Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing
Objectives To classify older adults into clusters based on accumulating long-term conditions (LTC) as trajectories, characterise clusters and quantify their associations with all-cause mortality.Design We conducted a longitudinal study using the English Longitudinal Study of Ageing over 9 years (n=1...
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BMJ Publishing Group
2024-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/7/e074902.full |
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| author | Beth Stuart Andrew Farmer Nusrat Khan Hajira Dambha-Miller Nazrul Islam Christos V Chalitsios Yvonne Nartey Glenn Simpson Cornelia Santoso |
| author_facet | Beth Stuart Andrew Farmer Nusrat Khan Hajira Dambha-Miller Nazrul Islam Christos V Chalitsios Yvonne Nartey Glenn Simpson Cornelia Santoso |
| author_sort | Beth Stuart |
| collection | DOAJ |
| description | Objectives To classify older adults into clusters based on accumulating long-term conditions (LTC) as trajectories, characterise clusters and quantify their associations with all-cause mortality.Design We conducted a longitudinal study using the English Longitudinal Study of Ageing over 9 years (n=15 091 aged 50 years and older). Group-based trajectory modelling was used to classify people into clusters based on accumulating LTC over time. Derived clusters were used to quantify the associations between trajectory memberships, sociodemographic characteristics and all-cause mortality by conducting regression models.Results Five distinct clusters of accumulating LTC trajectories were identified and characterised as: ‘no LTC’ (18.57%), ‘single LTC’ (31.21%), ‘evolving multimorbidity’ (25.82%), ‘moderate multimorbidity’ (17.12%) and ‘high multimorbidity’ (7.27%). Increasing age was consistently associated with a larger number of LTCs. Ethnic minorities (adjusted OR=2.04; 95% CI 1.40 to 3.00) were associated with the ‘high multimorbidity’ cluster. Higher education and paid employment were associated with a lower likelihood of progression over time towards an increased number of LTCs. All the clusters had higher all-cause mortality than the ‘no LTC’ cluster.Conclusions The development of multimorbidity in the number of conditions over time follows distinct trajectories. These are determined by non-modifiable (age, ethnicity) and modifiable factors (education and employment). Stratifying risk through clustering will enable practitioners to identify older adults with a higher likelihood of worsening LTC over time to tailor effective interventions to prevent mortality. |
| format | Article |
| id | doaj-art-bb7536c11e2c4132b290ec2aad112ce3 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-bb7536c11e2c4132b290ec2aad112ce32025-08-20T03:11:22ZengBMJ Publishing GroupBMJ Open2044-60552024-07-0114710.1136/bmjopen-2023-074902Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of AgeingBeth Stuart0Andrew Farmer1Nusrat Khan2Hajira Dambha-Miller3Nazrul Islam4Christos V Chalitsios5Yvonne Nartey6Glenn Simpson7Cornelia Santoso8Queen Mary University of London, London, UKprofessorPrimary Care Research Centre, University of Southampton, Southampton, UK1 Primary Care Research Centre, University of Southampton, Southampton, UKPrimary Care Research Centre, University of Southampton, Southampton, UK1 Primary Care Research Centre, University of Southampton, Southampton, UKPrimary Care Research Centre, University of Southampton, Southampton, UK1 Primary Care Research Centre, University of Southampton, Southampton, UKPrimary Care Research Centre, University of Southampton, Southampton, UKObjectives To classify older adults into clusters based on accumulating long-term conditions (LTC) as trajectories, characterise clusters and quantify their associations with all-cause mortality.Design We conducted a longitudinal study using the English Longitudinal Study of Ageing over 9 years (n=15 091 aged 50 years and older). Group-based trajectory modelling was used to classify people into clusters based on accumulating LTC over time. Derived clusters were used to quantify the associations between trajectory memberships, sociodemographic characteristics and all-cause mortality by conducting regression models.Results Five distinct clusters of accumulating LTC trajectories were identified and characterised as: ‘no LTC’ (18.57%), ‘single LTC’ (31.21%), ‘evolving multimorbidity’ (25.82%), ‘moderate multimorbidity’ (17.12%) and ‘high multimorbidity’ (7.27%). Increasing age was consistently associated with a larger number of LTCs. Ethnic minorities (adjusted OR=2.04; 95% CI 1.40 to 3.00) were associated with the ‘high multimorbidity’ cluster. Higher education and paid employment were associated with a lower likelihood of progression over time towards an increased number of LTCs. All the clusters had higher all-cause mortality than the ‘no LTC’ cluster.Conclusions The development of multimorbidity in the number of conditions over time follows distinct trajectories. These are determined by non-modifiable (age, ethnicity) and modifiable factors (education and employment). Stratifying risk through clustering will enable practitioners to identify older adults with a higher likelihood of worsening LTC over time to tailor effective interventions to prevent mortality.https://bmjopen.bmj.com/content/14/7/e074902.full |
| spellingShingle | Beth Stuart Andrew Farmer Nusrat Khan Hajira Dambha-Miller Nazrul Islam Christos V Chalitsios Yvonne Nartey Glenn Simpson Cornelia Santoso Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing BMJ Open |
| title | Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing |
| title_full | Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing |
| title_fullStr | Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing |
| title_full_unstemmed | Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing |
| title_short | Trajectories in long-term condition accumulation and mortality in older adults: a group-based trajectory modelling approach using the English Longitudinal Study of Ageing |
| title_sort | trajectories in long term condition accumulation and mortality in older adults a group based trajectory modelling approach using the english longitudinal study of ageing |
| url | https://bmjopen.bmj.com/content/14/7/e074902.full |
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