key covariates: age, gender, social class at birth, intelligence at age 7, secondary school type, educational attainment, alcohol, smoking, body mass index and adult social class.

Results: Of 9625 participants (51% males), 3% had multimorbidity. The death rate per 1000 person-years was 28.4 (95% CI 23.2 to 34.8) in those with multimorbidity and 5.7 (95% CI 5.3 to 6.1) in those without. In relation to the reference group of those with no multimorbidity, those with multimorbidity had a mortality HR of 4.5 (95% CI 3.4 to 6.0) over 15 years and this association remained when fully adjusted for the covariates (HR 2.5 (95% CI 1.5 to 4.0)).

Conclusion: Multimorbidity prevalence was 3% in mid-life when measured using secondary care administrative data. Multimorbidity in mid-life was associated with premature mortality.

Keywords: cohort; multimorbidity; premature mortality.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of ACONF study population and data linkage. *Lost to follow-up or embarked from the UK. ACONF, Aberdeen Children of the 1950s; CHI, Community Health Index; SMR, Scottish Morbidity Record.
Figure 2
Figure 2
Survival curve for multimorbidity from 2001 to 2016 with indication of number at risk over time.
See this image and copyright information in PMC

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