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
Observational Study
. 2024 Sep;14(3):1077-1088.
doi: 10.1007/s44197-024-00256-y. Epub 2024 Jun 13.

Age-specific Multimorbidity Patterns and Burden on All-Cause Mortality and Public Direct Medical Expenditure: A Retrospective Cohort Study

Sabrina Nan Hong #  1 , Francisco Tsz Tsun Lai #  2   3 , Boyuan Wang  1 , Edmond Pui Hang Choi  4 , Ian Chi Kei Wong  2   3   5   6 , Cindy Lo Kuen Lam  1   7 , Eric Yuk Fai Wan  8   9
Affiliations
Observational Study

Age-specific Multimorbidity Patterns and Burden on All-Cause Mortality and Public Direct Medical Expenditure: A Retrospective Cohort Study

Sabrina Nan Hong et al. J Epidemiol Glob Health. 2024 Sep.

Abstract

Objective: To evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups.

Patients and methods: Retrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50-64, 65-79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined.

Results: 4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60-4.03) and 1.38 (1.36-1.40), respectively, which increased to 14.22 (9.87-20.47) and 2.20 (2.13-2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43-2.53) among all identified clusters arising from the clustering analysis.

Conclusion: Given the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words).

Keywords: All-cause mortality; Healthcare expenditure; Multimorbidity; Observational study.

PubMed Disclaimer

Conflict of interest statement

Competing Interests FTTL has been supported by the RGC Postdoctoral Fellowship under the Hong Kong Research Grants Council and has received research grants from the Food and Health Bureau of the Government of the Hong Kong Special Administrative Region, outside the submitted work. ICKW reports research funding from Amgen, Bristol Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, the National Institute for Health Research in England, the European Commission, and the National Health and Medical Research Council in Australia, outside the submitted work; and is a non-executive director of Jacobson Medical in Hong Kong and a consultant to IQVIA and World Health Organization. EYFW has received research grants from the Food and Health Bureau of the Government of the Hong Kong Special Administrative Region, the Hong Kong Research Grants Council of the Government of the Hong Kong SAR, Narcotics Division, Security Bureau of the Government of the Hong Kong SAR, and National Natural Science Foundation of China, outside the submitted work. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prevalence of individual morbidities in the overall cohort and different age groups. HT: Hypertension; DM: Diabetes; Stroke/TIA: Stroke or transient ischemic attack; Constipation: Severe constipation; Pulmonary: Chronic Pulmonary disease; CKD: Chronic kidney disease; RA: Rheumatoid arthritis; HF: Chronic heart failure; PVD: Peripheral vascular disease; MI: Myocardial infarction.
Fig. 2
Fig. 2
Trend of morbidity count from 2009 to 2018
Fig. 3
Fig. 3
Kaplan-Meier curves of all-cause mortality in groups with different numbers of conditions overall and in different age groups
Fig. 4
Fig. 4
Within-cluster sum of squares across various numbers of clusters in K-means clustering WCSS = Within-Cluster Sum of Squares
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ho ISS, Azcoaga-Lorenzo A, Akbari A, Davies J, Khunti K, Kadam UT, et al. Measuring multimorbidity in research: Delphi consensus study. BMJ Med. 2022;1:e000247. - PMC - PubMed
    1. Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2016;67:130–8. - PubMed
    1. Van Oostrom SH, Picavet HSJ, De Bruin SR, Stirbu I, Korevaar JC, Schellevis FG, et al. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Fam Pract. 2014;15:1–9. - PMC - PubMed
    1. Colombo F, García-Goñi M, Schwierz C. Addressing multimorbidity to improve healthcare and economic sustainability. J Comorbidity. 2016;6:21–7. - PMC - PubMed
    1. Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009;57:225–30. - PubMed

Publication types

LinkOut - more resources