Onset and Progression to Multimorbidity over up to 19 Years of Follow-up: Sentinel Conditions, Accrual Patterns, and Timing in Older Europeans

Marcelo Pereira de Souza Fleury , European Doctoral School of Demography (EDSD)
Solveig A Cunningham, Netherlands Interdisciplinary Demographic Institute and Emory University

Non-communicable diseases are the leading causes of morbidity and mortality in middle- and high-income countries. Most multimorbidity research continues to emphasize prevalence, while incidence has been examined in relatively few studies. Yet incidence captures the dynamics and timing of disease accumulation, showing when people are most at risk of adding a new condition and when interventions could delay progression to multimorbidity. We used nine waves (2004-2022) of the Survey of Health, Ageing and Retirement in Europe (SHARE) to follow 15,573 adults aged 50+ in 11 countries who, at baseline, had zero or one doctor-diagnosed chronic condition. We identified the first - or sentinel - diagnosed disease and tracked subsequent transitions to multimorbidity for up to 19 years. Chronic conditions covered major cardiometabolic, musculoskeletal and neurodegenerative diseases. Roughly two-thirds of those who were disease-free at baseline developed a first condition and 40% became multimorbid; among those entering with one condition, around two-thirds progressed to multimorbidity. Median time to multimorbidity was about 8 years for those disease-free and 4 years for those with one condition. Cumulative incidence functions showed a consistent difference: the median age at multimorbidity was 9-11 years earlier for adults with one condition than for those disease-free in each age group (50-59, 60-69, 70+). Multimorbidity most often arose after cardiometabolic and musculoskeletal sentinel conditions, especially hypertension and arthritis, whereas neurodegenerative sentinels were more often followed by death. This study shows when multimorbidity emerges fastest and which groups to prioritise, supporting earlier and more integrated responses.

See extended abstract

 Presented in Session 10. Non-Communicable Diseases and Cardio-Metabolic Health