Quantifying interdependence in multiple patient-centered outcomes is important for understanding health declines among older adults.
Methods
Medicare-linked National Health and Aging Trends Study data (2011–2015) were used to estimate a joint longitudinal logistic regression model of disability in activities of daily living (ADL), fair/poor self-rated health (SRH), and mortality. We calculated personalized concurrent risk (PCR) and typical concurrent risk (TCR) using regression coefficients.
Results
For fair/poor SRH, highest odds were associated with COPD. For mortality, highest odds were associated with dementia, hip fracture, and kidney disease. Dementia and hip fracture were associated with highest odds of ADL disability. Hispanic respondents had highest odds of ADL disability. Hispanic and NH Black respondents had higher odds of fair/poor SRH, ADL disability, and mortality. PCRs/TCRs demonstrated wide variability for respondents with similar sociodemographic-multimorbidity profiles.
Discussion
These findings highlight the variability of personalized risk in examining interdependent outcomes among older adults.
AgogoG. O.MurphyT. E.McAvayG. J.AlloreH. G. (2019). Joint modeling of concurrent binary outcomes in a longitudinal observational study using inverse probability of treatment weighting for treatment effect estimation. Annals of Epidemiology, 35, 53–58. https://doi.org/10.1016/j.annepidem.2019.04.008
2.
AngelR. J.AngelJ. L.HillT. D. (2014). Longer lives, sicker lives? Increased longevity and extended disability among Mexican-origin elders. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(4), 639–649. https://doi.org/10.1093/geronb/gbu158
3.
Calderón‐LarrañagaA.VetranoD. L.FerrucciL.MercerS. W.MarengoniA.OnderG.EriksdotterM.FratiglioniL. (2019). Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways. Journal of Internal Medicine, 285(3), 255–271. https://doi.org/10.1111/joim.12843
4.
CaoY.AlloreH.GutmanR.Vander WykB.JørgensenT. S. H. (2022). Risk factors of skilled nursing facility admissions and the interrelation with hospitalization and amount of informal caregiving received. Medical Care, 60(4), 294–301. https://doi.org/10.1097/MLR.0000000000001697
CaskieG. I.SuttonM. C.MargrettJ. A. (2010). The relation of hypertension to changes in ADL/IADL limitations of Mexican american older adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65B(3), 296–305, https://doi.org/10.1093/geronb/gbq001
CrimminsE. M.KimJ. K.Sole-AuroA. (2011). Gender differences in health: Results from SHARE, ELSA and HRS. The European Journal of Public Health, 21(1), 81–91, https://doi.org/10.1093/eurpub/ckq022
9.
DekhtyarS.VetranoD. L.MarengoniA.WangH.-X.PanK.-Y.FratiglioniL.Calderón-LarrañagaA. (2019). Association between speed of multimorbidity accumulation in old age and life experiences: A cohort study. American Journal of Epidemiology, 188(9), 1627–1636, kwz101. https://doi.org/10.1093/aje/kwz101
10.
Diaz-RamirezL.JingB.CovinskyK.BoscardinW. (2020). Mixed-effects models and complex survey data with the GLIMMIX procedure. SAS Global Forum, Paper(4937–2020).
11.
DugravotA.FayosseA.DumurgierJ.BouillonK.RayanaT. B.SchnitzlerA.KivimakiM.SabiaS.Singh-ManouxA. (2020). Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: A 24-year follow-up of the whitehall II cohort study. The Lancet Public Health, 5(1), Article e42–e50. https://doi.org/10.1016/S2468-2667(19)30226-9
12.
FreedmanV. A.KasperJ. D. (2019). Cohort profile: The national health and aging trends study (NHATS). International Journal of Epidemiology, 48(4), 1044–1045g. https://doi.org/10.1093/ije/dyz109
13.
GoodmanR. A.PosnerS.HuangE. S.ParekhA. K.KohH. K. (2013). Defining and measuring chronic conditions: Imperatives for research, policy, program, and practice. Preventing Chronic Disease, 10, E66. https://doi.org/10.5888/pcd10.120239
14.
GorinaY.GouldingM. R.HoyertD. L.LentznerH. R. (2005). Trends in causes of death among older persons in the United States(cdc:6867). https://stacks.cdc.gov/view/cdc/6867
15.
HalfonN.HochsteinM. (2002). Life course health development: An integrated framework for developing health, policy, and research. The Milbank Quarterly, 80(3), 433–479. https://doi.org/10.1111/1468-0009.00019
16.
HouseJ. S.LantzP. M.HerdP. (2005). Continuity and change in the social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans’ Changing Lives Study). Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(Special_Issue_2), S15–S26. https://doi.org/10.1093/geronb/60.Special_Issue_2.S15
17.
JemalA.WardE.HaoY.ThunM. (2005). Trends in the leading causes of death in the United States, 1970-2002. JAMA, 294(10), 1255–1259. https://doi.org/10.1001/jama.294.10.1255
18.
KarlamanglaA.TinettiM.GuralnikJ.StudenskiS.WetleT.ReubenD. (2007). Comorbidity in older adults: Nosology of impairment, diseases, and conditions. The journals of gerontology. Series A, Biological sciences and medical sciences, 62(3), 296–300. https://doi.org/10.1093/gerona/62.3.296
19.
KeeneyT.JetteA. M. (2019). Individual and environmental determinants of late-life community disability for persons aging with cardiovascular disease. American Journal of Physical Medicine & Rehabilitation, 98(1), 30–34. https://doi.org/10.1097/PHM.0000000000001011
20.
LiangJ.BennettJ. M.ShawB. A.QuiñonesA. R.YeW.XuX.OfstedalM. B. (2008). Gender differences in functional status in middle and older age: Are there any age variations?Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 63(5), S282-S292, https://doi.org/10.1093/geronb/63.5.s282
21.
LiangJ.ShawB. A.BennettJ. M.KrauseN.KobayashiE.FukayaT.SugiharaY. (2007). Intertwining courses of functional status and subjective health among older Japanese. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62(5), S340–S348. https://doi.org/10.1093/geronb/62.5.S340
22.
MarventanoS.AyalaA.GonzalezN.Rodríguez–BlázquezC.Garcia-GutierrezS.ForjazM. J.Spanish Research Group of Quality of Life and Ageing (2014). Multimorbidity and functional status in community-dwelling older adults. European Journal of Internal Medicine, 25(7), 610–616. https://doi.org/10.1016/j.ejim.2014.06.018
23.
McAvayG. J.MurphyT. E.AgogoG. O.AlloreH. (2019). CRcoder: An interactive web application and SAS macro to support personalized clinical decisions. The Permanente Journal, 24(1), 19.078, https://doi.org/10.7812/TPP/19.078
24.
McAvayG. J.Vander WykB.AlloreH. (2021). Individual heterogeneity in the probability of hospitalization, skilled nursing facility admission, and mortality. The journals of gerontology. Series A, Biological sciences and medical sciences, 76(9), 1668–1677. https://doi.org/10.1093/gerona/glaa314
25.
MurphyT. E.McAvayG. J.AgogoG. O.AlloreH. G. (2019). Personalized and typical concurrent risk of limitations in social activity and mobility in older persons with multiple chronic conditions and polypharmacy. Annals of Epidemiology, 37, 24–30. https://doi.org/10.1016/j.annepidem.2019.08.001
26.
MurtaghK. N.HubertH. B. (2004). Gender differences in physical disability among an elderly cohort. American Journal of Public Health, 94(8), 1406–1411, https://doi.org/10.2105/ajph.94.8.1406
27.
OksuzyanA.JuelK.VaupelJ. W.ChristensenK. (2008). Men: Good health and high mortality. Sex differences in health and aging. Aging Clinical and Experimental Research, 20(2), 91–102. https://doi.org/10.1007/BF03324754
28.
PapadimitriouN.TsilidisK. K.OrfanosP.BenetouV.NtzaniE. E.SoerjomataramI.Künn-NelenA.Pettersson-KymmerU.ErikssonS.BrennerH.SchöttkerB.SaumK.-U.HolleczekB.GrodsteinF. D.FeskanichD.OrsiniN.WolkA.BellaviaA.WilsgaardT.TrichopoulouA. (2017). Burden of hip fracture using disability-adjusted life-years: A pooled analysis of prospective cohorts in the chances consortium. The Lancet Public Health, 2(5), Article e239–e246. https://doi.org/10.1016/S2468-2667(17)30046-4
29.
PerruccioA. V.KatzJ. N.LosinaE. (2012). Health burden in chronic disease: Multimorbidity is associated with self-rated health more than medical comorbidity alone. Journal of Clinical Epidemiology, 65(1), 100–106, https://doi.org/10.1016/j.jclinepi.2011.04.013
30.
QuiñonesA. R.MarkwardtS.BotoseneanuA. (2016). Multimorbidity combinations and disability in older adults. The journals of gerontology. Series A, Biological sciences and medical sciences, 71(6), 823–830. https://doi.org/10.1093/gerona/glw035
31.
QuiñonesA. R.NagelC. L.BotoseneanuA.NewsomJ. T.DorrD. A.KayeJ.ThielkeS. M.AlloreH. G. (2022). Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults. Journal of Multimorbidity and Comorbidity, 12, 26335565221143012. https://doi.org/10.1177/26335565221143012
32.
Rivera-AlmarazA.Manrique-EspinozaB.Ávila-FunesJ. A.ChatterjiS.NaidooN.KowalP.Salinas-RodríguezA. (2018). Disability, quality of life and all-cause mortality in older Mexican adults: Association with multimorbidity and frailty. BMC Geriatrics, 18(1), 236. https://doi.org/10.1186/s12877-018-0928-7
33.
RogersR. G.EverettB. G.OngeJ. M. S.KruegerP. M. (2010). Social, behavioral, and biological factors, and sex differences in mortality. Demography, 47(3), 555–578. https://doi.org/10.1353/dem.0.0119
Spencer-BonillaG.QuiñonesA. R.MontoriV. M.International Minimally Disruptive Medicine Workgroup. (2017). Assessing the burden of treatment. Journal of General Internal Medicine, 32(10), 1141–1145. https://doi.org/10.1007/s11606-017-4117-8
36.
StenholmS.WesterlundH.HeadJ.HydeM.KawachiI.PenttiJ.KivimäkiM.VahteraJ. (2015). Comorbidity and functional trajectories from midlife to old age: The health and retirement study. The journals of gerontology. Series A, Biological sciences and medical sciences, 70(3), 332–338. https://doi.org/10.1093/gerona/glu113
37.
US Department of Health and Human Services. (2010). Multiple chronic conditions—A strategic framework: Optimum health and quality of life for individuals with multiple chronic conditions. USDHHS.
38.
WilladsenT. G.BebeA.Køster-RasmussenR.JarbølD. E.GuassoraA. D.WaldorffF. B.ReventlowS.OlivariusN. d. F. (2016). The role of diseases, risk factors and symptoms in the definition of multimorbidity – a systematic review. Scandinavian Journal of Primary Health Care, 34(2), 112–121. https://doi.org/10.3109/02813432.2016.1153242
39.
XuX.LiangJ.BennettJ. M.BotoseneanuA.AlloreH. G. (2015). Socioeconomic stratification and multidimensional health trajectories: Evidence of convergence in later old age. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(4), 661–671, https://doi.org/10.1093/geronb/gbu095
40.
YoungY.FrickK. D.PhelanE. A. (2009). Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging. Journal of the American Medical Directors Association, 10(2), 87–92. https://doi.org/10.1016/j.jamda.2008.11.003
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