Cardiovascular Multimorbidity in Older Adults in the United States by Race and Sex

BACKGROUND: It is essential to understand the prevalence of cardiovascular multimorbidity and to recognize disparities by race and sex to promote health equity. OBJECTIVES: The objectives of the study are to investigate disparities in the development and progression of cardiovascular multimorbidity among older adults in the United States and estimate relative life expectancies among patients with cardiovascular multimorbidity. METHODS: This was a nationwide study of a 5% nationwide sample of fee-for-service Medicare beneficiaries aged 65 or older from 2010 to 2020. Multistate survival models were employed to estimate cardiovascular disease (CVD) progression and a microsimulation approach was used to derive life tables. Primary outcome was development and progression of cardiovascular multimorbidity. RESULTS: Of 2,189,633 beneficiaries, the median age was 69 (IQR: 66-78), median follow-up duration was 6 years (IQR: 3-9). Initially healthy males and females had similar risks for developing CVD (aHR: 1.00; 95% CI: 0.99-1.00), with males facing higher risks of progressing to multimorbidity (aHR: 1.29; 95% CI: 1.24-1.35). Males with CVD were more likely to advance to multimorbidity (aHR: 1.16; 95% CI: 1.15-1.17). Black beneficiaries showed greater risks of moving from a healthy state to CVD (aHR: 1.10; 95% CI: 1.09-1.11). Life table analysis showed that Black adults had lower chances of progressing to worse multimorbidity states or death from a healthy state. However, as their disease burden increased, they were more likely to die compared to White adults. CONCLUSIONS: These findings illuminate sex differences and racial disparities in cardiovascular multimorbidity progression, identifying a target for the promotion of health equity.