The combined effect of cancer and cardiometabolic conditions on the mortality burden in older adults

Parminder Raina (Corresponding author), Anne Gilsing, Heinz Freisling, Edwin van den Heuvel, Nazmul Sohel, Mazda Jenab, Pietro Ferrari, Anne Tjønneland, Vassiliki Benetou, Susan Picavet, Sture Eriksson, Ben Schöttker, Hermann Brenner, Kai Uwe Saum, Laura Perna, Tom Wilsgaard, Antonia Trichopoulou, Paolo Boffetta, Lauren E. Griffith

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Abstract

BACKGROUND: The number of older people living with cancer and cardiometabolic conditions is increasing, but little is known about how specific combinations of these conditions impact mortality. METHODS: A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, myocardial infarction (MI), stroke, and diabetes at baseline. Cox proportional hazards models for all-cause mortality were used to estimate the age- and sex-adjusted hazard ratio and rate advancement period (RAP) (in years). RESULTS: At baseline, 23.6% (n = 5,116) of participants reported having one condition and 4.2% (n = 955) had two or more conditions. Data from all studies combined showed that the RAP increased with each additional condition. Diabetes advanced the rate of dying by the most years (5.26 years; 95% confidence interval [CI], 4.53-6.00), but the effect of any single condition was smaller than the effect of disease combinations. Some combinations had a significantly greater impact on the period by which the rate of death was advanced than others with the same number of conditions, for example, 10.9 years (95% CI, 9.4-12.6) for MI and diabetes versus 6.4 years (95% CI, 4.3-8.5) for cancer and diabetes. CONCLUSIONS: Combinations of cancer and cardiometabolic conditions accelerate mortality rates in older adults differently. Although most studies investigating mortality associated with multimorbidity used disease counts, these provide little guidance for managing complex patients as they age.

Original languageEnglish
Pages (from-to)366-372
Number of pages7
JournalThe Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Volume74
Issue number3
DOIs
Publication statusPublished - 15 Feb 2019

Fingerprint

Mortality
Neoplasms
Confidence Intervals
Myocardial Infarction
Proportional Hazards Models
Comorbidity
Stroke

Keywords

  • Aging
  • Epidemiology
  • Multimorbidity
  • Risk factor

Cite this

Raina, Parminder ; Gilsing, Anne ; Freisling, Heinz ; van den Heuvel, Edwin ; Sohel, Nazmul ; Jenab, Mazda ; Ferrari, Pietro ; Tjønneland, Anne ; Benetou, Vassiliki ; Picavet, Susan ; Eriksson, Sture ; Schöttker, Ben ; Brenner, Hermann ; Saum, Kai Uwe ; Perna, Laura ; Wilsgaard, Tom ; Trichopoulou, Antonia ; Boffetta, Paolo ; Griffith, Lauren E. / The combined effect of cancer and cardiometabolic conditions on the mortality burden in older adults. In: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2019 ; Vol. 74, No. 3. pp. 366-372.
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abstract = "BACKGROUND: The number of older people living with cancer and cardiometabolic conditions is increasing, but little is known about how specific combinations of these conditions impact mortality. METHODS: A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, myocardial infarction (MI), stroke, and diabetes at baseline. Cox proportional hazards models for all-cause mortality were used to estimate the age- and sex-adjusted hazard ratio and rate advancement period (RAP) (in years). RESULTS: At baseline, 23.6{\%} (n = 5,116) of participants reported having one condition and 4.2{\%} (n = 955) had two or more conditions. Data from all studies combined showed that the RAP increased with each additional condition. Diabetes advanced the rate of dying by the most years (5.26 years; 95{\%} confidence interval [CI], 4.53-6.00), but the effect of any single condition was smaller than the effect of disease combinations. Some combinations had a significantly greater impact on the period by which the rate of death was advanced than others with the same number of conditions, for example, 10.9 years (95{\%} CI, 9.4-12.6) for MI and diabetes versus 6.4 years (95{\%} CI, 4.3-8.5) for cancer and diabetes. CONCLUSIONS: Combinations of cancer and cardiometabolic conditions accelerate mortality rates in older adults differently. Although most studies investigating mortality associated with multimorbidity used disease counts, these provide little guidance for managing complex patients as they age.",
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Raina, P, Gilsing, A, Freisling, H, van den Heuvel, E, Sohel, N, Jenab, M, Ferrari, P, Tjønneland, A, Benetou, V, Picavet, S, Eriksson, S, Schöttker, B, Brenner, H, Saum, KU, Perna, L, Wilsgaard, T, Trichopoulou, A, Boffetta, P & Griffith, LE 2019, 'The combined effect of cancer and cardiometabolic conditions on the mortality burden in older adults', The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, vol. 74, no. 3, pp. 366-372. https://doi.org/10.1093/gerona/gly053

The combined effect of cancer and cardiometabolic conditions on the mortality burden in older adults. / Raina, Parminder (Corresponding author); Gilsing, Anne; Freisling, Heinz; van den Heuvel, Edwin; Sohel, Nazmul; Jenab, Mazda; Ferrari, Pietro; Tjønneland, Anne; Benetou, Vassiliki; Picavet, Susan; Eriksson, Sture; Schöttker, Ben; Brenner, Hermann; Saum, Kai Uwe; Perna, Laura; Wilsgaard, Tom; Trichopoulou, Antonia; Boffetta, Paolo; Griffith, Lauren E.

In: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, Vol. 74, No. 3, 15.02.2019, p. 366-372.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The combined effect of cancer and cardiometabolic conditions on the mortality burden in older adults

AU - Raina, Parminder

AU - Gilsing, Anne

AU - Freisling, Heinz

AU - van den Heuvel, Edwin

AU - Sohel, Nazmul

AU - Jenab, Mazda

AU - Ferrari, Pietro

AU - Tjønneland, Anne

AU - Benetou, Vassiliki

AU - Picavet, Susan

AU - Eriksson, Sture

AU - Schöttker, Ben

AU - Brenner, Hermann

AU - Saum, Kai Uwe

AU - Perna, Laura

AU - Wilsgaard, Tom

AU - Trichopoulou, Antonia

AU - Boffetta, Paolo

AU - Griffith, Lauren E.

PY - 2019/2/15

Y1 - 2019/2/15

N2 - BACKGROUND: The number of older people living with cancer and cardiometabolic conditions is increasing, but little is known about how specific combinations of these conditions impact mortality. METHODS: A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, myocardial infarction (MI), stroke, and diabetes at baseline. Cox proportional hazards models for all-cause mortality were used to estimate the age- and sex-adjusted hazard ratio and rate advancement period (RAP) (in years). RESULTS: At baseline, 23.6% (n = 5,116) of participants reported having one condition and 4.2% (n = 955) had two or more conditions. Data from all studies combined showed that the RAP increased with each additional condition. Diabetes advanced the rate of dying by the most years (5.26 years; 95% confidence interval [CI], 4.53-6.00), but the effect of any single condition was smaller than the effect of disease combinations. Some combinations had a significantly greater impact on the period by which the rate of death was advanced than others with the same number of conditions, for example, 10.9 years (95% CI, 9.4-12.6) for MI and diabetes versus 6.4 years (95% CI, 4.3-8.5) for cancer and diabetes. CONCLUSIONS: Combinations of cancer and cardiometabolic conditions accelerate mortality rates in older adults differently. Although most studies investigating mortality associated with multimorbidity used disease counts, these provide little guidance for managing complex patients as they age.

AB - BACKGROUND: The number of older people living with cancer and cardiometabolic conditions is increasing, but little is known about how specific combinations of these conditions impact mortality. METHODS: A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, myocardial infarction (MI), stroke, and diabetes at baseline. Cox proportional hazards models for all-cause mortality were used to estimate the age- and sex-adjusted hazard ratio and rate advancement period (RAP) (in years). RESULTS: At baseline, 23.6% (n = 5,116) of participants reported having one condition and 4.2% (n = 955) had two or more conditions. Data from all studies combined showed that the RAP increased with each additional condition. Diabetes advanced the rate of dying by the most years (5.26 years; 95% confidence interval [CI], 4.53-6.00), but the effect of any single condition was smaller than the effect of disease combinations. Some combinations had a significantly greater impact on the period by which the rate of death was advanced than others with the same number of conditions, for example, 10.9 years (95% CI, 9.4-12.6) for MI and diabetes versus 6.4 years (95% CI, 4.3-8.5) for cancer and diabetes. CONCLUSIONS: Combinations of cancer and cardiometabolic conditions accelerate mortality rates in older adults differently. Although most studies investigating mortality associated with multimorbidity used disease counts, these provide little guidance for managing complex patients as they age.

KW - Aging

KW - Epidemiology

KW - Multimorbidity

KW - Risk factor

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DO - 10.1093/gerona/gly053

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VL - 74

SP - 366

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JO - The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences

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