TY - JOUR T1 - Multimorbidity and associations with clinical outcomes in a middle-aged population in Iran: a longitudinal cohort study JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-007278 VL - 7 IS - 5 SP - e007278 AU - Maria Lisa Odland AU - Samiha Ismail AU - Sadaf G Sepanlou AU - Hossein Poustchi AU - Alireza Sadjadi AU - Akram Pourshams AU - Tom Marshall AU - Miles D Witham AU - Reza Malekzadeh AU - Justine I Davies Y1 - 2022/05/01 UR - http://gh.bmj.com/content/7/5/e007278.abstract N2 - Background As the populations of lower-income and middle-income countries age, multimorbidity is increasing, but there is little information on its long-term consequences. We aimed to show associations between multimorbidity and outcomes of mortality and hospitalisation in Iran, a middle-income country undergoing rapid economic transition.Methods We conducted a secondary analysis of longitudinal data collected in the Golestan Cohort Study. Data on demographics, morbidities and lifestyle factors were collected at baseline, and information on hospitalisations or deaths was captured annually. Logistic regression was used to analyse the association between baseline multimorbidity and 10-year mortality, Cox-proportional hazard models to measure lifetime risk of mortality and zero-inflation models to investigate the association between hospitalisation and multimorbidity. Multimorbidity was classified as ≥2 conditions or number of conditions. Demographic, lifestyle and socioeconomic variables were included as covariables.Results The study recruited 50 045 participants aged 40–75 years between 2004 and 2008, 47 883 were available for analysis, 416 (57.3%) were female and 12 736 (27.94%) were multimorbid. The odds of dying at 10 years for multimorbidity defined as ≥2 conditions was 1.99 (95% CI 1.86 to 2.12, p<0.001), and it increased with increasing number of conditions (OR of 3.57; 95% CI 3.12 to 4.08, p<0.001 for ≥4 conditions). The survival analysis showed the hazard of death for those with ≥4 conditions was 3.06 (95% CI 2.74 to 3.43, p<0.001). The number of hospital admissions increased with number of conditions (OR of not being hospitalised of 0.36; 95% CI 0.31 to 0.52, p<0.001, for ≥4 conditions).Conclusion The long-terms effects of multimorbidity on mortality and hospitalisation are similar in this population to those seen in high-income countries.Data are available on reasonable request. Information about the study design, updated interim analyses, ongoing substudies and relevant publications are available at www.ddrc.ac.ir. Specific proposals for national and international collaborations are welcomed. Initial proposals, which include the aim of the proposed study, the required data and a time-table, should be submitted to RM (ri.ca.sma@kelam) or PB (rf.crai@atteffob). The proposals will be discussed within the steering committee, which includes the principal investigators of the study and, if necessary, other experts according to the proposal’s theme. ER -