Journal
BMJ OPEN
Volume 11, Issue 8, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2020-046749
Keywords
social medicine; epidemiology; geriatric medicine; multimorbidity
Categories
Funding
- Japan Society for the Promotion of Science, KAKENHI [JP15H01972]
- Health Labour Sciences Research Grant [H28-Choju-Ippan002]
- Japan Agency for Medical Research and Development [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP20dk0110034, JP20dk0110037]
- Open Innovation Platform with Enterprises, Research Institute and Academia (OPERA) from the Japan Science and Technology (JST) [JPMJOP1831]
- Innovative Research Program on Suicide Countermeasures [1-4]
- Sasakawa Sports Foundation
- Japan Health Promotion & Fitness Foundation
- Chiba Foundation for Health Promotion & Disease Prevention
- 8020 Research Grant for fiscal 2019 from the 8020 Promotion Foundation [19-2-06]
- Niimi Universit [1915010]
- Meiji Yasuda Life Foundation of Health and Welfare
- Research Funding for Longevity Sciences from National Center for Geriatrics and Gerontology [29-42, 30-22]
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This study compared the prediction of mortality among older Japanese adults between complex multimorbidity (CMM) and conventional multimorbidity (MM), finding that both CMM and MM similarly predict mortality in older adults. Further replication studies with larger samples are needed to confirm these findings.
Objectives There are limitations to defining multimorbidity (MM) based on a simple count of diseases. To address these limitations, the concept of complex MM (CMM) focuses on how many body systems are affected in a single patient, rather than counting comorbid conditions. This study compared the prediction of mortality among older Japanese adults between CMM and conventional MM. Design A population-based prospective cohort study. Setting The Japan Gerontological Evaluation Study, a nationwide longitudinal cohort study, which ran from 2010 to 2016. Participants Functionally independent individuals who were older than 65 and had complete illness data at the time of baseline survey were eligible. Outcomes measure CMM was defined as the coexistence of 3 or more body system disorders at baseline. We calculated the propensity for each individual to develop CMM based on a wide array of characteristics, including socioeconomic status and health behaviours. Individuals with and without CMM were then matched on their propensity scores before we estimated overall survival using a log-rank test. Results Our 6-year follow-up included 38 889 older adults: 20 233 (52.0%) and 7565 (19.5%) adults with MM and CMM, respectively. In the MM-matched cohort (n=15 666 pairs), the presence of MM was significantly associated with increased mortality (HR 1.07; 95% CI 1.01 to 1.14; p=0.02 by the log-rank test). A similar mortality association was found in the CMM-matched cohort (n=7524 pairs, HR, 1.07; 95% CI 0.99 to 1.16; p=0.08 by the log-rank test). Conclusion This is the first study to report the association between CMM and mortality among older adults in Japan. MM and CMM predict mortality in older adults to a similar degree. This finding needs to be replicated with more precision in larger samples.
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