Original article
Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly)

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Abstract

Older males are known to carry, more likely than younger people, one or more chronic diseases with an expected impact on mortality. This study was aimed at identifying the relationship of prevalent chronic diseases in elderly populations of different countries with all-cause mortality. Men aged 65–84 from defined areas were enrolled in Finland (N=716), the Netherlands (N=887) and Italy (N=682). They were survivors of cohorts studied for 25 years within the Seven Countries Study. Major chronic diseases were diagnosed at entry. Ten-year follow-up for mortality was completed. Entry prevalence of selected chronic diseases was higher in Finland (56%) than in Italy (51%) and the Netherlands (44%). Ten-year age-adjusted death rates from all causes were higher in Finland (565 per 1000) and lower in the Netherlands (478 per 1000) and Italy (445 per 1000). The absolute risk of death related to chronic disease was high in the three countries, but was higher in Finland than in the Netherlands and Italy. The most lethal condition was stroke, with 10-year death rates of 806 per 1000 in Finland and 707 and 729 per 1000 in the Netherlands and Italy, respectively. The relative risk of all-cause mortality for a set of seven chronic diseases (coronary heart disease, heart failure, claudicatio intermittens, cerebrovascular accidents, diabetes, COPD and cancer) adjusted by age, other diseases and cohort was less than two for each condition, except cerebrovascular accidents in the Netherlands (RR 2.20). In general, relative risk was higher in Finland, intermediate in the Netherlands and lower in Italy, where only cerebrovascular accidents, intermittent claudication, diabetes and the presence of any chronic condition had a significant relative risk. About one third of men had one chronic disease, and between 10% and 15% had two diseases. The coexistence of any two or three chronic conditions was associated with a relative risk of 2 or more in Finland and the Netherlands and less than 2 in Italy. In these elderly men prevalent morbidity and comorbidity was relatively common and it explained a large proportion of excess in all-cause mortality in 10 years of follow-up.

Introduction

The study of elderly cohorts has become relatively common during recent years, in relation with the interest in these strata of the population, whose numerical and social importance are increasing. Prolongation of life expectancy, prevention and/or delayed occurrence of chronic diseases and an improvement of their prognosis are receiving increasing attention in public health research.

Within the Seven Countries Study of Cardiovascular Diseases 1, 2, 3 five cohorts (two in Finland, two in Italy and one in the Netherlands) joined a new study on the elderly that started in the mid-1980s, in coincidence with the 25-year anniversary examination. At that time men were aged 65 to 84 years. The adopted baseline field examination of this new study was followed by collection of mortality data for 10 years.

Reports on 5- and 10-year mortality experience as a function of cardiovascular risk factors have been published 4, 5 or submitted. The purpose of the present analysis was to investigate another aspect of the problems among the elderly (i.e., the prevalence of some major chronic diseases) and its relevance in conditioning the expectancy of life. The age range at entry examination (65–84 years) covers, in most European populations, about 95% of all men aged 65 or more. In addition, the interest of this analysis is bound to the possibility to describe the disease–mortality relationship in cohorts of three countries differing in prevalence of chronic disease and mortality.

We hypothesized that major chronic diseases in these aged populations are important determinants of all-cause mortality and that the coexistence of more diseases in the same individual (multimorbidity) could represent an extra risk for mortality. Therefore, by multimorbidity we mean a combination of several diseases, without a single focal disease as reference.

Section snippets

Methods

The FINE study represents an extension of the Seven Countries Study of Cardiovascular Diseases beyond the deadline of 25 years. It includes the two rural Finnish cohorts known as East Finland (EF) and West Finland (WF), the Dutch cohort from the small town of Zutphen (ZU), and the two rural cohorts located in the villages of Crevalcore (CR) and Montegiorgio (MO), in northern and central Italy, respectively.

The original Seven Countries Study started in the late 1950s and early 1960s with the

Prevalence of chronic diseases

Age-adjusted prevalence rates per 100 for single and combined groups of diseases are given in Table 1. The statistical difference between each pair of rates in comparing countries is also reported in Table 1.

The Finnish cohorts had the highest rates for all conditions except heart failure, diabetes mellitus and COPD, which were more prevalent in Italy than in the other cultures, although the differences for heart failure and diabetes mellitus were not statistically significant. The cohort in

Discussion

Prevalence of a selection of chronic diseases is high in these population samples, although different among them. A higher prevalence from coronary heart disease and cardiovascular diseases in Finland was expected on the basis of previous long-term experience during the early periods of follow-up in the Seven Countries Study 2, 3. However, cancer and diabetes mellitus are also commonly prevalent in Finland, whereas COPD is more common in Italy.

Higher all-cause death rates in Finland, compared

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