Racial and Ethnic Differences in Multimorbidity Changes Over Time

Med Care. 2021 May 1;59(5):402-409. doi: 10.1097/MLR.0000000000001527.


Background: Our understanding of how multimorbidity progresses and changes is nascent.

Objectives: Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.

Design, setting, and participants: Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).

Measures: Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.

Results: Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.

Conclusions and relevance: Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cardiovascular Diseases* / mortality
  • Ethnicity / statistics & numerical data*
  • Female
  • Health Surveys
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders* / mortality
  • Middle Aged
  • Multimorbidity / trends*
  • Musculoskeletal Diseases* / mortality
  • Neoplasms* / mortality
  • Prospective Studies
  • Racial Groups*