Longer Multimorbidity Intervals Are Associated With Lower Mortality in Diabetes: A Whole-Population Nested Case-Control Study

Wenlong Liu, Yuqi Hu, Cuiling Wei, Lingyue Zhou, Boyan Liu, Qi Sun, Rachel Yui Ki Chu, Eric Yuk Fai Wan, Ian Chi Kei Wong, Francisco Tsz Tsun Lai*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background:: Approximately two-thirds of diabetes patients develop multimorbidity, which is associated with increased mortality. We aimed to examine whether, and to what extent, the time interval between pre-existing diabetes and a second chronic disease may be associated with the risk of mortality. Methods:: We carried out a territory-wide nested case-control study using incidence density sampling, utilizing electronic health records from Hong Kong’s public healthcare facilities. Among 158 732 patients first diagnosed with diabetes from January 1, 2010 to December 31, 2012 and subsequently developed multimorbidity as of December 31, 2019, we extracted those who died before December 31, 2019 as case participants. For each participant, we randomly matched with up to 4 people of the same sex, multimorbidity age, and second chronic condition who had not died after going through the same survival period of the case participant. Multimorbidity interval was included as a continuous variable. We used conditional logistic regression to estimate adjusted odds ratios (aOR) for mortality. Results:: In total, 3508 case participants were matched with 14 032 control participants. Conditional logistic regression showed there were 19%-reduced odds of mortality following the extension of multimorbidity interval by 1 year. Similar associations were observed in men, women, people aged 64 years or younger, and older people aged 65 years or more. Conclusions:: Delayed multimorbidity among patients living with diabetes may be related to a lower risk of mortality. This study suggests that we should focus on mitigating and lowering the risk of multimorbidity in clinical management of diabetes to reduce further complication and mortality.
Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalJournal of Primary Care & Community Health
Volume15
Early online date23 Oct 2024
DOIs
Publication statusPublished - 23 Oct 2024

Bibliographical note

Copyright © The Author(s) 2024. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Data Access Statement

Data will not be available for others as the data custodians have not given permission. The CDARS dataset is managed by the
Hong Kong Hospital Authority (HA). HA Data Sharing Portal provides various access channels to HA data for research purposes.
The related information can be found online (https://www3.ha.org.hk/data).

Keywords

  • population health
  • diabetes
  • epidemiology
  • chronic disease

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