Impact of medical and psychiatric multi-morbidity on mortality in diabetes: emerging evidence

BMC Endocrine Disorders

Leonard E Egede¹  Kelly J Hunt²  Yumin Zhao¹  Mulugeta Gebregziabher²  Cheryl P Lynch¹ 

[1] Department of General Internal Medicine & Geriatrics, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC, USA;Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA

关键词: Veterans;    Elderly;    Mortality;    Comorbidity;    Diabetes;   

Others  :  1085091
DOI  :  10.1186/1472-6823-14-68

 received in 2014-03-21, accepted in 2014-08-04,  发布年份 2014

【 摘 要 】

Background

Multi-morbidity, or the presence of multiple chronic diseases, is a major problem in clinical care and is associated with worse outcomes. Additionally, the presence of mental health conditions, such as depression, anxiety, etc., has further negative impact on clinical outcomes. However, most health systems are generally configured for management of individual diseases instead of multi-morbidity. The study examined the prevalence and differential impact of medical and psychiatric multi-morbidity on risk of death in adults with diabetes.

Methods

A national cohort of 625,903 veterans with type 2 diabetes was created by linking multiple patient and administrative files from 2002 through 2006. The main outcome was time to death. Primary independent variables were numbers of medical and psychiatric comorbidities over the study period. Covariates included age, gender, race/ethnicity, marital status, area of residence, service connection, and geographic region. Cox regression was used to model the association between time to death and multi-morbidity adjusting for relevant covariates.

Results

Hypertension (78%) and depression (13%) were the most prevalent medical and psychiatric comorbidities, respectively; 23% had 3+ medical comorbidities, 3% had 2+ psychiatric comorbidities and 22% died. Among medical comorbidities, mortality risk was highest in those with congestive heart failure (hazard ratio, HR = 1.92; 95% CI 1.89-1.95), Lung disease (HR = 1.42; 95% CI 1.40-1.44) and cerebrovascular disease (HR = 1.39; 95% CI 1.37-1.40). Among psychiatric comorbidities, mortality risk was highest in those with substance abuse (HR = 1.50; 95% CI 1.46-1.54), psychoses (HR = 1.16; 95% CI 1.14-1.19) and depression (HR = 1.05; 95% CI 1.03-1.07). There was an interaction between medical and psychiatric comorbidity (p = 0.003) so stratified analyses were performed. HRs for effect of 3+ medical comorbidity (2.63, 2.66, 2.15) remained high across levels of psychiatric comorbidities (0, 1, 2+), respectively. HRs for effect of 2+ psychiatric comorbidity (1.69, 1.63, 1.42, 1.38) declined across levels of medical comorbidity (0, 1, 2, 3+), respectively.

Conclusions

Medical and psychiatric multi-morbidity are significant predictors of mortality among older adults (veterans) with type 2 diabetes with a graded response as multimorbidity increases.

【 授权许可】

   
2014 Lynch et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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