Multimorbidity patterns and association with mortality in 0.5 million Chinese adults

作     者：Junning Fan Zhijia Sun Canqing Yu Yu Guo Pei Pei Ling Yang Yiping Chen Huaidong Du Dianjianyi Sun Yuanjie Pang Jun Zhang Simon Gilbert Daniel Avery Junshi Chen Zhengming Chen Jun Lyu Liming Li On Behalf of the China Kadoorie Biobank Collaborative Group Junning Fan;Zhijia Sun;Canqing Yu;Yu Guo;Pei Pei;Ling Yang;Yiping Chen;Huaidong Du;Dianjianyi Sun;Yuanjie Pang;Jun Zhang;Simon Gilbert;Daniel Avery;Junshi Chen;Zhengming Chen;Jun Lyu;Liming Li;On Behalf of the China Kadoorie Biobank Collaborative Group

作者机构：Department of Epidemiology and BiostatisticsSchool of Public HealthPeking UniversityBeijing 100191China Peking University Center for Public Health and Epidemic Preparedness and ResponsePeking UniversityBeijing 100191China National Clinical Research Center of Cardiovascular DiseasesNational Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China China Kadoorie Biobank National Coordination CentreChinese Academy of Medical SciencesBeijing 100730China Nuffield Department of Population HealthMedical Research Council Population Health Research UnitUniversity of OxfordOxford OX37LFUnited Kingdom Nuffield Department of Population HealthUniversity of OxfordClinical Trial Service Unit and Epidemiological Studies Unit(CTSU)Oxford OX37LFUnited Kingdom Suzhou Center for Disease Control and PreventionSuzhouJiangsu 215004China China National Center for Food Safety Risk AssessmentBeijing 100022China Key Laboratory of Molecular Cardiovascular SciencesPeking UniversityMinistry of EducationBeijing 100191China 不详 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2022年第135卷第6期

页      面：648-657页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 100401[医学-流行病与卫生统计学] 10[医学] 

基　　金：supported by grants from the National Natural Science Foundation of China(No.81941018) The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong,China.The long-term follow-up is supported by grants from the UK Wellcome Trust(Nos.212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,and 088158/Z/09/Z) grants from the National Key R&D Program of China(Nos.2016YFC0900500 and 2016YFC1303904) National Natural Science Foundation of China(No.81390540) Chinese Ministry of Science and Technology(No.2011BAI09B01)。 

主　　题：Multimorbidity Pattern Mortality Chinese 

摘      要：Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.