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Original article Trends and all-cause mortality associated with multimorbidity of noncommunicable diseases among adults in the United States, 1999-2018: a retrospective cohort study
Mengzi Sun1orcid , Ling Wang1orcid , Xuhan Wang1orcid , Li Tong2orcid , Lina Jin1orcid , Bo Li1orcid
Epidemiol Health 2022;e2023023
DOI: https://doi.org/10.4178/epih.e2023023 [Accepted]
Published online: February 14, 2023
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1Jilin University School of Public Health, Changchun, China
2Jilin University School of Public Health, Changchun, China
Corresponding author:  Lina Jin,
Email: li_bo@jlu.edu.cn
Bo Li,
Email: li_bo@jlu.edu.cn
Received: 5 November 2022   • Revised: 4 January 2023   • Accepted: 7 January 2023
Full Article

Abstract

Objectives
Multimorbidity of noncommunicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. However, the patterns, temporal trends, and all-cause mortality associated with NCD multimorbidity over time have not been well described in the United States.
Methods
All adult participants were sourced from nationally representative data from the National Health and Nutrition Examination Survey. In total, 55,081 participants were included in trend analysis, and 38,977 participants were included in Cox regression.
Results
The 5 NCDs with the largest increases over the study period were diabetes, osteoporosis, obesity, liver conditions, and cancer. The estimated prevalence of multimorbidity increased with age, especially for middle-aged participants with 5 or more NCDs; in general, the prevalence of NCD multimorbidity was higher among women than men. Participants with 5 or more NCDs were at 4.49 times the risk of all-cause mortality of participants without any diseases. Significant interactions were found between multimorbidity and age group (P for interaction<0.001), race/ethnicity (P for interaction<0.001), and educational attainment (P for interaction=0.010).
Conclusions
The prevalence of multiple NCDs significantly increased from 1999 to 2018. Those with 5 or more NCDs had the highest risk of all-cause mortality, especially among the young population. The data reported by this study could serve as a reference for additional NCD research.

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