Health equity
Does having more long-term illnesses raise the risk of death?
Open access · cc by · source: Europe PMC
The more long-term conditions a middle-aged or older adult had, the higher their risk of dying over about seven years, and the relative jump in risk was largest in younger adults.
Study at a glance
- Design
- Cohort — Prospective population cohort: self-reported long-term conditions at recruitment (2006-2010) linked to national death records over a median 7 years, analysed with Cox models adjusted for sex, deprivation, smoking, alcohol, physical activity and BMI.
- N
- N=500769 · 500,769 UK Biobank participants with data on long-term conditions linked to mortality status; model Ns varied slightly with missing covariates.
- Population
- Middle-aged and older adults (about 37-73 years) recruited from the general population in England, Scotland and Wales
- Outcome
- All-cause mortality, with cancer and vascular mortality as cause-specific outcomes
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Key findings
Risk rose step by step with each extra condition: compared with people with none, those with one condition had a hazard ratio of 1.46 and those with four or more had 2.79 for all-cause death. The gradient was steeper for vascular death (HR 3.71 for 4+ conditions) than for cancer death (HR 2.01). Cardiometabolic conditions were linked to all three outcomes. Absolute death rates were highest in older people, but the relative increase was biggest among those aged 37-49, especially men; deprivation did not change the relative effect of multimorbidity.
Methodology
The researchers used UK Biobank, counting how many of 43 long-term conditions (such as diabetes, depression or COPD) each participant reported at recruitment. They followed participants through national death records for a median of 7 years and compared death rates across groups with 0, 1, 2, 3 or 4+ conditions, adjusting for lifestyle and deprivation. They also looked at which types and combinations of conditions mattered most and whether age, sex or socioeconomic status changed the relationship.
Limitations
Conditions were self-reported at baseline and simply counted, with no information on severity, and the count gives each disease equal weight. UK Biobank volunteers are healthier, more often white British and less deprived than the UK population, so effects may be underestimated and may not generalise. As an observational study, residual confounding is likely, and it cannot show that the conditions themselves, rather than associated factors, cause the deaths.
How this study connects
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