Comorbid chronic diseases, discordant impact on mortality in the elderly; a 14 year longitudinal population study.
- Gillian E Caughey1,*,
- Emmae N Ramsay2,
- Agnes I Vitry1,
- Andrew L Gilbert1,
- Mary A Luszcz3,
- Philip Ryan4,
- Elizabeth E Roughead1
- 1 QUMPRC, Sansom Institute, University of South Australia, Australia;
- 2 Discipline of Public Health, Universityof Adelaide, Australia;
- 3 School of Psychology, Flinders university, Australia;
- 4 Discipline of Public Health university of Adelaide, Australia
- Correspondence to: Gillian E Caughey, Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, Reid Building Frome Rd, Adelaide, 5000, Australia; gillian.caughey{at}unisa.edu.au
- Received 4 February 2009
- Accepted 1 October 2009
- Published Online First 23 October 2009
Abstract
Objectives: To determine the impact of comorbid chronic diseases on mortality in the elderly.
Design: Prospective cohort study, (1992-2006). Associations between numbers of chronic diseases or mutually exclusive comorbid chronic diseases on mortality over 14 years, by Cox-proportional hazards model adjusting for socio-demographic variables or kaplan-meier analyses, respectively.
Setting: Population based, Australia.
Participants: 2087 randomly selected participants aged ≥65 years old, living in the community or institutions.
Main Results: Participants with 3-4 diseases or ≥5 had a 25% (95% CI 1.05-1.5, p=0.01) and 80% (95% CI 1.5-2.2, p<0.0001) increased risk of mortality, respectively, by comparison with no chronic disease, after adjusting for age, sex and residential status. When cardiovascular disease (CVD), mental health problem or diabetes were comorbid with arthritis there was a trend toward increased survival (range 8.2-9.5 years) by comparison with CVD, mental health problem or diabetes alone (survival 5.8-6.9 years). This increase in survival with arthritis as a comorbidity was negated when CVD and mental health problems or CVD and diabetes were present in disease combinations together.
Conclusion: Elderly persons with ≥3 chronic diseases have increased risk of mortality, but discordant effects on survival dependant on specific disease combinations. These results raise the hypothesis that patients who have an increased likelihood of opportunity for care from their physician are more likely to have comorbid diseases detected and managed.
