Racial and Ethnic Differences in Multimorbidity Changes Over Time

医学 民族 共病 疾病 队列 糖尿病 前瞻性队列研究 潜在类模型 优势比 老年学 冲程(发动机) 队列研究 人口学 内科学 内分泌学 社会学 人类学 工程类 统计 机械工程 数学
作者
Ana Quiñones,Jason T. Newsom,Miriam R. Elman,Sheila Markwardt,Corey Nagel,David A. Dorr,Heather Allore,Anda Botoseneanu
出处
期刊:Medical Care [Ovid Technologies (Wolters Kluwer)]
卷期号:59 (5): 402-409 被引量:17
标识
DOI:10.1097/mlr.0000000000001527
摘要

Our understanding of how multimorbidity progresses and changes is nascent.Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.
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