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. 2023 Jun 12;22(1):135.
doi: 10.1186/s12933-023-01858-9.

Duration-dependent impact of cardiometabolic diseases and multimorbidity on all-cause and cause-specific mortality: a prospective cohort study of 0.5 million participants

Yuting Han  1 , Yizhen Hu  1 , Canqing Yu  1   2   3 , Dianjianyi Sun  1   2   3 , Yuanjie Pang  1   3 , Pei Pei  2 , Ling Yang  4   5 , Yiping Chen  4   5 , Huaidong Du  4   5 , Jingchao Liu  6 , Dan Schmidt  5 , Daniel Avery  5 , Junshi Chen  7 , Zhengming Chen  5 , Liming Li  8   9   10 , Jun Lv  11   12   13
Affiliations

Duration-dependent impact of cardiometabolic diseases and multimorbidity on all-cause and cause-specific mortality: a prospective cohort study of 0.5 million participants

Yuting Han et al. Cardiovasc Diabetol. .

Abstract

Background: The association of incident cardiometabolic multimorbidity (CMM) with mortality risk is rarely studied, and neither are the durations of cardiometabolic diseases (CMDs). Whether the association patterns of CMD durations with mortality change as individuals progress from one CMD to CMM is unclear.

Methods: Data from China Kadoorie Biobank of 512,720 participants aged 30-79 was used. CMM was defined as the simultaneous presence of two or more CMDs of interest, including diabetes, ischemic heart disease, and stroke. Cox regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the duration-dependent associations of CMDs and CMM with all-cause and cause-specific mortality. All information on exposures of interest was updated during follow-up.

Results: During a median follow-up of 12.1 years, 99,770 participants experienced at least one incident CMD, and 56,549 deaths were documented. Among 463,178 participants free of three CMDs at baseline, compared with no CMD during follow-up, the adjusted HRs (95% CIs) between CMM and all-cause mortality, mortality from circulatory system diseases, respiratory system diseases, cancer, and other causes were 2.93 (2.80-3.07), 5.05 (4.74-5.37), 2.72 (2.35-3.14), 1.30 (1.16-1.45), and 2.30 (2.02-2.61), respectively. All CMDs exhibited a high mortality risk in the first year of diagnosis. Subsequently, with prolonged disease duration, mortality risk increased for diabetes, decreased for IHD, and sustained at a high level for stroke. With the presence of CMM, the above association estimates inflated, but the pattern of which remained.

Conclusion: Among Chinese adults, mortality risk increased with the number of the CMDs and changed with prolonged disease duration, the patterns of which varied among the three CMDs.

Keywords: Cardiometabolic disease; Mortality; Multimorbidity; Prospective cohort.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Risks of all-cause and cause-specific mortality by updated cardiometabolic disease status during follow-up in 463,178 participants. PY, person-year; HR, hazard ratio; CI, confidence interval; CMD, cardiometabolic disease; IHD, ischemic heart disease. CMDs included diabetes, IHD, and stroke. Participants with a prior diagnosis of diabetes, IHD, or stroke at baseline were excluded. Multivariable models were stratified by age in the 5-year interval and study area, and adjusted for sex, education, household income, marital status, family history of diabetes, heart attack or stroke, smoking, alcohol drinking, dietary habits, physical activity, body mass index, waist circumference, prevalent hypertension, kidney diseases, and rheumatic heart disease
Fig. 2
Fig. 2
Risks of all-cause mortality by duration of diabetes, ischemic heart disease, and stroke in 512,720 participants. PY, person-year; HR, hazard ratio; CI, confidence interval; CMD, cardiometabolic disease. CMDs included diabetes, ischemic heart disease, and stroke. The status and durations of CMDs were collected at baseline and updated during follow-up. Multivariable models were stratified by age in the 5-year interval and study area, and adjusted for sex, education, household income, marital status, family history of diabetes, heart attack or stroke, smoking, alcohol drinking, dietary habits, physical activity, body mass index, waist circumference, prevalent hypertension, kidney diseases, and rheumatic heart disease
Fig. 3
Fig. 3
Risks of mortality from circulatory system diseases by duration of diabetes, ischemic heart disease, and stroke in 512,720 participants. PY, person-year; HR, hazard ratio; CI, confidence interval; CMD, cardiometabolic disease. CMDs included diabetes, ischemic heart disease, and stroke. The status and durations of CMDs were collected at baseline and updated during follow-up. Multivariable models were stratified by age in the 5-year interval and study area, and adjusted for sex, education, household income, marital status, family history of diabetes, heart attack or stroke, smoking, alcohol drinking, dietary habits, physical activity, body mass index, waist circumference, prevalent hypertension, kidney diseases, and rheumatic heart disease
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