TY - JOUR

T1 - The effect of disease onset chronology on mortality among patients with multimorbidity

T2 - A Danish nationwide register study

AU - Willadsen, Tora Grauers

AU - Siersma, Volkert Dirk

AU - Nicolaisdottir, Dagny Ros

AU - Køster-Rasmussen, Rasmus

AU - Reventlow, Susanne

AU - Rozing, Maarten Pieter

PY - 2022

Y1 - 2022

N2 - Background: Multimorbidity is associated with increased mortality. Certain combinations of diseases are known to bemore lethal than others, but the limited knowledge of how the chronology in which diseases develop impacts mortality mayimpair the development of effective clinical interventions for patients with multimorbidity.Objective: To explore if in multimorbidity the chronology of disease onset is associated with mortality. Design: Aprospective nationwide cohort study, including 3,986,209 people aged ≥18 years on 1 January 2000, was performed. Weincluded ten diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. We defined multimorbidity as the presence of at least two diagnoses from twodiagnosis groups (out of ten). To determine mortality, logistic regression models were used to calculate odds ratios (OR)and ratio of ORs (RORs).Results: For most combinations of multimorbidity, the chronology of disease onset does not change mortality. However,when multimorbidity included mental health diagnoses, mortality was in general higher if the mental health diagnosisappeared first. If multimorbidity included heart and sensory diagnoses, mortality was higher if these developed second. Forthe majority of multimorbidity combinations, there was excess mortality if multimorbidity was diagnosed simultaneously,rather than consecutively, for example, heart and kidney (3.58 ROR; CI 2.39–5.36), or mental health and musculoskeletaldiagnoses (2.38 ROR; CI 1.70–3.32).Conclusions: Overall, in multimorbidity, the chronology in which diseases develop is not associated with mortality, withfew exceptions. For almost all combinations of multimorbidity, diagnoses act synergistically in relation to mortality ifdiagnosed simultaneously.

AB - Background: Multimorbidity is associated with increased mortality. Certain combinations of diseases are known to bemore lethal than others, but the limited knowledge of how the chronology in which diseases develop impacts mortality mayimpair the development of effective clinical interventions for patients with multimorbidity.Objective: To explore if in multimorbidity the chronology of disease onset is associated with mortality. Design: Aprospective nationwide cohort study, including 3,986,209 people aged ≥18 years on 1 January 2000, was performed. Weincluded ten diagnosis groups: lung, musculoskeletal, endocrine, mental, cancer, neurological, gastrointestinal, cardiovascular, kidney, and sensory organs. We defined multimorbidity as the presence of at least two diagnoses from twodiagnosis groups (out of ten). To determine mortality, logistic regression models were used to calculate odds ratios (OR)and ratio of ORs (RORs).Results: For most combinations of multimorbidity, the chronology of disease onset does not change mortality. However,when multimorbidity included mental health diagnoses, mortality was in general higher if the mental health diagnosisappeared first. If multimorbidity included heart and sensory diagnoses, mortality was higher if these developed second. Forthe majority of multimorbidity combinations, there was excess mortality if multimorbidity was diagnosed simultaneously,rather than consecutively, for example, heart and kidney (3.58 ROR; CI 2.39–5.36), or mental health and musculoskeletaldiagnoses (2.38 ROR; CI 1.70–3.32).Conclusions: Overall, in multimorbidity, the chronology in which diseases develop is not associated with mortality, withfew exceptions. For almost all combinations of multimorbidity, diagnoses act synergistically in relation to mortality ifdiagnosed simultaneously.

U2 - 10.1177/26335565221122025

DO - 10.1177/26335565221122025

M3 - Journal article

C2 - 36032184

VL - 12

JO - J Multimorb Comorb .

JF - J Multimorb Comorb .

SN - 2633-5565

ER -