Journal article
Association of Cardiometabolic Multimorbidity With Mortality The Emerging Risk Factors Collaboration
JAMA : the journal of the American Medical Association, Vol.314(1), pp.52-60
07/07/2015
DOI: 10.1001/jama.2015.7008
PMCID: PMC4664176
PMID: 26151266
Abstract
IMPORTANCE The prevalence of cardiometabolic multimorbidity is increasing.
OBJECTIVE To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.
DESIGN, SETTING, AND PARTICIPANTS Age-and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.
EXPOSURES A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).
MAIN OUTCOMES AND MEASURES All-cause mortality and estimated reductions in life expectancy.
RESULTS In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.
CONCLUSIONS AND RELEVANCE Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.
Details
- Title: Subtitle
- Association of Cardiometabolic Multimorbidity With Mortality The Emerging Risk Factors Collaboration
- Creators
- Emanuele Di Angelantonio - University of CambridgeStephen Kaptoge - University of CambridgeDavid Wormser - University of CambridgePeter Willeit - University of CambridgeAdam S. Butterworth - University of CambridgeNarinder Bansal - University of CambridgeLinda M. O'Keeffe - University of CambridgePei Gao - University of CambridgeAngela M. Wood - University of CambridgeStephen Burgess - University of CambridgeDaniel F. Freitag - University of CambridgeLisa Pennells - University of CambridgeSanne A. Peters - Utrecht UniversityCarole L. Hart - University of GlasgowLise Lund Haheim - University of OsloRichard F. Gillum - Howard UniversityBorge G. Nordestgaard - University of CopenhagenBruce M. Psaty - University of WashingtonBu B. Yeap - The University of Western AustraliaMatthew W. Knuiman - The University of Western AustraliaPaul J. Nietert - Medical University of South CarolinaJussi Kauhanen - University of Eastern FinlandJukka T. Salonen - Analytical ServicesLewis H. Kuller - University of PittsburghLeon A. Simons - UNSW SydneyYvonne T. van der Schouw - Utrecht UniversityElizabeth Barrett-Connor - University of California San DiegoRandi Selmer - Norwegian Institute of Public HealthCarlos J. Crespo - Portland State UniversityBeatriz Rodriguez - University of Hawaii SystemW. M. Monique Verschuren - National Institute for Public Health and the EnvironmentVeikko Salomaa - National Institutes of HealthKurt Svardsudd - Uppsala UniversityPim van der Harst - University Medical Center GroningenCecilia Bjorkelund - University of GothenburgLars Wilhelmsen - University of GothenburgRobert B. Wallace - University of IowaHermann Brenner - German Cancer Research CenterPhilippe Amouyel - Institut PasteurElizabeth L. M. Barr - Baker Heart and Diabetes InstituteHiroyasu Iso - The University of OsakaAltan Onat - Istanbul UniversityMaurizio Trevisan - City College of New YorkRalph B. D'Agostino - Boston UniversityCyrus Cooper - University of OxfordMaryam Kavousi - Erasmus University RotterdamLennart Welin - Lidkoping Hosp, Lidkoping, SwedenRonan Roussel - InsermFrank B. Hu - Harvard UniversityShinichi SatoKarina W. Davidson - Columbia University Irving Medical CenterBarbara V. Howard - MedStar HealthMaarten Leening - Erasmus MC, Rotterdam, NetherlandsAnnika Rosengren - University of GothenburgMarcus Dorr - Universitätsmedizin GreifswaldDorly J. H. Deeg - Vrije Universiteit AmsterdamStefan Kiechl - Universität InnsbruckCoen D. A. Stehouwer - Maastricht University Medical CentreAulikki Nissinen - National Institutes of HealthSimona Giampaoli - Istituto Superiore di SanitàChiara Donfrancesco - Istituto Superiore di SanitàDaan Kromhout - Wageningen University & ResearchJackie F. Price - University of EdinburghAnnette Peters - Helhmolhtz Zentrum Munchen, German Res Ctr Environm Hlth, Inst Epidemiol 2, Neuherberg, GermanyTom W. Meade - University of LondonEdoardo Casiglia - University of PaduaDebbie A. Lawlor - University of BristolJohn Gallacher - Cardiff UniversityDorothea Nagel - Ludwig-Maximilians-Universität MünchenOscar H. Franco - Erasmus University RotterdamGerd Assmann - Assmann Stiftung Pravent, Munster, GermanyGilles R. Dagenais - Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, CanadaJ. Wouter Jukema - Leiden University Medical CenterJohan Sundstrom - Uppsala UniversityMark Woodward - The University of SydneyEric J. Brunner - University College LondonKay-Tee Khaw - University of CambridgeNicholas J. Wareham - Medical Research CouncilEric A. Whitsel - University of North Carolina at Chapel HillInger Njolstad - Univ Tromso, Tromso, NorwayBo Hedblad - Lund UniversitySylvia Wassertheil-Smoller - Albert Einstein College of MedicineGunnar Engstrom - Lund UniversityWayne D. Rosamond - University of North Carolina at Chapel HillElizabeth Selvin - Johns Hopkins UniversityNaveed Sattar - University of GlasgowSimon G. Thompson - University of CambridgeJohn Danesh - University of CambridgeEmerging Risk Factors Collaboration
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.314(1), pp.52-60
- DOI
- 10.1001/jama.2015.7008
- PMID
- 26151266
- PMCID
- PMC4664176
- NLM abbreviation
- JAMA
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Publisher
- Amer Medical Assoc
- Number of pages
- 9
- Grant note
- 268834 / European Research Council; European Research Council (ERC); European Commission HEALTH-F2-2012-279233 / European Commission; European Commission Joint Research Centre G0800270 / UK Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) British Heart Foundation Cambridge Cardiovascular Centre of Excellence UK National Institute for Health Research Cambridge Biomedical Research Centre; National Institute for Health Research (NIHR) P30ES005605 / NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Environmental Health Sciences (NIEHS) SP/09/002 / British Heart Foundation UL1TR001450 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) MC_U147585819 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC)
- Language
- English
- Date published
- 07/07/2015
- Academic Unit
- Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984363636502771
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