Journal of comorbidity最新文献

{"title":"Prevalence and correlates of multimorbidity among adults in border areas of the Central Highland Region of Vietnam, 2017.","authors":"Nguyen Van Ba,&nbsp;Hoang Van Minh,&nbsp;Le Bach Quang,&nbsp;Nguyen Van Chuyen,&nbsp;Bui Thi Thu Ha,&nbsp;Tran Quoc Dai,&nbsp;Duong Minh Duc,&nbsp;Nguyen Thuy Quynh,&nbsp;Pham Gia Khanh","doi":"10.1177/2235042X19853382","DOIUrl":"https://doi.org/10.1177/2235042X19853382","url":null,"abstract":"<p><strong>Introduction: </strong>The objectives of this study are to estimate the prevalence of multimorbidity (MM) among adults in the Central Highland Region (a poor region) of Vietnam in 2017 and to identify the sociodemographic correlates of these conditions.</p><p><strong>Methods: </strong>We used data from a cross-sectional study conducted in 2018 on health status among people in four provinces in the Central Highlands Region (Tay Nguyen) of Vietnam. A sample of 1680 adults (aged 15 years and older) were randomly selected for this study. Respondents were asked whether they had been told by a health worker that they had cancer, heart and circulatory conditions, chronic joint problems, chronic pulmonary diseases, chronic kidney problems, chronic digestive problems, psychological illness, diabetes, and/or other chronic conditions.</p><p><strong>Results: </strong>The prevalence of MM among the study participants was 16.4% (95% confidence interval (CI): 14.6%-18.2%). By looking at the 95% CIs, the differences in MM prevalence between the groups classified by gender, age, education, and occupation were not statistically significant. Only the difference in MM prevalence between farmers and government staff was statistically significant. Multivariate logistic analyses show education and occupations were shown to be significant correlates of MM.</p><p><strong>Conclusion: </strong>MMs were quite common among the adult populations in the study area, especially among people with lower socioeconomic status. Given the evidence, actions to reduce levels of MM in the setting are clearly urgent. The interventions should address all people in society, with focus on disadvantaged groups, like those with lower education and farmers.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"9 ","pages":"2235042X19853382"},"PeriodicalIF":0.0,"publicationDate":"2019-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X19853382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37325549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of cardiac- and noncardiac-related conditions on adverse outcomes in patients hospitalized with acute myocardial infarction.","authors":"Mayra Tisminetzky,&nbsp;Jerry H Gurwitz,&nbsp;Ruben Miozzo,&nbsp;Joel M Gore,&nbsp;Darleen Lessard,&nbsp;Jorge Yarzebski,&nbsp;Robert J Goldberg","doi":"10.1177/2235042X19852499","DOIUrl":"https://doi.org/10.1177/2235042X19852499","url":null,"abstract":"<p><strong>Background: </strong>To examine the impact of cardiac- and noncardiac-related conditions on the risk of hospital complications and 7- and 30-day rehospitalizations in older adult patients with an acute myocardial infarction (AMI).</p><p><strong>Methods and results: </strong>The study population consisted of 3863 adults aged 65 years and older hospitalized with AMI in Worcester, Massachusetts, during six annual periods between 2001 and 2011. Individuals were categorized into four groups based on the presence of 11 previously diagnosed cardiac and noncardiac conditions. The median age of the study population was 79 years and 49% were men. Twenty-eight percent of patients had two or less cardiac- and no noncardiac-related conditions, 21% had two or less cardiac and one or more noncardiac conditions, 20% had three or more cardiac and no noncardiac conditions, and 31% had three or more cardiac and one or more noncardiac conditions. Individuals who presented with one or more noncardiac-related conditions were less likely to have been prescribed evidence-based medications and/or to have undergone coronary revascularization procedures than patients without any noncardiac condition. After multivariable adjustment, individuals with three or more cardiac and one or more noncardiac conditions were at greatest risk for all adverse outcomes.</p><p><strong>Conclusions: </strong>Older patients hospitalized with AMI carry a significant burden of cardiac- and noncardiac-related conditions. Older adults who presented with multiple cardiac and noncardiac conditions experienced the worse short-term outcomes and treatment strategies should be developed to improve their in-hospital and post-discharge care and outcomes.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"9 ","pages":"2235042X19852499"},"PeriodicalIF":0.0,"publicationDate":"2019-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X19852499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37325547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and preliminary effects of an integrated hospital-to-home transitional care intervention for older adults with stroke and multimorbidity: A study protocol.","authors":"Maureen Markle-Reid, Ruta Valaitis, Amy Bartholomew, Kathryn Fisher, Rebecca Fleck, Jenny Ploeg, Jennifer Salerno, Lehana Thabane","doi":"10.1177/2235042X19828241","DOIUrl":"10.1177/2235042X19828241","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major life-altering event and the leading cause of death and disability in Canada. Most older adults who have suffered a stroke will return home and require ongoing rehabilitation in the community. Transitioning from hospital to home is reportedly very stressful and challenging, particularly if stroke survivors have multiple chronic conditions. New interventions are needed to improve the quality of transitions from hospital to home for this vulnerable population.</p><p><strong>Objectives: </strong>The primary objective of this study is to examine the feasibility of implementing a new 6-month transitional care intervention supported by a web-based app. The secondary objective is to explore its preliminary effects.</p><p><strong>Design: </strong>A single arm, pre/post, pragmatic feasibility study of 20-40 participants in Ontario, Canada. Participants will be community-dwelling older adults (≥55 years) with a confirmed stroke diagnosis, ≥2 co-morbid conditions, and referred to a hospital-based outpatient stroke rehabilitation centre. The 6-month transitional care intervention will be delivered by an interprofessional (IP) team and involve care coordination/system navigation, self-management education and support, home visits, telephone contacts, IP team meetings and a web-based app. Primary evaluation of the intervention will be based on feasibility outcomes (e.g. acceptability, fidelity). Preliminary intervention effects will be based on 6-month changes in health outcomes, patient experience, provider experience and cost.</p><p><strong>Conclusions: </strong>Information on the feasibility and preliminary effects of this newly-developed intervention will be used to optimize the design and methods for a future pragmatic trial to test the effectiveness and implementation of the intervention in other contexts and settings.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"9 ","pages":"2235042X19828241"},"PeriodicalIF":0.0,"publicationDate":"2019-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/d0/10.1177_2235042X19828241.PMC6416989.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37073393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonconventional diabetes-related care strategies for patients with chronic kidney disease: A scoping review of the literature.","authors":"Kristin K Clemens, Vinusha Kalatharan, Bridget L Ryan, Sonja Reichert","doi":"10.1177/2235042X19831918","DOIUrl":"10.1177/2235042X19831918","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes and chronic kidney disease (CKD) are at high risk of diabetes-related complications. Diabetes care can support these individuals, but outpatient clinic appointments can be difficult to attend, given their already high burden of multimorbidity.</p><p><strong>Methods: </strong>We systematically searched the medical and grey literature for studies that evaluated the effect of nonconventional diabetes care strategies on diabetes-related outcomes in adults with stages 2-5 CKD or using dialysis (end of search December 30, 2017). We included both randomized-controlled trials and observational studies. Study selection and data extraction were completed by two independent reviewers. Diabetes-related outcomes included glycemic, blood pressure, and lipid control, along with microvascular complications, macrovascular complications, and death.</p><p><strong>Results: </strong>After screening 2177 relevant citations, we identified 34 studies which met inclusion. The majority were observational studies. Studies were frequently small, single-centered, and excluded patients with more advanced CKD. Nonconventional diabetes care strategies included community-based care, unique self-management and education programs, nurse-led care clinics, dialysis-based diabetes programs, telemedicine, and interdisciplinary care clinics. Programs were most often developed by study investigators. Although there were limitations to several of the included studies, programs were described to have modest effects on physiologic outcomes, and in some cases, diabetes-related complications and death.</p><p><strong>Conclusions: </strong>Nonconventional diabetes-related care might be helpful to patients with CKD. Prior to developing and implementing programs, however, it will be important to study them more rigorously, understand their acceptability to patients, and evaluate their costs and feasibility in a real-world setting.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"9 ","pages":"2235042X19831918"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/ef/10.1177_2235042X19831918.PMC6416990.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37073396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time trends in patients managed simultaneously in multiple hospital outpatient specialty clinics for chronic diseases: A register-based cross-sectional study.","authors":"Donna Lykke Wolff,&nbsp;Christian Von Plessen,&nbsp;Frans Boch Waldorff,&nbsp;Thomas Lund Sørensen,&nbsp;Søren Bie Bogh,&nbsp;Katrine Hass Rubin,&nbsp;Christian Backer Mogensen","doi":"10.1177/2235042X19831907","DOIUrl":"https://doi.org/10.1177/2235042X19831907","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of patients with multimorbidity in the general population affects the health-care system. There is a lack of knowledge of the proportion of patients attending multiple hospital outpatient specialty clinics simultaneously.</p><p><strong>Objective: </strong>This study describes the development in the proportion of patients managed simultaneously in multiple hospital outpatient specialty clinics.</p><p><strong>Design: </strong>We obtained three cross-sectional samples from all of the hospitals in Denmark. The data set consists of adults (age 18+) in long-term outpatient care on January 1 in 2004, 2009, and 2014 with one or more of 50 consensus-selected chronic diseases. Descriptive statistics were used to examine and compare the proportion of patients treated simultaneously in multiple outpatient specialty clinics. We also investigated the most common combinations of outpatient specialty clinics.</p><p><strong>Results: </strong>In 2004, 176,786 patients with chronic diseases were registered as receiving outpatient care in Denmark. This figure increased to 246,542 patients in 2009 and 341,015 in 2014. The proportion of patients managed simultaneously in multiple outpatient specialty clinics was 4.0% in 2004, 5.5% in 2009, and 7.7% in 2014. The most common specialty clinic combination was endocrinology and cardiology, accounting for 12.1% in 2004, 11.5% in 2009, and 9.6% in 2014.</p><p><strong>Conclusions: </strong>The proportion of patients in multiple clinics nearly doubled over a 10-year period. While there were some common specialty clinic combinations in which patients were treated most often, there was also considerable variation. Further studies are needed to identify generic and disease-specific initiatives.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"9 ","pages":"2235042X19831907"},"PeriodicalIF":0.0,"publicationDate":"2019-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X19831907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37073392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in multimorbidity, complex multimorbidity and multiple functional limitations in the ageing population of England, 2002–2015","authors":"L. Singer, M. Green, Francisco Rowe, Y. Ben-Shlomo, H. Kulu, Karyn Morrissey","doi":"10.1177/2235042X19872030","DOIUrl":"https://doi.org/10.1177/2235042X19872030","url":null,"abstract":"This study aimed to estimate the prevalence of three measures of multimorbidity among people aged 50 years or older in England. Beside the basic measure of two or more diseases within a person, we added a measure of three or more affected body systems (complex multimorbidity) and a measure of 10 or more functional limitations. We found that the three health outcomes became more prevalent between 2002 and 2015. They were more common among females than males and were becoming more common among younger age groups. While in 2002, the prevalence of basic multimorbidity overcame 50% from the 70–74 age group upwards, in 2015 it crossed the same threshold in the 65–69 age group. The distribution of multimorbidity and multiple functional limitations were stratified by the amount of household wealth. Multiple functional limitations reflected the largest differences between the most and the least affluent groups (5.9-fold in 2014/2015), followed by the measure of complex multimorbidity (2.8-fold in 2014/2015) and basic multimorbidity (1.9-fold) in 2014/2015.While age acted as a levelling factor for the wealth differences in basic multimorbidity, it had no such effect on the two other outcomes. Our study observed social polarization among multimorbid ageing population in England where complex multimorbidity and multiple functional limitations increase faster and reflect stronger inequality than basic multimorbidity.","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X19872030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43926576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic obstructive pulmonary disease and rheumatic diseases: A systematic review on a neglected comorbidity","authors":"I. Gergianaki, I. Tsiligianni","doi":"10.1177/2235042X18820209","DOIUrl":"https://doi.org/10.1177/2235042X18820209","url":null,"abstract":"Background: Although, both chronic obstructive pulmonary disease (COPD) and rheumatic diseases (RDs) are common, and each has significant impact on patients’ overall health/quality of life, their co-occurrence has received little attention, while 15% of COPD remains undiagnosed in RDs. Objective: To update the information regarding the comorbid state of RD/COPD (prevalence, incidence), to examine whether patients with RD have increased risk of developing COPD and vice versa, and what implications this comorbidity has on patients’ outcomes (mortality, hospitalizations, exacerbations). Methods: We performed a systematic literature review regarding the comorbidity of an RD (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), primary Sjogren syndrome disease (pSS), and systemic sclerosis (SSc)) with COPD. From 2803 reports retrieved, 33 articles were further screened. Finally, 27 articles were included. Results: Robust evidence supports that COPD develops up to 68% more frequently in patients with RA, as compared to the general population. Similarly, COPD is increased in every other RD that was studied. Further, self-referred arthritis is more common in COPD patients versus non-COPD controls and a predictor of worst self-rated health status. Patients with inflammatory arthritis/COPD have increased mortality (threefold in RA-COPD, irrespectively of which is first diagnosed), hospitalizations, and emergency visits. Conclusion: COPD is more common in patients with RA, AS, PsA, SLE, pSS, and SSc; yet, the association, vice versa, warrants further investigation. Nevertheless, COPD/RDs coexistence has significant prognostic value for worst outcomes; therefore, awareness is required to track early identification, especially in primary care.","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X18820209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42975907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity, functional limitations, and outcomes: Interactions in a population-based cohort of older adults","authors":"A. Chamberlain, L. Rutten, D. Jacobson, Chun Fan, Patrick M. Wilson, W. Rocca, V. Roger, J. S. St. Sauver","doi":"10.1177/2235042X19873486","DOIUrl":"https://doi.org/10.1177/2235042X19873486","url":null,"abstract":"Objective: To understand the interaction of multimorbidity and functional limitations in determining health-care utilization and survival in older adults. Methods: Olmsted County, Minnesota, residents aged 60–89 years in 2005 were categorized into four cohorts based on the presence or absence of multimorbidity (≥3 chronic conditions from a list of 18) and functional limitations (≥1 limitation in an activity of daily living from a list of 9), and were followed through December 31, 2016. Andersen–Gill and Cox regression estimated hazard ratios (HRs) for emergency department (ED) visits, hospitalizations, and death using persons with neither multimorbidity nor functional limitations as the reference (interaction analyses). Results: Among 13,145 persons, 34% had neither multimorbidity nor functional limitations, 44% had multimorbidity only, 4% had functional limitations only, and 18% had both. Over a median follow-up of 11 years, 5906 ED visits, 2654 hospitalizations, and 4559 deaths occurred. Synergistic interactions on an additive scale of multimorbidity and functional limitations were observed for all outcomes; however, the magnitude of the interactions decreased with advancing age. The HR (95% confidence interval) for death among persons with both multimorbidity and functional limitations was 5.34 (4.40–6.47) at age 60–69, 4.16 (3.59–4.83) at age 70–79, and 2.86 (2.45–3.35) at age 80–89 years. Conclusion: The risk of ED visits, hospitalizations, and death among persons with both multimorbidity and functional limitations is greater than additive. The magnitude of the interaction was strongest for the youngest age group, highlighting the importance of interventions to prevent and effectively manage multimorbidity and functional limitations early in life.","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X19873486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48072376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the association between marginalization and multimorbidity in Ontario, Canada: A cross-sectional study.","authors":"John Sina Moin,&nbsp;Rahim Moineddin,&nbsp;Ross Edward Grant Upshur","doi":"10.1177/2235042X18814939","DOIUrl":"https://doi.org/10.1177/2235042X18814939","url":null,"abstract":"<p><p>There is growing evidence to suggest that multimorbidity is not only a consequence of aging but also other environmental risk factors such as socio-economic status and social marginalization. In this study, the prevalence of multimorbidity was examined (defined as the simultaneous occurrence of two or more chronic morbidities) by age, gender and the Ontario Marginalization index (material deprivation, residential instability, dependency and ethnic concentration). With a cross-sectional design, 2015 data on 18 morbidities from 12,516,587 residents of the province of Ontario, Canada, were analysed. About 82.1% of the population had one or no chronic conditions, 10.3% were multimorbid with two chronic conditions and 7.6% had three or more chronic conditions. The results showed that the prevalence of multimorbidity is noticeably higher in the most deprived areas compared to least deprived for all age groups. Our findings challenge the notion that multimorbidity is primarily driven by aging. Of the 18% of the total population which were multimorbid, 43% of them were under the age of 65. We noted a substantial excess of multimorbidity in younger and middle-aged adults who were most deprived. In some cases, those in the most deprived areas were showing increased cases of multimorbidity nearly 10 years sooner than those who were least deprived. This study shows that environmental factors such as material deprivation and residential instability are correlated with higher prevalence of multimorbidity.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"8 1","pages":"2235042X18814939"},"PeriodicalIF":0.0,"publicationDate":"2018-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X18814939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36803741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity patterns and 5-year overall mortality: Results from a claims data-based observational study.","authors":"Ingmar Schäfer,&nbsp;Hanna Kaduszkiewicz,&nbsp;Truc Sophia Nguyen,&nbsp;Hendrik van den Bussche,&nbsp;Martin Scherer,&nbsp;Gerhard Schön","doi":"10.1177/2235042X18816588","DOIUrl":"https://doi.org/10.1177/2235042X18816588","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is prevalent and related to adverse outcomes. The effect on mortality is disputed, possibly because studies show differences in the diseases which operationalize multimorbidity. The aim of this study is to analyze the effects of three multimorbidity patterns (representing subgroups of diseases) on mortality.</p><p><strong>Methods: </strong>We conducted a longitudinal observational study based on insurance claims data of ambulatory care from 2005 to 2009. Analyses are based on 46 chronic conditions with a prevalence ≥1%. We included 52,217 females and 71,007 males aged 65+ and insured by the Gmünder ErsatzKasse throughout 2004. Our outcome was 5-year overall mortality documented as exact time of death. We calculated hazard ratios by Cox regression analyses with time-dependent covariates. Three statistical models were analyzed: (a) the individual diseases, (b) the number of diseases in multimorbidity patterns, and (c) a count of all diseases, all calculated separately for genders and adjusted for age.</p><p><strong>Results: </strong>During the study period, 12,473 males (17.6%) and 7,457 females (14.3%) died. The general effect of multimorbidity on mortality was small (females: 1.02, 1.01-1.02; males: 1.04, 1.03-1.04). The number of neuropsychiatric disorders was related to higher mortality (1.33, 1.30-1.36; 1.46, 1.43-1.50). Cardiovascular and metabolic disorders had inconsistent effects (0.99, 0.97-1.01; 1.08, 1.07-1.09). Psychiatric, psychosomatic, and pain-related disorders were related to higher life expectancy (0.87, 0.86-0.89; 0.88, 0.87-0.90).</p><p><strong>Conclusions: </strong>Chronic diseases have heterogeneous effects on mortality and generalized measures of multimorbidity reflect and even out the effects of the single diseases. In multimorbidity studies, a careful selection of diseases is therefore important.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"8 1","pages":"2235042X18816588"},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2235042X18816588","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36835693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}