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Background <p>This study aimed to evaluate the association of three multimorbidity indicators with mortality risk among senior adults, and compare their predictive performance on mortality risk.</p> Methods <p>This prospective cohort study was conducted using data from the Yuexiu Ageing and Health Cohort, a dynamic cohort established since January 2016. Annual health examination is conducted for the senior adults aged ≥ 65 years in the jurisdiction. Following exclusions for insufficient follow-up (&lt; 6 months) and missing data, 162,958 participants were included. Mortality data up to 31 December 2023 were obtained from the National Death Registry of China. Information on eleven system diseases was extracted; three multimorbidity indicators (condition count, multimorbidity patterns, and multimorbidity index) were created. Hazard ratio (HR) with 95% confidence intervals (CI) was calculated using Cox proportional hazard model after adjustment for confounders. The C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used to compare the performance of multimorbidity indicators.</p> Results <p>Fifteen thousand five hundred twenty-five deaths were identified during a median of 4.79 years of follow-up. Compared with participants with no multimorbidity, those with multimorbidity had a 1.56-fold risk of all-cause mortality. Every one condition count increment was associated with a 17% increased risk of all-cause mortality. Three multimorbidity patterns labeled as Patterns I, II, and III were extracted and were significantly associated with the increased mortality risk, with HR being 1.97, 1.41, and 1.44 for Patterns I, II, and III respectively. Every 1-unit increment of multimorbidity index was associated with an 18% increased mortality risk. The multimorbidity index demonstrated a slightly better discriminative ability compared to the condition count (IDI: 0.003, NRI: 0.0046) and multimorbidity pattern (IDI: 0.007, NRI: 0.0055).</p> Conclusions <p>Three multimorbidity indicators were all associated with the increased mortality risk in community-dwelling older Chinese. The multimorbidity index is considered an optimal indicator for predicting mortality risk in community-dwelling older adults. The condition count is also suggested due to its simplicity and superior predictive performance.</p>

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Association of multimorbidity with mortality risk in Chinese senior adults: a population-based cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月7日

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  • Ming Gui,
  • Chuan-Jiang Chen,
  • Yufeng Chen,
  • Fan Wen,
  • Yongqi Wang,
  • Yiting Tan,
  • Zuyi Feng,
  • Jun Yun,
  • Zhelin Yang,
  • Dexing Zhang,
  • Xudong Liu,
  • Wenjing Zhao

摘要

Background

This study aimed to evaluate the association of three multimorbidity indicators with mortality risk among senior adults, and compare their predictive performance on mortality risk.

Methods

This prospective cohort study was conducted using data from the Yuexiu Ageing and Health Cohort, a dynamic cohort established since January 2016. Annual health examination is conducted for the senior adults aged ≥ 65 years in the jurisdiction. Following exclusions for insufficient follow-up (< 6 months) and missing data, 162,958 participants were included. Mortality data up to 31 December 2023 were obtained from the National Death Registry of China. Information on eleven system diseases was extracted; three multimorbidity indicators (condition count, multimorbidity patterns, and multimorbidity index) were created. Hazard ratio (HR) with 95% confidence intervals (CI) was calculated using Cox proportional hazard model after adjustment for confounders. The C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used to compare the performance of multimorbidity indicators.

Results

Fifteen thousand five hundred twenty-five deaths were identified during a median of 4.79 years of follow-up. Compared with participants with no multimorbidity, those with multimorbidity had a 1.56-fold risk of all-cause mortality. Every one condition count increment was associated with a 17% increased risk of all-cause mortality. Three multimorbidity patterns labeled as Patterns I, II, and III were extracted and were significantly associated with the increased mortality risk, with HR being 1.97, 1.41, and 1.44 for Patterns I, II, and III respectively. Every 1-unit increment of multimorbidity index was associated with an 18% increased mortality risk. The multimorbidity index demonstrated a slightly better discriminative ability compared to the condition count (IDI: 0.003, NRI: 0.0046) and multimorbidity pattern (IDI: 0.007, NRI: 0.0055).

Conclusions

Three multimorbidity indicators were all associated with the increased mortality risk in community-dwelling older Chinese. The multimorbidity index is considered an optimal indicator for predicting mortality risk in community-dwelling older adults. The condition count is also suggested due to its simplicity and superior predictive performance.