Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records

Khondoker, Mizanur ORCID:, Macgregor, Alexander ORCID:, Bachmann, Max O. ORCID:, Hornberger, Michael ORCID:, Fox, Chris and Shepstone, Lee (2023) Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records. Journal of Epidemiology and Community Health. ISSN 0143-005X

[thumbnail of Final submitted authors' version all files combined]
PDF (Final submitted authors' version all files combined) - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

Download (1MB) | Preview


Background: Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia.   Methods: 447,888 dementia free participants of the UK Biobank cohort at baseline (2006 – 2010) were followed-up until 31 May 2020 with a median follow-up duration of 11.3 years to identify incident cases of dementia. Latent Class Analysis (LCA) was used to identify multimorbidity patterns at baseline and covariate adjusted Cox regression was used to investigate their predictive effects on the risk of developing dementia. Potential effect moderations by C-reactive protein (CRP) and APOE genotype were assessed via statistical interaction.   Results: LCA identified four multimorbidity clusters representing Mental health, Cardiometabolic, Inflammatory/autoimmune and Cancer related pathophysiology respectively. Estimated hazard ratios (HR) suggests that multimorbidity clusters dominated by Mental health (HR=2.12, p<0.001, 95%CI: 1.88 to 2.39), and Cardiometabolic conditions (2.02, p<0.001, 1.87 to 2.19) have the highest risk of developing dementia. Risk level for the Inflammatory/autoimmune cluster was intermediate (1.56, p<0.001, 1.37 to 1.78) and that for the Cancer cluster was least pronounced (1.36, p<0.001, 1.17 to 1.57). Contrary to expectation, neither C-reactive protein (CRP) nor APOE genotype was found to moderate the effects of multimorbidity clusters on the risk of dementia.   Conclusions: Early identification of older adults at higher risk of accumulating multimorbidity of specific pathophysiology, and tailored interventions to prevent or delay the onset of such multimorbidity may help prevention of dementia.

Item Type: Article
Uncontrolled Keywords: multimorbidity,dementia,latent class analysis,clustering,hazard ratio,sdg 3 - good health and well-being,4* ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 27 Feb 2023 11:31
Last Modified: 09 Mar 2023 14:30
DOI: 10.1136/jech-2022-220034

Actions (login required)

View Item View Item