Background
Methods
Data source and study population
Coding of diseases
Outcomes and variables
Statistical analysis
Results
Multimorbidity group | Non-multimorbidity group | Total | ||
---|---|---|---|---|
Cardiovascular morbidity | Non-cardiovascular morbidity | |||
Variables | (n = 442,816) | (n = 375,355) | (n = 931,539) | (N = 1,749,710) |
Age (years) | 65.7 (14.6) | 48.2 (15.4) | 38.3 (12.7) | 47.4 (17.8) |
Sex (% females) | 56.1 | 57.5 | 45.5 | 50.7 |
Number of chronic diseases (median, IQR) | 5.0 (3.0;7.0) | 3.0 (2.0;4.0) | 0.0 (0.0;1.0) | 1.0 (0.0;3.0) |
Visits (median, IQR) | 10.0 (6.0;18.0) | 6.0 (3.0;11.0) | 1.0 (0.0;4.0) | 4.0 (1.0;9.0) |
Urban setting (%) | 83.4 | 84.0 | 84.2 | 84.0 |
Physical examination | ||||
BMI (kg/cm2) (n= 509,368) | 29.7 (5.1) | 28.0 (5.4) | 26.0 (4.7) | 28.3 (5.3) |
Systolic BP (mm Hg) (n = 773,446) | 135.2 (16.2) | 126.6 (14.6) | 123.8 (14.9) | 129.7 (16.3) |
Diastolic BP (mm Hg) (n = 774,139) | 76.7 (10.3) | 76.0 (9.6) | 74.5 (10.1) | 75.9 (10.1) |
Laboratory tests | ||||
Glycated haemoglobin (%)(SD) (n = 208,581) | 6.6 (1.3) | 6.3 (1.5) | 5.7 (1.2) | 6.4 (1.4) |
Creatinine (mg/dl) (SD) (n = 738,083) | 0.9 (0.4) | 0.8 (0.2) | 0.8 (0.2) | 0.9 (0.3) |
Uric acid (mg/dl) (SD) (n = 475, 334) | 5.5 (1.6) | 4.8 (1.4) | 4.8 (1.4) | 5.2 (1.5) |
Total cholesterol (mg/dl) (SD) (n = 745,010) | 202.0 (39.7) | 209.0 (40.6) | 194.3 (38.4) | 201.8 (40.0) |
Triglycerides (mg/dl) (SD) (n = 190,159) | 132.9 (82.9) | 129 (98.7) | 113.3 (75.7) | 127.5 (86.4) |
Glomerular filtration rate < 60 % (%) (n = 544,438) | 17.6 | 3.2 | 1.3 | 9.2 |
Multimorbidity group | Non-multimorbidity group | Total | ||
---|---|---|---|---|
Cardiovascular morbidity | Non-cardiovascular morbidity | |||
(n = 442,816) | (n = 375,355) | (n = 931,539) | (N = 1,749,710) | |
Major modifiable cardiovascular risk factors | ||||
Smoking (n = 1,329,331) | 15.1 | 33.3 | 39.0 | 29.9 |
Hypertension (n = 1,749,710) | 75.9 | 0.0 | 1.8 | 20.2 |
Hypercholesterolemia (n = 1,749,710) | 47.7 | 31.8 | 3.2 | 20.6 |
Diabetes (n = 1,749,710) | 22.8 | 7.1 | 0.5 | 7.6 |
Other factors | ||||
Hypertriglyceridemia (n = 190,159) | 27.8 | 24.9 | 18.2 | 24.9 |
Obesity (n = 1,749,710) | 24.5 | 15.5 | 1.8 | 10.5 |
Alcoholism (n = 577,213) | 28.2 | 29.8 | 32.4 | 29.9 |
Sum of major factors (median, [IQR]) (n = 1,329,331) | 2 [1;2] | 1 [0;1] | 0 [0;1] | 1 [0;1] |
Cardiovascular risk score (REGICOR) (median, [IQR]) (n = 264,773)a | 4 [3;7] | 3 [2;5] | 2 [1;4] | 4 [2;6] |
Cardiovascular risk score (REGICOR) (n = 264,773)a | ||||
Low | 60.6 | 74.6 | 84.5 | 67.4 |
Moderate | 30.1 | 20.5 | 13.4 | 25.4 |
High | 6.9 | 3.8 | 1.7 | 5.4 |
Very high | 2.4 | 1.1 | 0.4 | 1.8 |
Age Groups (years) | Female n = 248,407 | Male n = 194,409 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Cardiovascular index disease | Associated disease 1 |
n
| % | 95 % CI | Cardiovascular index disease | Associated disease 1 |
n
| % | 95 % CI | |
19–24 n = 2,152 | Varicose veins of leg | Anxiety disorder/anxiety state | 92 | 7.1 | (5.8–8.7) | Hypertension, uncomplicated | Obesity | 78 | 9.0 | (7.2–11.2) |
Postural hypotension | Anxiety disorder/anxiety state | 83 | 6.4 | (5.2–8.0) | Heart disease, other | Acne | 39 | 4.5 | (3.3–6.2) | |
Hypertension, uncomplicated | Obesity | 35 | 2.7 | (1.9–3.8) | Postural hypotension | Acne | 16 | 1.8 | (1.1–3.1) | |
Paroxysmal tachycardia | Anxiety disorder/anxiety state | 31 | 2.4 | (1.7–3–4) | Varicose veins of leg | Acquired deformity of spine | 16 | 1.8 | (0.8–2.6) | |
Heart disease, other | Anxiety disorder/anxiety state | 24 | 1.9 | (1.2–2.8) | Congenital anomaly cardiovascular | Acne | 13 | 1.5 | (0.8–2.6) | |
25–44 n = 37,308 | Varicose veins of leg | Anxiety disorder/anxiety state | 2,794 | 13.0 | (12.6–13.5) | Hypertension, uncomplicated | Lipid disorder | 3,425 | 21.6 | (21.0–22.3) |
Hypertension, uncomplicated | Obesity | 2,125 | 9.9 | (9.5–10.3) | Varicose veins of leg | Lipid disorder | 476 | 3.0 | (2.7–3.3) | |
Postural hypotension | Anxiety disorder/anxiety state | 527 | 2.5 | (2.3–2.7) | Heart disease, other | Lipid disorder | 451 | 2.8 | (2.6–3.1) | |
Heart disease, other | Anxiety disorder/anxiety state | 253 | 1.2 | (1.0–1.3) | Hypertension, complicated | Hypertension, uncomplicated | 201 | 1.3 | (1.1–1.5) | |
Paroxysmal tachycardia | Anxiety disorder/anxiety state | 215 | 1.0 | (0.9–1.1) | Acute myocardial infarction | Lipid disorder | 159 | 1.0 | (0.9–1.2) | |
45–64 n = 154,049 | Hypertension, uncomplicated | Lipid disorder | 25,930 | 32.5 | (32.2–32.9) | Hypertension, uncomplicated | Lipid disorder | 30,975 | 41.7 | (41.3–42.0) |
Varicose veins of leg | Lipid disorder | 10,339 | 13.0 | (12.7–13.2) | Heart disease, other | Hypertension, uncomplicated | 4,186 | 5.6 | (5.5–5.8) | |
Heart disease, other | Hypertension, uncomplicated | 2,057 | 2.6 | (2.5–2.7) | Ischaemic heart disease w/o angina | Lipid disorder | 2,992 | 4.0 | (3.9–4.2) | |
Heart valve disease NOS | Hypertension, uncomplicated | 1,131 | 1.4 | (1.3–1.5) | Varicose veins of leg | Lipid disorder | 2,745 | 3.7 | (3.6–3.8) | |
Stroke/cerebrovascular accident | Hypertension, uncomplicated | 895 | 1.1 | (1.1–1.2) | Acute myocardial infarction | Lipid disorder | 2,582 | 3.5 | (3.3–3.6) | |
65–79 n = 168,340 | Hypertension, uncomplicated | Lipid disorder | 46,236 | 49.5 | (49.2–49.8) | Hypertension, uncomplicated | Lipid disorder | 32,003 | 42.7 | (42.3–43.1) |
Varicose veins of leg | Hypertension, uncomplicated | 16,214 | 17.4 | (17.1–17.6) | Heart disease, other | Hypertension, uncomplicated | 8,156 | 10.9 | (10.7–11.1) | |
Heart disease, other | Hypertension, uncomplicated | 7,075 | 7.6 | (7.4–7.7) | Ischaemic heart disease w/o angina | Hypertension, uncomplicated | 5,297 | 7.1 | 6.9–7.3) | |
Atrial fibrillation/flutter | Hypertension, uncomplicated | 4,739 | 5.1 | (4.9–5.2) | Atrial fibrillation/flutter | Hypertension, uncomplicated | 4,765 | 6.4 | (6.2–6.5) | |
Heart valve disease NOS | Hypertension, uncomplicated | 4,164 | 4.5 | (4.3–4.6) | Stroke/cerebrovascular accident | Hypertension, uncomplicated | 4,522 | 6.0 | (5.9–6.2) | |
80+ n = 80,967 | Hypertension, uncomplicated | Lipid disorder | 22,984 | 43.7 | (43.3–44.2) | Hypertension, uncomplicated | Lipid disorder | 9,115 | 32.1 | (31.5–32.6) |
Varicose veins of leg | Hypertension, uncomplicated | 8,923 | 17.0 | (16.7–17.3) | Heart disease, other | Hypertension, uncomplicated | 4,244 | 14.9 | (14.5–15.4) | |
Atrial fibrillation/flutter | Hypertension, uncomplicated | 6,404 | 12.2 | (11.9–12.5) | Atrial fibrillation/flutter | Hypertension, uncomplicated | 3,600 | 12.7 | (12.3–13.1) | |
Heart disease, other | Hypertension, uncomplicated | 6,022 | 11.5 | (11.2–11.7) | Stroke/cerebrovascular accident | Hypertension, uncomplicated | 2,651 | 9.3 | (9.0–9.7) | |
Heart failure | Hypertension, uncomplicated | 5,814 | 11.1 | (10.8–11.3) | Heart failure | Hypertension, uncomplicated | 2,579 | 9.1 | (8.7–9.4) |
Age Groups (years) | Women n = 248,407 | Men n = 194,409 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Index cardiovascular disease | Associated disease 1 | Associated disease 2 | n | % | 95 % CI | Index cardiovascular disease | Associated disease 1 | Associated disease 2 | n | % | 95 % CI | |
19–24 n = 2,152 | Postural hypotension | Acne | Anxiety disorder/anxiety state | 14 | 1.1 | (0.6–1.9) | Hypertension, uncomplicated | Obesity | Acne | 8 | 0.9 | (0.4–1.9) |
Varicose veins of leg | Acne | Anxiety disorder/anxiety state | 13 | 1.0 | (0.6–1.8) | Heart disease, other | Dermatitis/atopic eczema | Asthma | 6 | 0.7 | (0.3–1.6) | |
Hypertension, uncomplicated | Endocrine/metabolic/nutritional disorder, other | Obesity | 9 | 0.7 | (0.3–1.4) | Congenital anomaly cardiovascular | Asthma | Heart valve disease NOS | 3 | 0.3 | (0.1–1.1) | |
Heart valve disease NOS | Acne | Acne | 5 | 0.4 | (0.1–1.0) | Cardiac arrhythmia NOS | Acne | Musculoskeletal disease, other | 3 | 0.3 | (0.1–1.1) | |
Paroxysmal tachycardia | Depressive disorder | Anxiety disorder/anxiety state | 4 | 0.3 | (0.1–0.9) | Heart valve disease NOS | Asthma | Congenital anomaly, cardiovascular | 3 | 0.3 | (0.1–1.1) | |
25–44 n = 37,308 | Hypertension, uncomplicated | Lipid disorder | Obesity | 538 | 2.5 | (2.3–2.7) | Hypertension, uncomplicated | Lipid disorder | Obesity | 1,076 | 6.8 | (6.4–7.2) |
Varicose veins of leg | Depressive disorder | Anxiety disorder/ anxiety state | 491 | 2.3 | (2.1–2.5) | Heart disease, other | Lipid disorder | Hypertension, uncomplicated | 138 | 0.9 | (0.7–1.0) | |
Postural hypotension | Depressive disorder | Anxiety disorder/anxiety state | 102 | 0.5 | (0.4–0.6) | Varicose veins of leg | Lipid disorder | Obesity | 105 | 0.7 | (0.5–0.8) | |
Phlebitis/thrombo-phlebitis | Obesity | Varicose veins of leg | 59 | 0.3 | (0.2–0.4) | Hypertension, complicated | Lipid disorder | Hypertension, uncomplicated | 66 | 0.4 | (0.3–0.5 | |
Heart disease, other | Depressive disorder | Anxiety disorder/anxiety state | 46 | 0.2 | (0.2–0–3) | Acute myocardial infarction | Lipid disorder | Hypertension, uncomplicated | 60 | 0.4 | (0.3–0.5 | |
45–64 n = 154,049 | Hypertension, uncomplicated | Lipid disorder | Obesity | 9,134 | 11.5 | (11.2–11.7) | Hypertension, uncomplicated | Lipid disorder | Diabetes, non-insulin dependent | 8,631 | 11.6 | (11.4–11.8) |
Varicose veins of leg | Lipid disorder | Hypertension, uncomplicated | 3,761 | 4.7 | (4.6–4.9) | Heart disease, other | Lipid disorder | Hypertension, uncomplicated | 2,275 | 3.1 | (2.9–3.2) | |
Heart disease, other | Lipid disorder | Hypertension, uncomplicated | 1,081 | 1.4 | (1.3–1.4) | Ischaemic heart disease w/o angina | Lipid disorder | Hypertension, uncomplicated | 1,744 | 2.3 | (2.2–2.5) | |
Heart valve disease NOS | Lipid disorder | Hypertension, uncomplicated | 578 | 0.7 | (0.7–0–8) | Acute myocardial infarction | Lipid disorder | Hypertension, uncomplicated | 1,361 | 1.8 | (1.7–1.9) | |
Stroke/cerebrovascular accident | Lipid disorder | Hypertension, uncomplicated | 500 | 0.6 | (0.6–0.7) | Atherosclerosis/PVD | Lipid disorder | Hypertension, uncomplicated | 1,275 | 1.7 | (1.6–1.8) | |
65–79 n = 168,340 | Hypertension, uncomplicated | Lipid disorder | Obesity | 15,115 | 16.2 | (15.9–16.4) | Hypertension, uncomplicated | Lipid disorder | Diabetes, non-insulin dependent | 11,573 | 15.4 | (15.2–15.7) |
Varicose veins of leg | Lipid disorder | Hypertension, uncomplicated | 9,365 | 10.0 | (9.8–10.2) | Heart disease, other | Lipid disorder | Hypertension, uncomplicated | 4,389 | 5.9 | (5.7–6.0) | |
Heart disease, other | Lipid disorder | Hypertension, uncomplicated | 4,298 | 4.6 | (4.5–4.7) | Ischaemic heart disease w/o angina | Lipid disorder | Hypertension, uncomplicated | 3,346 | 4.5 | (4.3–4.6) | |
Heart valve disease NOS | Lipid disorder | Hypertension, uncomplicated | 2,530 | 2.7 | (2.6–2.8) | Atherosclerosis/PVD | Lipid disorder | Hypertension, uncomplicated | 2675 | 3.6 | (3.4–3.7) | |
Atrial fibrillation/flutter | Lipid disorder | Hypertension, uncomplicated | 2,525 | 2.7 | (2.6–2.8) | Stroke/cerebrovascular accident | Lipid disorder | Hypertension, uncomplicated | 2,557 | 3.4 | (3.3–3.5) | |
80+ n = 80,967 | Hypertension, uncomplicated | Lipid disorder | Diabetes, non-insulin dependent | 6,769 | 12.9 | (12.6–13.2) | Hypertension, uncomplicated | Benign prostatic hypertrophy | Lipid disorder | 3658 | 12.9 | (12.5–13.3) |
Varicose veins of leg | Lipid disorder | Hypertension, uncomplicated | 4,445 | 8.5 | (8.2–8.7) | Heart disease, other | Lipid disorder | Hypertension, uncomplicated | 1,823 | 6.4 | (6.1–6.7) | |
Heart disease, other | Lipid disorder | Hypertension, uncomplicated | 3,255 | 6.2 | (6.0–6.4) | Atrial fibrillation/flutter | Benign prostatic hypertrophy | Hypertension, uncomplicated | 1,466 | 5.2 | (4.9–5.4) | |
Atrial fibrillation/flutter | Lipid disorder | Hypertension, uncomplicated | 2,900 | 5.5 | (5.3–5.7) | Ischaemic heart disease w/o angina | Lipid disorder | Hypertension, uncomplicated | 1,357 | 4.8 | (4.5–5.0) | |
Heart failure | Lipid disorder | Hypertension, uncomplicated | 2,776 | 5.3 | (5.1–5.5) | Stroke/cerebrovascular accident | Lipid disorder | Hypertension, uncomplicated | 1,153 | 4.1 | (3.8–4.3) |