Effects of potential risk factors on the development of cardiometabolic multimorbidity and mortality among the elders in China

Objectives: To examine the impact of demographic, socioeconomic, and behavioral factors on the development of cardiometabolic multimorbidity and mortality in Chinese elders. Methods: Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2002-2018 was used in the study. Cardiometabolic multimorbidity was defined as the presence of two or more cardiometabolic disorders, such as hypertension, diabetes, cardiovascular disease (CVD), heart disease, or stroke. Cox regression model and multi-state Markov model were developed to evaluate the association of the study factors with the progression of cardiometabolic conditions and mortality. The outcomes included three states (first cardiometabolic disease, cardiometabolic multimorbidity, and all-cause mortality) and five possible transitions among the three states. Results: Of the 13,933 eligible individuals, 7,917 (56.8%) were female, and 9,540 (68.50%) were over 80 years old. 2,766 (19.9%) participants had their first cardiometabolic disease, 975 (7.0%) participants suffered from cardiometabolic multimorbidity, and 9,365 (67.2%) participants died. The progression to cardiometabolic multimorbidity was positively associated with being female (HR = 1.42; 95%CI, 1.10 - 1.85), living in the city (HR = 1.41; 95%CI, 1.04 - 1.93), overweight (HR = 1.43; 95%CI, 1.08 - 1.90), and obesity (HR = 1.75; 95% CI, 1.03 - 2.98). A higher risk for the first cardiometabolic disease was associated with being female (HR = 1.26; 95% CI, 1.15 - 1.39), higher socioeconomic status (SES, HR = 1.17; 95%CI, 1.07 - 1.28), lack of regular physical activity (HR = 1.13; 95%CI, 1.04 - 1.23), smoking (HR = 1.20; 95%CI, 1.08 - 1.33), ≤ 5 h sleep time (HR = 1.15; 95%CI, 1.02 - 1.30), overweight (HR = 1.48; 95% CI, 1.32 - 1.66), and obesity (HR = 1.34; 95%CI, 1.06 - 1.69). It also should be noted that not in marriage, lower SES and unhealthy behavioral patterns were risk factors for mortality. Conclusion: This study emphasized the importance of lifestyle and SES in tackling the development of cardiometabolic conditions among Chinese elders and provided a reference for policy-makers to develop a tailored stage-specific intervention strategy.