Epidemiology of multimorbidity associated with atherosclerotic cardiovascular disease in the United States, 1999-2018

Abstract

Background: The multimorbidity of Atherosclerotic cardiovascular disease (ASCVD) and many other chronic conditions is becoming common. This study aimed to assess multimorbidity distribution in ASCVD among adults in the United States from 1999 to 2018.

Methods: This cross-sectional survey from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 using stratified multistage probability design. Among the 53,083 survey respondents during the study period, 5,729 US adults aged ≥ 20 years with ASCVD. Joinpoint regression was used to assess the statistical significance of prevalence trends in the prevalence of ASCVD stratified by multimorbidity. The Apriori association rule mining algorithm was used to identify common multimorbidity association patterns in ASCVD patients.

Results: Overall, 5,729 of 53,083 individuals had ASCVD, and the prevalence showed a slow declining trend (biannual percentage change = -0.81%, p = 0.035, average 7.71%). The prevalence of ASCVD significantly decreased in populations without dyslipidemia, diabetes mellitus (DM), hypertension, asthma, chronic obstructive pulmonary disease (COPD), and arthritis (all groups, p < 0.05). Additionally, 65.6% of ASCVD patients had at least four of the 12 selected chronic conditions, with four and five being the most common numbers of conditions (17.9% and 17.7%, respectively). The five most common chronic conditions were (in order) dyslipidemia, hypertension, arthritis, chronic kidney disease, and DM. The coexistence of hypertension and dyslipidemia had the highest support in association rules (support = 0.63), while the coexistence of dyslipidemia, hypertension, metabolic syndrome, and DM had the highest lift (lift = 1.82).

Conclusions: During the 20-year survey period, there was a significant decrease in the overall prevalence of ASCVD. However, this reduction was primarily observed in individuals without dyslipidemia, DM, hypertension, asthma, COPD, and arthritis. Among populations with any of the evaluated chronic conditions, the prevalence of ASCVD remained unchanged. Most of ASCVD patients had four or more concurrent chronic conditions.

Keywords: Atherosclerotic cardiovascular disease; Multimorbidity; National Health and Nutrition Examination Survey.

Fig. 1

Distribution of the number and type of multimorbidity in ASCVD. ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; DM, diabetes mellitus; CLD, chronic liver disease; CHF, congestive heart failure; MetS, metabolic syndrome; COPD, chronic obstructive pulmonary disease

Fig. 2

The 10 rules with the highest support show. As shown in the figure, dyslipidemia and hypertension continued to be the core diseases with strong association rules

Fig. 3

Independent association of multimorbidity with ASCVD in a multivariable logistic regression model with interaction. Model adjusted for age, sex, race/ethnicity, education, ratio of family income to poverty, insurance, and smoking status. Error bars indicate 95% CI. ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; DM, diabetes mellitus; CLD, chronic liver disease; CHF, congestive heart failure; MetS, metabolic syndrome; COPD, chronic obstructive pulmonary disease; OR, odds ratio; CI, confidence interval