Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study
Abstract Background We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year...
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2025-01-01
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| author | Michelle M. C. Tan Charlotte Hanlon Graciela Muniz-Terrera Tatiana Benaglia Roshidi Ismail Devi Mohan Ann Breeze Joseph Konkoth Daniel Reidpath Pedro José M. Rebello Pinho Pascale Allotey Zaid Kassim Matthew Prina Tin Tin Su |
| author_facet | Michelle M. C. Tan Charlotte Hanlon Graciela Muniz-Terrera Tatiana Benaglia Roshidi Ismail Devi Mohan Ann Breeze Joseph Konkoth Daniel Reidpath Pedro José M. Rebello Pinho Pascale Allotey Zaid Kassim Matthew Prina Tin Tin Su |
| author_sort | Michelle M. C. Tan |
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| description | Abstract Background We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL). Methods Using data from 18,101 individuals (aged 18–97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012–2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders. Results Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44–2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18–1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04–1.59). Conclusions Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns. |
| format | Article |
| id | doaj-art-1046794913c44f648ffd0d4cfc019d3d |
| institution | Kabale University |
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| language | English |
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| spelling | doaj-art-1046794913c44f648ffd0d4cfc019d3d2025-01-12T12:26:48ZengBMCBMC Medicine1741-70152025-01-0123111710.1186/s12916-024-03796-zMultimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system studyMichelle M. C. Tan0Charlotte Hanlon1Graciela Muniz-Terrera2Tatiana Benaglia3Roshidi Ismail4Devi Mohan5Ann Breeze Joseph Konkoth6Daniel Reidpath7Pedro José M. Rebello Pinho8Pascale Allotey9Zaid Kassim10Matthew Prina11Tin Tin Su12Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College LondonDivision of Psychiatry, Centre for Clinical Brain Sciences, The University of EdinburghEdinburgh Dementia Prevention, The University of Edinburgh and Western General HospitalDepartment of Statistics, Institute of Mathematics, Statistics and Scientific Computing, Universidade Estadual de Campinas (UNICAMP)South East Asia Community Observatory (SEACO), Monash University MalaysiaGlobal Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University MalaysiaBiostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle UniversityGlobal Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University MalaysiaPsychogeriatric Unit, Department of Psychiatry, Medical School, Universidade Federal de São Paulo (UNIFESP)Department of Sexual and Reproductive Health and Research, World Health Organization (WHO)District Health Office Segamat, Ministry of Health MalaysiaDepartment of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College LondonGlobal Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University MalaysiaAbstract Background We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL). Methods Using data from 18,101 individuals (aged 18–97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012–2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders. Results Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44–2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18–1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04–1.59). Conclusions Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.https://doi.org/10.1186/s12916-024-03796-zMultimorbidityLatent classesHealth and demographic surveillance systemMortalityRisk factorsHealth-related quality of life |
| spellingShingle | Michelle M. C. Tan Charlotte Hanlon Graciela Muniz-Terrera Tatiana Benaglia Roshidi Ismail Devi Mohan Ann Breeze Joseph Konkoth Daniel Reidpath Pedro José M. Rebello Pinho Pascale Allotey Zaid Kassim Matthew Prina Tin Tin Su Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study BMC Medicine Multimorbidity Latent classes Health and demographic surveillance system Mortality Risk factors Health-related quality of life |
| title | Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study |
| title_full | Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study |
| title_fullStr | Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study |
| title_full_unstemmed | Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study |
| title_short | Multimorbidity latent classes in relation to 11-year mortality, risk factors and health-related quality of life in Malaysia: a prospective health and demographic surveillance system study |
| title_sort | multimorbidity latent classes in relation to 11 year mortality risk factors and health related quality of life in malaysia a prospective health and demographic surveillance system study |
| topic | Multimorbidity Latent classes Health and demographic surveillance system Mortality Risk factors Health-related quality of life |
| url | https://doi.org/10.1186/s12916-024-03796-z |
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