- Design
- Secondary analysis of a randomised trial cohort using latent class analysis
- Population
- 16,095 community-dwelling adults aged 70 or over (mean age 75.3)
- Primary outcome
- All-cause mortality by multimorbidity cluster over median 10.85 years
- Effect
- Frailty, depression and osteoporosis cluster aHR 1.56 (1.40 to 1.73) men; 1.68 (1.49 to 1.89) women
This secondary analysis of the ASPREE trial included 16,095 Australians aged 70 or over without prior dementia or cardiovascular disease, 88.3% of whom had multimorbidity at baseline. Latent class analysis of 15 chronic conditions found five clusters overall; there were 4,217 deaths over a median 10.85 years.
The clusters were hypertension and dyslipidaemia (52.1%), gout and metabolic (14.4%), depressive symptoms with osteoporosis and frailty (10.0%), anaemia and kidney disease (10.2%), and hypotension with thyroid disease and past cancer (13.3%). The frailty, depression and osteoporosis cluster carried higher mortality in both sexes (adjusted HR 1.56, 95% CI 1.40 to 1.73 in men; 1.68, 1.49 to 1.89 in women). Clusters with gout and kidney disease also carried higher mortality, notably in women (adjusted HR 1.96, 1.74 to 2.21).
The authors call the findings hypothesis-generating. The trial population was selected for good health and Australian, and clusters were derived from baseline data only.
- Frailty, depressive symptoms and osteoporosis occurring together flagged higher mortality in both sexes.
- Gout with kidney disease and anaemia also marked higher mortality, especially in women.
- Look for the cluster rather than counting conditions.
- Use as a prompt for review, not a prognostic tool.
Why it matters
It suggests that which conditions cluster tells you more about risk than how many an older person has.
Don't overread it
Hypothesis-generating clusters from a relatively healthy trial population; not validated as a clinical risk tool.
The statistics, in plain English
Latent class analysis groups people by which conditions tend to appear together, but the groups are statistical constructs that may differ in another population. A hazard ratio of 1.68 means about two thirds higher mortality than the reference cluster over follow-up.
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