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Multimorbidity patterns and premature mortality in a prospective cohort: effect modifications by socioeconomic status and healthy lifestyles

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机构: [1]Department of Epidemiology and Health Statistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China. [2]Section of Epidemiology and Population Health, Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & Children's Medicine Key Laboratory of Sichuan Province, West China Second University Hospital, Sichuan University, 3-17 Renmin Nanlu, Chengdu, 610041, Sichuan, China. [3]Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China. [4]Center for Immunological and Metabolic Diseases, MED-X Institute, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China. [5]Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. [6]Center for Obesity and Metabolic Health & Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China. [7]Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China. [8]The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia. [9]Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. [10]Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China. [11]West China Hospital, West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China.
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关键词: Multimorbidity Socioeconomic status Healthy lifestyles Mortality Cohort study

摘要:
Few studies have explored the impact of multimorbidity patterns on premature mortality. This study aimed to assess the associations between multimorbidity patterns and long-term mortality and whether the associations were modified by socioeconomic status (SES) and healthy lifestyles.Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 in the US. The latent class analysis was used to establish multimorbidity patterns based on 11 chronic conditions. Mortality outcomes were ascertained by linking with the public-use mortality data from the National Death Index through December 31, 2019. Accelerated failure time models were used to estimate time ratios (TRs) and corresponding 95% confidence intervals (CIs) for the associations between multimorbidity patterns and all-cause and CVD mortality and to exmine the extent to which SES and healthy lifestyles modified those associations.In our study, six multimorbidity patterns were identified, including "relatively healthy", "hypercholesterolemia", "metabolic", "arthritis-respiratory", "CKD-vascular-cancer", and "severely impaired" classes. Compared with the "relatively healthy" class, TRs for all-cause and CVD mortality progressively decreased across the multimorbidity classes, with the "severely impaired" class showing the shortest survival time (TR, 0.53; 95% CI: 0.48, 0.58 for all-cause mortality; 0.42; 0.35, 0.50 for CVD mortality). A significant interaction was noted between SES and multimorbidity patterns for survival time, with a stronger positive association in individuals with low SES. Adherence to healthy lifestyles was related to longer survival time across all multimorbidity patterns, especially in those with relatively less severe multimorbidity.Multiple multimorbidity patterns were identified and associated with mortality. Lower SES was associated with higherexcess multimorbidity-associated mortality, while adopting healthy lifestyles contributed to longer survival regardless of multimorbidity patterns. Efforts should be mobilized to reduce SES gaps and promote healthy lifestyles to alleviate the health burden of multimorbidity.© 2025. The Author(s).

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出版当年[2025]版:
大类 | 2 区 医学
小类 | 2 区 公共卫生、环境卫生与职业卫生
最新[2025]版:
大类 | 2 区 医学
小类 | 2 区 公共卫生、环境卫生与职业卫生
第一作者:
第一作者机构: [1]Department of Epidemiology and Health Statistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China. [2]Section of Epidemiology and Population Health, Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & Children's Medicine Key Laboratory of Sichuan Province, West China Second University Hospital, Sichuan University, 3-17 Renmin Nanlu, Chengdu, 610041, Sichuan, China.
通讯作者:
通讯机构: [2]Section of Epidemiology and Population Health, Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & Children's Medicine Key Laboratory of Sichuan Province, West China Second University Hospital, Sichuan University, 3-17 Renmin Nanlu, Chengdu, 610041, Sichuan, China. [10]Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China. [11]West China Hospital, West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China.
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