Longitudinal Analysis of the Transition Between Multimorbidity and Mortality Patterns from a Syndemic Perspective

Abstract

Background

Longitudinal analysis of multimorbidity (MM) from a holistic approach to the aging population is necessary to guide medical care.

Aims

To estimate the probability of transition between different MM patterns and the “death” stage and to characterize the socioeconomic, health, behavioral, and functional dimensions of MM patterns from a syndemic perspective.

Methods

A cohort of 7,120 people ≥50 from the Mexican Health and Aging Study and mortality data at 11 and 17 years of follow-up were analyzed using the latent class approach. MM was defined as the coexistence of two or more chronic diseases (CDs). Socioeconomic, health, behavioral, and functional indicators were registered. Descriptive analysis, latent class analysis, and Markov chain models were carried out.

Results

The model included three latent classes: “healthy” (low probability of CD); “multi-organic” (high probability of hypertension, arthritis, diabetes mellitus, lung disease, and myocardial infarction); and “sensitive-emotional, mental, neurological” (high probability of chronic pain, depression, and cognitive impairment). At the first follow-up, people in the “multi-organic” class were more likely to move on to death, and at the second follow-up, they were in the “sensitive-emotional, mental, neurological” class. In addition, the characteristic profiles of the indicators for each latent class were identified.

Conclusions

The probabilities of transition between the three classes of MM and death, as well as the socioeconomic, behavioral, and functional dimensions in those over 50 years of age, revealed, from a syndemic perspective, the variability in the likelihood of progressing toward an unfavorable outcome.