Prevalence of somatic-mental multimorbidity and its prospective association with disability among older adults in China

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)

BACKGROUND

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

METHODS

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

RESULTS

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

CONCLUSIONS

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Longitudinal trajectories of disability among Chinese adults: the role of cardiometabolic multimorbidity

BACKGROUND

Cardiometabolic multimorbidity (CM) has been found to be associated with higher mortality and functional limitations. However, few studies have investigated the longitudinal association between CM and disability in the Chinese population and whether these associations vary by smoking status.

METHODS

The study included 16,754 participants from four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) (mean age: 59, female: 51%). CM was assesed at baseline and defined as having two or more of diabetes, stroke, or heart disease. Disability was repeatedly measured by summing the number of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL) during the 7-year follow-up. Linear mixed-effects model was used to determine the association of CM and trajectories of disability and to assess the modification effect of smoking status in these associations.

RESULTS

Participants with CM at baseline had a faster progression of disability compared to those without CM (CM: β = 0.13, 95% CI: 0.05 to 0.21). Current smokers with CM developed disability faster than their counterparts (Pinteraction for smoking=0.011). In addition, there was a significant association between CM and the annual change of disability in current smokers (β = 0.34, 95% CI: 0.17 to 0.50) while no such association was observed in current non-smokers (β = 0.08, 95% CI: -0.02 to 0.17).

CONCLUSION

CM was associated with more a rapid disability progression. Notably, being current smokers may amplify the adverse effects of CM on disability progression.

Gender-specific association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms

BACKGROUND

In the era of rapid aging with a rising prevalence of multimorbidity, complex interactions between physical and psychological conditions have challenged the health care system. However, little is known about the association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms, especially in developed countries.

METHODS

This population-based cohort study used data from the Health and Retirement Study. A total of 22,335 middle-aged and older adults participated in the 2014 (T1), 2016 (T2), and 2018 (T3) waves of the cohort were included. The accumulation of chronic conditions and disability were defined as the number of chronic diseases and the five activities of daily living. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. A longitudinal mediation model with a cross-lagged panel model was run. As robust check, the models were applied with a longer follow-up period (from 2012 to 2018). Additionally, results were estimated in China.

RESULTS

Bidirectional associations have been found among the accumulation of chronic conditions, disability, and depressive symptoms, especially between disability and depression. Disability (T2) mediated 11.11 % and 16.87 % of the association between the accumulation of chronic conditions (T1) and depression (T3) for men and women in the United States. The results were consistent in robust analysis.

CONCLUSIONS

This study found that men and women routinely experienced disability and depressive symptoms because of the accumulation of chronic conditions. In terms of depressive symptoms, women were more sensitive to the accumulation of chronic conditions through disability.

Association between residential proximity to major roadways and chronic multimorbidity among Chinese older adults: a nationwide cross-sectional study

BACKGROUND

Multiple negative health outcomes were linked to residential proximity to major roadways. Nevertheless, there is limited knowledge regarding the association between residential proximity to major roadways and chronic multimorbidity.

METHODS

We used data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, which included 12,214 individuals aged ≥ 60. We derived the residential proximity to major roadways from self-reported data, defining chronic multimorbidity as the presence of two or more concurrent chronic diseases. A binary logistic regression model was utilized to investigate the association between residential proximity to major roadways and chronic multimorbidity. The model accounted for some demographic features, socioeconomic conditions, social participation, and health conditions. Subsequently, we conducted subgroup analyses to examine potential interaction effects.

RESULTS

Residential proximity to major roadways was associated with chronic multimorbidity, even after adjusting for confounding factors. Compared with those living > 300 m from major roadways, the OR for those living 201-300 m, 101-200 m, 50-100 m, and < 50 m were increased. When subgroup analyses were conducted using a cutoff point of 200 m, the risk of chronic multimorbidity associated with residential proximity to major roadways was stronger in participants with education levels > 6 years (P = 0.017).

CONCLUSION

Our findings provide important implications for improving residential area siting, transportation policies, and environmental regulations to reduce the risk of chronic multimorbidity caused by traffic-related exposure.

Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions

The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.

Association between activities of daily living and depressive symptoms among older adults in China: evidence from the CHARLS

Objective

The limitation of activities of daily living (ADL) affects the mental health of older adults. We distinguished activities of daily living into basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and aimed to explore the relationship between the two limitations and depressive symptoms among Chinese older adults by using nationally representative cross-sectional data.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS, wave 4) were used, and 9,789 older adults aged 60 years and above were screened. The 10-item Center for Epidemiologic Studies Depression (CES-D-10) scale was used to measure the depressive symptoms of older adults, and a 12-item scale for ADL was used to estimate functional limitations. Generalized linear mixed-effect models were employed to examine the relationship between BADL/IADL and depressive symptoms among older adults.

Results

The prevalence of high-risk depression among older adults was 43.5%, and the rates of limitation in BADL and IADL were 19.02 and 25.29%, respectively. The prevalence of high-risk depression significantly differed among subgroups of smoking, drinking, chronic diseases, duration of sleep, having social activities or not, and the type of medical insurance. Older adults with limited BADL or IADL were at a higher risk of depression than those without limitations of BADL or IADL; BADL (OR-adjusted = 2.71; 95% CI: 2.40-3.06) and IADL (OR-adjusted = 2.68; 95% CI: 2.41-2.98) had various influences on the risk of depression in older adults.

Conclusion

ADL was a related factor in the risk of depression among older adults in China. BADL and IADL had different effects on the risk of depression, suggesting that older adults with physical function limitations might be more likely to suffer from depression.

Effects of family multi-generational relationship on multimorbidity and healthy life expectancy for second generations: insight from the China Health and Retirement Longitudinal Study

OBJECTIVE

In the context of aging, Chinese families consisting of more than three generations (grandparents, parents, children) are the norm. The second generation (parents) and other family members may establish a downward (contact only with children) or two-way multi-generational relationship (contact with children and grandparents). These multi-generational relationships may have the potential effect on multimorbidity burden and healthy life expectancy in the second generation, but less is known about the direction and intensity of this effect. This study aims to explore this potential effect.

METHODS

We obtained longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2018, which included 6,768 people. Cox proportional hazards regression was used to assess the association between multi-generational relationships and the number of multimorbidity. The Markov multi-state transition model was used to analyze the relationship between multi-generational relationships and the severity of multimorbidity. The multistate life table was used to calculate healthy life expectancy for different multi-generational relationships.

RESULTS

The risk of multimorbidity in two-way multi-generational relationship was 0.830 (95% CIs: 0.715, 0.963) times higher than that in downward multi-generational relationship. For mild multimorbidity burden, downward and two-way multi-generational relationship may prevent aggravation of burden. For severe multimorbidity burden, two-way multi-generational relationship may aggravate the burden. Compared with two-way multi-generational relationship, the second generations with downward multi-generational relationship has a higher healthy life expectancy at all ages.

CONCLUSION

In Chinese families with more than three generations, the second generations with severe multimorbidity burden may aggravate the condition by providing support to elderly grandparents, and the support provided by offspring to the second generations plays a vital positive role in improving the quality of life and narrowing the gap between healthy life expectancy and life expectancy.

The association between healthy aging index and trajectories of disability: a population-based cohort study

BACKGROUND

Healthy aging index (HAI) could predict adverse health consequences including mortality and disability independent of age and comorbidity. We investigated the role of HAI on trajectories of disability throughout later life based on a nationally representative sample.

METHODS

We examined 1733 participants aged over 60 years from the China Health and Retirement Longitudinal Study (CHARLS) followed for 7 years/4 waves repeatedly. Systolic blood pressure [SBP], cognitive function, cystatin C, peak expiratory flow [PEF], and fasting glucose were categorized using tertile or clinical reference range, and scored as 0 (healthiest), 1 (less healthy) and 2 (least healthy) respectively to further generate HAI summary scores (range 0-10). Disability was defined as the sum of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL). We used linear mixed-effects model to study the association between HAI and trajectories of disability.

RESULTS

A total of 10.5% of participants represented in the healthiest group and 22.5% ended up as the least healthy. After adjusting for all potential confounders, disability progression was significantly faster (β = 0.27, 95% CI 0.11-0.42) in the least healthy group when comparing with the healthiest.

CONCLUSION

Our findings suggest that HAI is associated with disability progression among adults aged over 60 years old. It might be beneficial for future interventions to specifically target older adults with high HAI scores as a means of reducing disability.

Developing and validating a Chinese multimorbidity-weighted index for middle-aged and older community-dwelling individuals

OBJECTIVE

To develop and validate an index to quantify the multimorbidity burden in Chinese middle-aged and older community-dwelling individuals.

METHODS

We included 20,035 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (CHARLS) and 19,297 individuals aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Health outcomes of physical functioning (PF), basic and instrumental activities of daily living (ADL and IADL) and mortality were obtained. Based on self-reported disease status, we calculated five commonly used western multimorbidity indexes for CHARLS baseline participants. The one that predicted the health outcomes the best was selected and then modified through a linear mixed model using the repeated individual data in CHARLS. The performance of the modified index was internally and externally evaluated with CHARLS and CLHLS data.

RESULTS

The multimorbidity-weighted index (MWI) performed the best among the five indexes. In the modified Chinese multimorbidity-weighted index (CMWI), the weights of the diseases varied greatly (range 0.2-5.1). The top three diseases with the highest impact were stroke, memory-related diseases and cancer, corresponding to weights of 5.1, 4.3 and 3.4, respectively. Compared with the MWI, the CMWI showed better model fits for PF and IADL with larger R2 and smaller Akaike information criterion, and comparable prediction performances for ADL, IADL and mortality (e.g. the same predictive accuracy of 0.80 for ADL disability).

CONCLUSION

The CMWI is an adequate index to quantify the multimorbidity burden for Chinese middle-aged and older community-dwelling individuals. It can be directly computed via disease status examined in regular community health check-ups to facilitate health management.

Longitudinal Follow-Up Studies on the Bidirectional Association between ADL/IADL Disability and Multimorbidity: Results from Two National Sample Cohorts of Middle-Aged and Elderly Adults

BACKGROUND AND OBJECTIVES

Few studies have investigated the bidirectional relationship between disability and multimorbidity, which are common conditions among the older population. Based on the data from the China Health and Retirement Longitudinal Study (CHARLS) and the Survey of Health, Ageing and Retirement in Europe (SHARE), we aimed to investigate the bidirectional relationship between disability and multimorbidity.

METHODS

The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure disability. In stage I, we used multinomial logistic regression to assess the longitudinal association between ADL/IADL disability and follow-up multimorbidity. In stage II, binary logistic regression was used to evaluate the multimorbidity effect on future disability.

RESULTS

Compared with those free of disability, people with disability possessed ascending risks for developing an increasing number of diseases. For ADL disability, the odds ratio (OR) (95% confidence interval [CI]) values of developing ≥4 diseases were 4.10 (2.58, 6.51) and 6.59 (4.54, 9.56) in CHARLS and SHARE; for IADL disability, the OR (95% CI) values were 2.55 (1.69, 3.84) and 4.85 (3.51, 6.70) in CHARLS and SHARE. Meanwhile, the number of diseases at baseline was associated, in a dose-response manner, with future disability. Compared with those without chronic diseases, participants carrying ≥4 diseases had OR (95% CI) values of 4.82 (3.73, 6.21)/4.66 (3.65, 5.95) in CHARLS and 3.19 (2.59, 3.94)/3.28 (2.71, 3.98) in SHARE for developing ADL/IADL disability.

CONCLUSION

The consistent findings across 2 national longitudinal studies supported a strong bidirectional association between disability and multimorbidity among middle-aged and elderly adults. Thus, tailored interventions should be taken to prevent the mutual development of disability and multimorbidity.

Increased quality of life in patients with stroke during the COVID-19 pandemic: a matched-pair study

Patients with stroke are likely to experience impaired health-related quality of life (QOL), especially during the COVID-19 pandemic. This study aimed to evaluate the QOL of Chinese patients with stroke during the pandemic and explore the associated variables. A matched-pair, multicenter survey was conducted before and during the COVID-19 pandemic. Questionnaires including the 36-item Short-Form Health Survey (SF-36), the Activities of Daily Living (ADL) scale, and the Questionnaire about the Process of Recovery (QPR) were used. A total of 172 matched pairs (344 patients) were recruited in this study. Hierarchical multiple regression analysis was performed to analyze variables associated with QOL. Physical and mental component scores (PCS and MCS) were higher among the stroke patients during the pandemic (44.20 ± 18.92 and 54.24 ± 19.08) than before the pandemic (37.98 ± 14.52 and 43.50 ± 20.94). Pandemic stress, demographic and clinical characteristics were negative variables associated with PCS and MCS. QPR was positively associated with PCS and MCS. The QOL of Chinese stroke patients was higher during than before the COVID-19 pandemic. Pandemic stress aggravated stroke patients’ QOL, while personal recovery could alleviate the detrimental effect of pandemic stress on QOL for stroke patients.