Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 19;11(3):e042633.
doi: 10.1136/bmjopen-2020-042633.

Multimorbidity, ageing and mortality: normative data and cohort study in an American population

Walter A Rocca  1   2   3 , Brandon R Grossardt  4 , Cynthia M Boyd  5 , Alanna M Chamberlain  6 , William V Bobo  7 , Jennifer L St Sauver  6   8
Affiliations

Multimorbidity, ageing and mortality: normative data and cohort study in an American population

Walter A Rocca et al. BMJ Open. .

Abstract

Objectives: To describe the percentile distribution of multimorbidity across age by sex, race and ethnicity, and to demonstrate the utility of multimorbidity percentiles to predict mortality.

Design: Population-based descriptive study and cohort study.

Setting: Olmsted County, Minnesota (USA).

Participants: We used the medical records-linkage system of the Rochester Epidemiology Project (REP; http://www.rochesterproject.org) to identify all residents of Olmsted County, Minnesota who reached one or more birthdays between 1 January 2005 and 31 December 2014 (10 years).

Methods: For each person, we obtained the count of chronic conditions (out of 20 conditions) present on each birthday by extracting all of the diagnostic codes received in the 5 years before the index birthday from the electronic indexes of the REP. To compare each person's count to peers of same age, the counts were transformed into percentiles of the total population and displayed graphically across age by sex, race and ethnicity. In addition, quintiles 1, 2, 4 and 5 were compared with quintile 3 (reference) to predict the risk of death at 1 year, 5 years and through end of follow-up using time-to-event analyses. Follow-up was passive using the REP.

Results: We identified 238 010 persons who experienced a total of 1 458 094 birthdays during the study period (median of 6 birthdays per person; IQR 3-10). The percentiles of multimorbidity across age did not vary noticeably by sex, race or ethnicity. In general, there was an increased risk of mortality at 1 and 5 years for quintiles 4 and 5 of multimorbidity. The risk of mortality for quintile 5 was greater for younger age groups and for women.

Conclusions: The assignment of multimorbidity percentiles to persons in a population may be a simple and intuitive tool to assess relative health status, and to predict short-term mortality, especially in younger persons and in women.

Keywords: epidemiology; general medicine (see internal medicine); geriatric medicine; statistics & research methods.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Accumulation of chronic conditions over age in the overall population (both sexes and all race and ethnicity groups combined).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Fabbri E, Zoli M, Gonzalez-Freire M, et al. . Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. J Am Med Dir Assoc 2015;16:640–7. 10.1016/j.jamda.2015.03.013 - DOI - PMC - PubMed
    1. St Sauver JL, Boyd CM, Grossardt BR, et al. . Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open 2015;5:e006413. 10.1136/bmjopen-2014-006413 - DOI - PMC - PubMed
    1. Fabbri E, An Y, Zoli M, et al. . Association between accelerated multimorbidity and age-related cognitive decline in older Baltimore longitudinal study of aging participants without dementia. J Am Geriatr Soc 2016;64:965–72. 10.1111/jgs.14092 - DOI - PMC - PubMed
    1. Vetrano DL, Calderón-Larrañaga A, Marengoni A, et al. . An international perspective on chronic multimorbidity: approaching the elephant in the room. J Gerontol A Biol Sci Med Sci 2018;73:1350–6. 10.1093/gerona/glx178 - DOI - PMC - PubMed
    1. Rocca WA, Boyd CM, Grossardt BR, et al. . Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc 2014;89:1336–49. 10.1016/j.mayocp.2014.07.010 - DOI - PMC - PubMed

Publication types

LinkOut - more resources