2277-P: Multimorbidity and Mortality in U.S. Adults with Diabetes: The Role of Age and Diabetes Duration

Introduction and Objective: To address limited evidence on how multimorbidity relates to mortality across age and diabetes mellitus (DM) duration, this study evaluates associations between the number of comorbidities and multimorbidity patterns with all-cause mortality. Methods: National Health and Nutrition Examination Survey 1999-2016 data linked to mortality data through 2019 was analyzed for adults age ≥20 years with DM. Hazard ratios (HRs) were estimated by age (<65 or ≥65) and DM duration (≤5 or >5 years) using sociodemographic adjusted Cox models with three-way interactions between age, DM duration, and number of comorbidities (0-3, 4-5, or 6-9). Separate models were fit for multimorbidity patterns. Patterns were defined by metabolic risk factors, vascular disease, and/or discordant conditions (those metabolically unrelated to DM). Results: Among adults <65 years, mortality increased with the number of comorbidities for both DM duration categories. Those with 6-9 comorbidities (vs. 0-3) had the highest risk (HR=4.3, 95% CI: 1.1-7.4 for ≤5 years; HR=4.3: 2.2-6.3, for >5 years). Regarding pattern types, vascular disease alone elevated risk for >5 years duration (HR=4.0: 2.0-6.2 vs metabolic risk factors only). Vascular disease plus discordant conditions had the greatest risk: HR: 3.1, 1.7-4.6 for ≤5 years duration; HR=5.6, 2.8-8.3 for >5 years. Among adults ≥65 years, associations were reduced: for 6-9 comorbidities, HR=1.9, 1.1-2.8 for duration ≤5 years; HR=1.7, 1.20-2.30 for >5 years. Vascular disease alone increased mortality in both duration groups: HR=2.9, 1.8-4.0 for ≤5 years and HR=2.5, 1.6-3.5 for >5 years. Vascular disease plus discordant conditions increased mortality 2.7-fold in both duration groups. Conclusion: This study suggests the strong association between the number of comorbidities and mortality is more pronounced among younger adults. Vascular disease, especially combined with discordant conditions, shows the highest mortality in both adults <65 years and those ≥65 years. Disclosure D. Choi: None. S. Onufrak: None. Y.J. Cheng: None. O. Idubor: None.