TY - JOUR
T1 - Long-term multimorbidity trajectories in older adults
T2 - The role of cancer, demographics, and health behaviors
AU - Rees-Punia, Erika
AU - Masters, Matthew
AU - Teras, Lauren R.
AU - Leach, Corinne R.
AU - Williams, Grant R.
AU - Newton, Christina C.
AU - Diver, W. Ryan
AU - Patel, Alpa V.
AU - Parsons, Helen M.
N1 - Publisher Copyright:
© 2023 American Cancer Society.
PY - 2024/1/15
Y1 - 2024/1/15
N2 - Background: Multimorbidity is associated with premature mortality and excess health care costs. The burden of multimorbidity is highest among patients with cancer, yet trends and determinants of multimorbidity over time are poorly understood. Methods: Via Medicare claims linked to Cancer Prevention Study II data, group-based trajectory modeling was used to compare National Cancer Institute comorbidity index score trends for cancer survivors and older adults without a cancer history. Among cancer survivors, multinomial logistic regression analyses evaluated associations between demographics, health behaviors, and comorbidity trajectories. Results: In 82,754 participants (mean age, 71.6 years [SD, 5.1 years]; 56.9% female), cancer survivors (n = 11,265) were more likely than older adults without a cancer history to experience the riskiest comorbidity trajectories: (1) steady, high comorbidity scores (remain high; odds ratio [OR], 1.36; 95% CI, 1.29–1.45), and (2) high scores that increased over time (start high and increase; OR, 1.51; 95% CI, 1.38–1.65). Cancer survivors who were physically active postdiagnosis were less likely to fall into these two trajectories (OR, 0.73; 95% CI, 0.64–0.84, remain high; OR, 0.42; 95% CI, 0.33–0.53, start high and increase) compared to inactive survivors. Cancer survivors with obesity were more likely to have a trajectory that started high and increased (OR, 2.83; 95% CI, 2.32–3.45 vs. normal weight), although being physically active offset some obesity-related risk. Cancer survivors who smoked postdiagnosis were also six times more likely to have trajectories that started high and increased (OR, 6.86; 95% CI, 4.41–10.66 vs. never smokers). Conclusions: Older cancer survivors are more likely to have multiple comorbidities accumulated at a faster pace than older adults without a history of cancer. Weight management, physical activity, and smoking avoidance postdiagnosis may attenuate that trend.
AB - Background: Multimorbidity is associated with premature mortality and excess health care costs. The burden of multimorbidity is highest among patients with cancer, yet trends and determinants of multimorbidity over time are poorly understood. Methods: Via Medicare claims linked to Cancer Prevention Study II data, group-based trajectory modeling was used to compare National Cancer Institute comorbidity index score trends for cancer survivors and older adults without a cancer history. Among cancer survivors, multinomial logistic regression analyses evaluated associations between demographics, health behaviors, and comorbidity trajectories. Results: In 82,754 participants (mean age, 71.6 years [SD, 5.1 years]; 56.9% female), cancer survivors (n = 11,265) were more likely than older adults without a cancer history to experience the riskiest comorbidity trajectories: (1) steady, high comorbidity scores (remain high; odds ratio [OR], 1.36; 95% CI, 1.29–1.45), and (2) high scores that increased over time (start high and increase; OR, 1.51; 95% CI, 1.38–1.65). Cancer survivors who were physically active postdiagnosis were less likely to fall into these two trajectories (OR, 0.73; 95% CI, 0.64–0.84, remain high; OR, 0.42; 95% CI, 0.33–0.53, start high and increase) compared to inactive survivors. Cancer survivors with obesity were more likely to have a trajectory that started high and increased (OR, 2.83; 95% CI, 2.32–3.45 vs. normal weight), although being physically active offset some obesity-related risk. Cancer survivors who smoked postdiagnosis were also six times more likely to have trajectories that started high and increased (OR, 6.86; 95% CI, 4.41–10.66 vs. never smokers). Conclusions: Older cancer survivors are more likely to have multiple comorbidities accumulated at a faster pace than older adults without a history of cancer. Weight management, physical activity, and smoking avoidance postdiagnosis may attenuate that trend.
KW - Medicare claims data
KW - cancer survivors
KW - multimorbidity
KW - postdiagnosis health behaviors
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U2 - 10.1002/cncr.35047
DO - 10.1002/cncr.35047
M3 - Article
C2 - 37837241
AN - SCOPUS:85174024746
SN - 0008-543X
VL - 130
SP - 312
EP - 321
JO - Cancer
JF - Cancer
IS - 2
ER -