@article {13468, title = {Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study.}, journal = {Gerontology}, volume = {69}, year = {2023}, pages = {826-838}, abstract = {

INTRODUCTION: Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear.

METHODS: Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58\% female, 25\% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score.

RESULTS: Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95\% CI = 1.01-1.20), diabetes (IRR = 1.19, 95\% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95\% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95\% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95\% CI = 1.02-1.11), hypertension (IRR = 1.06, 95\% CI = 1.02-1.11), heart disease (IRR = 1.06, 95\% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95\% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men.

CONCLUSION: The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.

}, keywords = {Activities of Daily Living, Aged, Arthritis, C-reactive protein, Diabetes Mellitus, Disabled Persons, Female, Glycated Hemoglobin, Heart Diseases, Humans, Hypertension, Inflammation, Longitudinal Studies, Male, multimorbidity, Prospective Studies, Stroke}, issn = {1423-0003}, doi = {10.1159/000528648}, author = {Botoseneanu, Anda and Markwardt, Sheila and Qui{\~n}ones, Ana R} } @article {12247, title = {Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {e89-e97}, abstract = {

BACKGROUND: Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups.

METHOD: We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (>=2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases.

RESULTS: Overweight and obesity were more prevalent in non-Hispanic Black (82.3\%) and Hispanic (78.9\%) than non-Hispanic White (70.9 \%) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants.

CONCLUSIONS: Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.

}, keywords = {Body Mass Index, Disease accumulation, multimorbidity, Race/ethnicity}, issn = {1758-535X}, doi = {10.1093/gerona/glab116}, author = {Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Allore, Heather G and Jason T Newsom and David A Dorr and Ana R Qui{\~n}ones} } @article {12985, title = {Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)}, journal = {Innovation in Aging}, volume = {5}, year = {2022}, pages = {614}, abstract = {Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2\%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2\%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6\%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1\% in youngest age category [67-69] vs. 50.3\% for incident and 66.7\% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6\% CIND/dementia vs. 15.4\% for incident and 16.8\% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4\%) than in the incident (11.8\%) and no multimorbidity groups (13.4\%). Non-Hispanic White beneficiaries were more represented in the incident (83.5\%) than the prevalent (77.2\%) and the no multimorbidity (77.7\%). Hispanic beneficiaries were more represented in the no (8.9\%) than the prevalent (7.4\%) and incident multimorbidity groups (4.7\%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.}, keywords = {Medicare Beneficiaries, multimorbidity progression}, doi = {10.1093/geroni/igab046.2347}, author = {Qui{\~n}ones, Ana R and Markwardt, Sheila and Allore, Heather and Newsom, Jason and Nagel, Corey and Dorr, David and Botoseneanu, Anda} } @article {10.1093/geroni/igab046.2347, title = {Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)}, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {614}, abstract = {Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2\%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2\%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6\%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1\% in youngest age category [67-69] vs. 50.3\% for incident and 66.7\% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6\% CIND/dementia vs. 15.4\% for incident and 16.8\% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4\%) than in the incident (11.8\%) and no multimorbidity groups (13.4\%). Non-Hispanic White beneficiaries were more represented in the incident (83.5\%) than the prevalent (77.2\%) and the no multimorbidity (77.7\%). Hispanic beneficiaries were more represented in the no (8.9\%) than the prevalent (7.4\%) and incident multimorbidity groups (4.7\%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.}, issn = {2399-5300}, doi = {10.1093/geroni/igab046.2347}, author = {Qui{\~n}ones, Ana and Markwardt, Sheila and Allore, Heather and Newsom, Jason and Nagel, Corey and Dorr, David and Botoseneanu, Anda} } @article {8409, title = {Multimorbidity Combinations and Disability in Older Adults}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {71}, year = {2016}, pages = {823-830}, publisher = {71}, abstract = {Background: Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults.Methods: Prospective cohort study using longitudinal Health and Retirement Study data (2010 2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score 4).Results: We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index.Conclusions: Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.}, keywords = {Disabilities, Health Conditions and Status}, doi = {10.1093/gerona/glw035}, url = {http://biomedgerontology.oxfordjournals.org/content/71/6/823.abstract}, author = {A. R. Quinones and Markwardt, Sheila and Anda Botoseneanu} }