Palabras clave
Noncommunicable chronic diseases
Mortality
Multimorbilidad
Enfermedades crónicas no transmisibles
Mortalidad
Cómo citar
Resumen
Objetivo: Estimar la prevalencia de multimorbilidad por enfermedades crónicas no transmisibles, la prevalencia de pares y tríadas de estas enfermedades y el respectivo riesgo de mortalidad asociado en adultos mayores de Costa Rica. Métodos: Los datos pertenecen al estudio Costa Rica: Estudio de Longevidad y Envejecimiento Saludable, un estudio longitudinal representativo a nivel nacional de 2,831 costarricenses de 60 años o más en 2005. Se estimaron modelos de Gompertz (ajustados por factores sociodemográficos, comportamientos relacionados con la salud y estatus funcional) para analizar la asociación de la multimorbilidad con la mortalidad por todas las causas entre 2005 y 2009. La población estudiada consiste en 2,565 personas con información en todas las variables de interés en la línea basal. Resultados: La prevalencia de multimorbilidad fue 42,6%. Los pares de enfermedades crónicas más frecuentes combinan hipertensión con diabetes, cardiopatía coronaria, enfermedades respiratorias, artritis y osteoporosis (14%, 10%, 9%, 7% y 6%, respectivamente). Las tríadas más frecuentes son diabetes-hipertensión-enfermedades respiratorias (3%) y diabetes-hipertensión-cardiopatía coronaria (3%). La multimorbilidad incrementa 64% el riesgo de muerte, si no se ajusta por limitaciones funcionales, y 37% ajustando por ellas. Las siguientes combinaciones incrementan el riesgo de muerte, comparando con personas sin estas combinaciones de enfermedades al inicio del estudio: diabetes-hipertensión (49%); cáncer-enfermedades respiratorias, diabetes-cardiopatía coronaria, y diabetes-apoplejía (100%); cáncer-hipertensión y cáncer-diabetes (200%); diabetes-hipertensión-cardiopatía coronaria y diabetes-hipertensión-osteoporosis (100%). Conclusión: Es necesario desarrollar estrategias para hacer frente a la carga que la multimorbilidad, especialmente a multimorbilidad cardiometabólica, impone a los individuos y al sistema de salud.
Citas
Almirall, J., & Fortin, M. (2013). The coexistence of terms to describe the presence of multiple concurrent diseases. Journal of Comorbidity, 3, 4–9. https://doi.org/10.15256/joc.2013.3.22
Arokiasamy, P., Uttamacharya, U., Jain, K., Biritwum, R. B., Yawson, A. E., Wu, F., Guo, Y., Maximova, T., Espinoza, B. M., Rodríguez, A. S., Afshar, S., Pati, S., Ice, G., Banerjee, S., Liebert, M. A., Snodgrass, J. J., Naidoo, N., Chatterji, S., & Kowal, P. (2015). The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?. BMC Medicine, 13, 178. https://doi.org/10.1186/s12916-015-0402-8
Bezzina, C., & Pope, L. (2023). Multimorbidity and the need to rethink medical education. Journal of Multimorbidity and Comorbidity, 13, 26335565231207811. https://doi.org/10.1177/26335565231207811
Bloom, D. E., Chen, S., & McGovern, M. E. (2018). The economic burden of noncommunicable diseases and mental health conditions: results for Costa Rica, Jamaica, and Peru. Pan American Journal of Public Health, 42, e18. https://doi.org/10.26633/RPSP.2018.18
Calderón, A., Guzmán, P., & Murphy, J. D. (2023). Epidemiological patterns of common cancers in Costa Rica: an overview up to 2020. Open Journal of Social Sciences, 11(6), 500–517. https://doi.org/10.4236/jss.2023.116033
Carr, P. R., Webb, K. L., Neumann, J. T., Thao, Le T. P., Beilin, L. J., Ernst, M. E., Fitzgibbon, B., Gasevic, D., Nelson, M. R., Newman, A. B., Orchard, S. G., Owen, A., Reid, C. M., Stocks, N., Tonkin, A. M., Woods, R. L., & McNeil, J. J. (2023). Associations of body size with all-cause and cause-specific mortality in healthy older adults. Scientific Reports, 13, 3799. https://doi.org/10.1038/s41598-023-29586-w
Cuccia, L., Chadwick, J., Hassan, A., Kim, A., Sivarajan, R., & Wong, V. (2019). Costa Rica’s health care reform: impact and success of the EBAIS model. McGill Journal of Global Health, III (Spring). https://mghjournal.com/wp-content/uploads/2019/07/costa-ricas-health-care-report_ebais-model_luca-cuccia-et-al..pdf
DuGoff, E. H., Canudas-Romo, V., Buttorff, C., Leff, B., & Anderson, G. F. (2014). Multiple chronic conditions and life expectancy: a life table analysis. Medical Care, 52(8), 688–694. https://doi.org/10.1097/MLR.0000000000000166
Emerging Risk Factors Collaboration, Sarwar, N., Gao, P., Seshasai, S. R., Gobin, R., Kaptoge, S., Di Angelantonio, E., Ingelsson, E., Lawlor, D. A., Selvin, E., Stampfer, M., Stehouwer, C. D., Lewington, S., Pennells, L., Thompson, A., Sattar, N., White, I. R., Ray, K. K., & Danesh, J. (2010). Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet (London, England), 375(9733), 2215–2222. https://doi.org/10.1016/S0140-6736(10)60484-9
Eriksson, M., Norrving, B., Terént, A., & Stegmayr, B. (2008). Functional outcome 3 months after stroke predicts long-term survival. Cerebrovascular Diseases (Basel, Switzerland), 25(5), 423–429. https://doi.org/10.1159/000121343
Ferrer, A., Formiga, F., Sanz, H., Almeda, J., & Padrós, G. (2017). Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study. Clinical Interventions in Aging, 12, 223–231. https://doi.org/10.2147/CIA.S123173
Fortin, M., Haggerty, J., Sanche, S., & Almirall, J. (2017). Self-reported versus health administrative data: implications for assessing chronic illness burden in populations. A cross-sectional study. CMAJ Open, 5(3), E729–E733. https://doi.org/10.9778/cmajo.20170029
Fukushima, N., Kikuchi, H., Sato, H., Sasai, H., Kiyohara, K., Sawada, S. S., Machida, M., Amagasa, S., & Inoue, S. (2024). Dose-response relationship of physical activity with all-cause mortality among older adults: an umbrella review. Journal of the American Medical Directors Association, 25(3), 417–430. https://doi.org/10.1016/j.jamda.2023.09.028
Guisado-Clavero, M., Roso-Llorach, A., López-Jimenez, T., Pons-Vigués, M., Foguet-Boreu, Q., Muñoz, M. A., & Violán, C. (2018). Multimorbidity patterns in the elderly: a prospective cohort study with cluster analysis. BMC Geriatrics, 18(1), 16. https://doi.org/10.1186/s12877-018-0705-7
Holzer, B. M., Siebenhuener, K., Bopp, M., & Minder, C. E. (2017). Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates. Population Health Metrics, 15(1), 9. https://doi.org/10.1186/s12963-017-0126-4
IHME-CHAIN Collaborators (2024). Effects of education on adult mortality: a global systematic review and meta-analysis. The Lancet. Public Health, 9(3), e155–e165. https://doi.org/10.1016/S2468-2667(23)00306-7
Jani, B. D., Hanlon, P., Nicholl, B. I., McQueenie, R., Gallacher, K. I., Lee, D., & Mair, F. S. (2019). Relationship between multimorbidity, demographic factors and mortality: findings from the UK Biobank cohort. BMC Medicine, 17(1), 74. https://doi.org/10.1186/s12916-019-1305-x
Jiang, L., Zhang, B., Smith, M. L., Lorden, A. L., Radcliff, T. A., Lorig, K., Howell, B. L., Whitelaw, N., & Ory, M. G. (2015). Concordance between self-reports and Medicare claims among participants in a National Study of Chronic Disease Self-Management Program. Frontiers in Public Health, 3, 222. https://doi.org/10.3389/fpubh.2015.00222
Jiménez Herrera, L. G., & Fernández Rojas, X. (2008). Caracterización del uso de medicamentos en personas adultas mayores, Costa Rica 2007. Revista Costarricense de Salud Pública, 17(33), 47-55. http://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S1409-14292008000200009&lng=en&tlng=es
Juckett, D. A., & Rosenberg, B. (1993). Comparison of the Gompertz and Weibull functions as descriptors for human mortality distributions and their intersections. Mechanisms of Ageing and Development, 69(1-2), 1–31. https://doi.org/10.1016/0047-6374(93)90068-3
Kivimäki, M., Kuosma, E., Ferrie, J. E., Luukkonen, R., Nyberg, S. T., Alfredsson, L., Batty, G. D., Brunner, E. J., Fransson, E., Goldberg, M., Knutsson, A., Koskenvuo, M., Nordin, M., Oksanen, T., Pentti, J., Rugulies, R., Shipley, M. J., Singh-Manoux, A., Steptoe, A., Suominen, S. B., … Jokela, M. (2017). Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. The Lancet. Public Health, 2(6), e277–e285. https://doi.org/10.1016/S2468-2667(17)30074-9
Klopack, E. T., Carroll, J. E., Cole, S. W., Seeman, T. E., & Crimmins, E. M. (2022). Lifetime exposure to smoking, epigenetic aging, and morbidity and mortality in older adults. Clinical Epigenetics, 14(1), 72. https://doi.org/10.1186/s13148-022-01286-8
Lam, A., Keenan, K., Cézard, G., Kulu, H., & Myrskylä, M. (2024). Inequalities in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 79(8), gbae093. https://doi.org/10.1093/geronb/gbae093
Lefèvre, T., d’Ivernois, J., De Andrade, V., Crozet, C., Lombrail, P., & Gagnayre, R. (2014). What do mean by multimorbidity? An analysis of the literature on multimorbidity measure, associated factors, and impact on health services organization. Revue d'Épidémiologie et de Santé Publique, 62, 305-314.
Medellín, N., Maleš, P. J., & Matus-López, M. (2019). Envejecimiento y atención a la dependencia en Costa Rica. Washington, DC: Inter-American Development Bank; 2019. http://dx.doi.org/10.18235/0002035
Miranda, J. J., Bernabe-Ortiz, A., Gilman, R. H., Smeeth, L., Malaga, G., Wise, R. A., Checkley, W., & CRONICAS Cohort Study Group (2019). Multimorbidity at sea level and high-altitude urban and rural settings: The CRONICAS Cohort Study. Journal of Comorbidity, 9, 2235042X19875297. https://doi.org/10.1177/2235042X19875297
Ministry of Health (2021). Costa Rica. Ministerio de Salud. Estrategia Nacional de Abordaje Integral de las Enfermedades No Transmisibles y Obesidad 2022-2030 - San José, Costa Rica: El Ministerio 2021. https://www.iccp-portal.org/system/files/plans/estrategia_nacional_abordaje_integral_2022_2030.pdf
Ministry of Health. (2019). Análisis de la situación integral en salud. Ministerio de Salud.
Ministry of Health. (2018). Estrategia Nacional para un envejecimiento saludable basado en el curso de vida 2018-2020 (1st ed). Ministerio de Salud; 2018.
National Archive of Computerized Data on Aging. (2013). CRELES: Costa Rica Estudio de Longevidad y Envejecimiento Saludable, 2005. https://www.icpsr.umich.edu/icpsrweb/NACDA/studies/26681/version/2
Navarro-Ureña, I., Evans-Meza, R., Bonilla, R., & Alvarado-Rodríguez, Y. (2019). Evolución de la mortalidad por edad, sexo, causas y distribución geográfica en personas de 65 o más años en Costa Rica, 1970-2014. Revista Hispanoamericana de Ciencias de la Salud, 4(4), 131-142. https://www.uhsalud.com/index.php/revhispano/article/view/380
NCD Risk Factor Collaboration (NCD-RisC) (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet (London, England), 398(10304), 957–980. https://doi.org/10.1016/S0140-6736(21)01330-1
Nunes, B. P., Flores, T. R., Mielke, G. I., Thumé, E., & Facchini, L. A. (2016). Multimorbidity and mortality in older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 67, 130–138. https://doi.org/10.1016/j.archger.2016.07.008
Onder, G., Palmer, K., Navickas, R., Jurevičienė, E., Mammarella, F., Strandzheva, M., Mannucci, P., Pecorelli, S., Marengoni, A., & Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) (2015). Time to face the challenge of multimorbidity. A European perspective from the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS). European Journal of Internal Medicine, 26(3), 157–159. https://doi.org/10.1016/j.ejim.2015.02.020
Ording, A. G., & Sørensen, H. T. (2013). Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs. Clinical Epidemiology, 5, 199–203. https://doi.org/10.2147/CLEP.S45305
Pabón-Páramo, C. A. (2020). Actualización en la prevalencia y carga de la enfermedad cerebrovascular en Costa Rica en el período comprendido entre 2009-2019. Revista Médica de Costa Rica, 86(630), 6-15. https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=101650
Palloni, A., Beltrán-Sánchez, H., Novak, B., Pinto, G., & Wong, R. (2015). Adult obesity, disease and longevity in Mexico. Salud Publica de Mexico, 57 Suppl 1(0 1), S22–S30. https://doi.org/10.21149/spm.v57s1.7586
Ricklefs, R. E., & Scheuerlein, A. (2002). Biological implications of the Weibull and Gompertz models of aging. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57(2), B69–B76. https://doi.org/10.1093/gerona/57.2.b69
Roman Lay, A. A., Ferreira do Nascimento, C., Caba Burgos, F., Larraín Huerta, A. D. C., Rivera Zeballos, R. E., Pantoja Silva, V., & Duarte, Y. A. O. (2020). Gender differences between multimorbidity and all-cause mortality among older adults. Current Gerontology and Geriatrics Research, 2020, 7816785. https://doi.org/10.1155/2020/7816785
Sánchez-Sánchez, J. L., Lu, W. H., Gallardo-Gómez, D., Del Pozo Cruz, B., de Souto Barreto, P., Lucia, A., & Valenzuela, P. L. (2024). Association of intrinsic capacity with functional decline and mortality in older adults: a systematic review and meta-analysis of longitudinal studies. The lancet. Healthy Longevity, 5(7), e480–e492. https://doi.org/10.1016/S2666-7568(24)00092-8
Salive, M. E. (2013). Multimorbidity in older adults. Epidemiologic Reviews, 35, 75–83. https://doi.org/10.1093/epirev/mxs009
Santamaría-Ulloa, C., & Montero-López, M. (2020). Projected impact of diabetes on the Costa Rican healthcare system. International Journal for Equity in Health, 19(1), 172. https://doi.org/10.1186/s12939-020-01291-4
Santamaría-Ulloa, C., Montero-López, M., & Rosero-Bixby, L. (2019). Diabetes epidemics: inequalities increase the burden on the healthcare system. Health Policy and Planning, 34(Supplement_2), ii45–ii55. https://doi.org/10.1093/heapol/czz109
Sinnige, J., Braspenning, J., Schellevis, F., Stirbu-Wagner, I., Westert, G., & Korevaar, J. (2013). The prevalence of disease clusters in older adults with multiple chronic diseases – A systematic literature review. PLoS One, 8(11), e79641, doi:10.1371/journal.pone.0079641
Singh-Manoux, A., Fayosse, A., Sabia, S., Tabak, A., Shipley, M., Dugravot, A., & Kivimäki, M. (2018). Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: a cohort study. PLoS Medicine, 15(5), e1002571. https://doi.org/10.1371/journal.pmed.1002571
St John, P. D., Tyas, S. L., Menec, V., & Tate, R. (2014). Multimorbidity, disability, and mortality in community-dwelling older adults. Medecin de Famille Canadien, 60(5), e272–e280
Storeng, S. H., Vinjerui, K. H., Sund, E. R., & Krokstad, S. (2020). Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway. BMC Geriatrics, 20(1), 21. https://doi.org/10.1186/s12877-020-1425-3
Sun, M., Wang, L., Wang, X., Tong, L., Jin, L., & Li, B. (2023). Trends and all-cause mortality associated with multimorbidity of non-communicable diseases among adults in the United States, 1999-2018: a retrospective cohort study. Epidemiology and Health, 45, e2023023. https://doi.org/10.4178/epih.e2023023
University of Costa Rica Central American Population Center, University of Costa Rica Vice Rector's Office for Social Action. Integral Program for the Elderly, Costa Rica National Council for the Elderly, Costa Rica, Brenes Camacho, G., Masís Fernández, K. G., & Rapso Brenes, M. (2020). II Informe estado de situación de la persona adulta mayor en Costa Rica. [San José, Costa Rica]: Universidad de Costa Rica. https://archivo.cepal.org/pdfs/ebooks/segundo_Informe_estado_persona_adulta_mayor_CostaRica.pdf
Vancampfort, D., Stubbs, B., & Koyanagi, A. (2017). Physical chronic conditions, multimorbidity and sedentary behavior amongst middle-aged and older adults in six low- and middle-income countries. The International Journal of Behavioral Nutrition and Physical Activity, 14(1), 147. https://doi.org/10.1186/s12966-017-0602-z
Wang, L., & Yi, Z. (2023). Marital status and all-cause mortality rate in older adults: a population-based prospective cohort study. BMC Geriatrics, 23(1), 214. https://doi.org/10.1186/s12877-023-03880-8
Wong-McClure, R. (2016). Vigilancia de los factores de riesgo cardiovascular, segunda encuesta 2014. http://hdl.handle.net/20.500.11764/628
Wong-McClure, R., Gregg, E. W., Barcelo, A., Sanabria-Lopez, L., Lee, K., Abarca-Gomez, L., Cervantes-Loaiza, M., & Luman, E. T. (2016). Prevalence of diabetes and impaired fasting glucose in Costa Rica: Costa Rican National Cardiovascular Risk Factors Survey, 2010. Journal of Diabetes, 8(5), 686–692. https://doi.org/10.1111/1753-0407.12348
World Health Organization (WHO) (2015). World report on ageing and health. https://iris.who.int/bitstream/handle/10665/186463/9789240694811_eng.pdf?sequence=1
World Health Organization (WHO) (2018). For individuals and households seeking care, NCDs impose significant financial costs. https://iris.who.int/bitstream/handle/10665/272534/WHO-NMH-NVI-18.8-eng.pdf?sequence=1
Yang, Y., Du, Z., Liu, Y., Lao, J., Sun, X., & Tang, F. (2021). Disability and the risk of subsequent mortality in elderly: a 12-year longitudinal population-based study. BMC Geriatrics, 21(1), 662. https://doi.org/10.1186/s12877-021-02611-1
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