Additive effect of frailty with distinct multimorbidity patterns on mortality amongst middle-aged and older adults in Taiwan: A 16-year population-based study

Wei-Min Chu; Hsin-En Ho; Chih-Jung Yeh; James Cheng-Chung Wei; Hidenori Arai; Meng-Chih Lee

doi:10.1111/ggi.14647

Additive effect of frailty with distinct multimorbidity patterns on mortality amongst middle-aged and older adults in Taiwan: A 16-year population-based study

Geriatr Gerontol Int. 2023 Sep;23(9):684-691. doi: 10.1111/ggi.14647. Epub 2023 Aug 9.

Authors

Wei-Min Chu^{1

2

3

4

5

6}, Hsin-En Ho^{7

8

9}, Chih-Jung Yeh¹⁰, James Cheng-Chung Wei^{7

11

12}, Hidenori Arai¹³, Meng-Chih Lee^{7

14

15

16

17}

Affiliations

¹ Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
³ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴ Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁵ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁶ Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan.
⁷ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁸ Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan.
⁹ School of Medicine, National Defense Medical Center, Taipei, Taiwan.
¹⁰ School of Public Health, Chung-Shan Medical University, Taichung, Taiwan.
¹¹ Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹² Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
¹³ National Center for Geriatrics and Gerontology, Obu, Japan.
¹⁴ Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
¹⁵ Institute of Population Sciences, National Health Research Institutes, Miaoli County, Taiwan.
¹⁶ College of Management, Chaoyang University of Technology, Taichung, Taiwan.
¹⁷ Study Group of Integrated Health and Social Care Project, Ministry of Health and Welfare, Taipei, Taiwan.

PMID: 37555551
DOI: 10.1111/ggi.14647

Abstract

Aim: This study aimed to explore the association between multimorbidity patterns with/without frailty and future mortality among Taiwanese middle-aged and older adults through a population-based cohort study design.

Methods: Data were collected from the Taiwan Longitudinal Study on Aging. The data were obtained from Wave 3, with the multimorbidity patterns in the years of 1996 being analyzed through latent class analysis. Frailty was defined using the modified Fried criteria. The association between each disease group with/without frailty and mortality was examined using logistic regression, with the reference group as the Relatively healthy group without frailty. Survival analysis was performed using Cox regression, and the follow-up period of mortality was from 1 January 1996 to 31 December 2012.

Results: A total of 4748 middle-aged and older adults with an average age of 66.3 years (SD: 9.07 years) were included. Four disease patterns were identified in 1996, namely the Cardiometabolic (21.0%), Arthritis-cataract (11.9%), Relatively healthy (61.6%), and Multimorbidity (5.5%) groups. After adjusting for all covariates, the Relatively healthy group with frailty showed the highest risk for mortality (odds ratio: 3.66, 95% confidence interval [95% CI]: 2.24-5.95), followed by the Cardiometabolic group with frailty (odds ratio: 3.58, 95% CI: 1.96-6.54), Multimorbidity group with frailty (odds ratio: 2.28, 95% CI: 1.17-4.44), Multimorbidity group without frailty (odds ratio: 1.44, 95% CI: 1.01-2.04), and the Cardiometabolic group without frailty (odds ratio: 1.24, 95% CI: 1.04-1.49).

Conclusions: Frailty plays an important role in mortality among middle-aged and older adults with distinct multimorbidity patterns. Middle-aged and older adults with a relatively healthy multimorbidity pattern or a cardiometabolic multimorbidity pattern with frailty encountered dismal outcomes. Geriatr Gerontol Int 2023; 23: 684-691.

Keywords: frailty; middle age; mortality; multimorbidity patterns; older adults.

MeSH terms

Aged
Cardiovascular Diseases*
Cohort Studies
Frail Elderly
Frailty* / epidemiology
Humans
Longitudinal Studies
Middle Aged
Multimorbidity
Taiwan / epidemiology

Grants and funding

M06M2346/Ministry of Health and Welfare