Sequence, timing of HF, diabetes, psychosis have ‘complex’ effect on long-term mortality
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Key takeaways:
- Development of diabetes, psychosis and heart failure in that order led to poorer prognosis than the same conditions developed in different orders.
- Congestive HF had the worst prognosis as a single condition.
Adults who developed diabetes, psychosis and congestive HF, in that order, had reduced life expectancy compared with people who developed the same three conditions in a different order, researchers reported.
“Multimorbidity is a major health concern worldwide as global populations live longer, with vast implications for health service providers such as the National Health Service and the Department of Health and Social Care in the U.K.,” Rhiannon K. Owen, PhD, associate professor of statistics at Swansea University Medical School in Wales, United Kingdom, and colleagues wrote in the study background. “Health care decision-making has previously focused on developing recommendations for disease-specific guidelines in single conditions. However, standardized care for each chronic condition in isolation can be inappropriate for individuals with multimorbidity. Targeted approaches to prevention or delay of multimorbidity are advocated as being a crucial component of future health care planning.”
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In a population-scale, retrospective study, Owen and colleagues analyzed health records data from the Wales Multimorbidity e-Cohort for 1,675,585 adults aged 25 years and older living in Wales on Jan. 1, 2000, with follow-up continuing until Dec. 31, 2019, the first break in Welsh residency or death. The median age at cohort entry was 51 years and 51.6% of participants were women. The researchers applied multistate models to the data to assess trajectories of disease in multimorbidity and their associated effect on all-cause mortality, accounting for competing risks. Researchers calculated life expectancy as the restricted mean survival time (bound by the maximum follow-up of 20 years) for each of the transitions from the health states to death and used Cox regression models to estimate baseline HRs for transitions between health states.
The findings were published in The Lancet Public Health.
As the index condition, 1.5% of adults developed psychosis, 16.8% of adults developed diabetes and 7.4% of adults developed congestive HF during follow-up.
Researchers found that the order of disease acquisition in cases of multimorbidity had an important and complex association with patient life expectancy. Adults who developed diabetes, psychosis and congestive HF, in that order, had reduced life expectancy compared with people who developed the same three conditions in a different order.
For a man aged 50 years in the third quintile of the Welsh Index of Multiple Deprivation (reference), developing diabetes, psychosis and then HF was associated with a loss in life expectancy of 13.23 years compared with the general otherwise healthy or otherwise diseased population.
Congestive HF as a single condition was associated with mean loss in life expectancy of 12.38 years, and with a loss of 12.95 years when preceded by psychosis and 13.45 years when followed by psychosis.
Within 5 years of an initial diagnosis of diabetes, the risk for developing psychosis or congestive HF, or both, was increased, according to the researchers.
The researchers noted that identifying of periods of increased risk for the development of subsequent conditions or death is essential to improve the management and care of individuals at risk for and living with multimorbidity.
“The sequence and timing of disease onset in a trio of long-term conditions associated with high mortality had an important and complex effect on all-cause mortality,” the researchers wrote. “Multistate models provide a flexible framework to analyze trajectories of disease development and their associated effects on patient outcomes, and thus allow assessment of potential risk factors, screening opportunities and targeted interventions for health care policy- and decision-making.”
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