The role of multimorbidity in short-term mortality of lung cancer patients in Spain: a population-based cohort study.
AIM
Chronic diseases often occur simultaneously and tend to be associated with adverse health outcomes, but limited research has been undertaken to understand their role in lung cancer mortality. Therefore, this study aims to describe the prevalence and patterns of having one (comorbidity) or ≥ 2 chronic diseases (multimorbidity) among lung cancer patients in Spain, and to examine the association between comorbidity or multimorbidity and short-term mortality risk at six months after cancer diagnosis.


METHODS
In this population-based cohort study, data were drawn from two Spanish population-based cancer registries, Girona and Granada, and electronic health records. We identified 1259 adult lung cancer patients, diagnosed from 1st January 2011 to 31st December 2012. We identified the most common patterns of individual comorbidities and their pairwise correlations. We used a flexible parametric modelling approach to assess the overall short-term mortality risk 6 months after cancer diagnosis by levels of comorbidity after adjusting for age, sex, smoking status, province of residence, surgery, cancer stage, histology, and body mass index.


RESULTS
We found high prevalence of comorbidity in lung cancer patients, especially among the elderly, men, those diagnosed with advanced-stage tumours, smokers, and obese patients. The most frequent comorbidities were chronic obstructive pulmonary disease (36.6%), diabetes (20.7%) and heart failure (16.8%). The strongest pairwise correlation was the combination of heart failure with renal disease (r = 0.20, p < 0.01), and heart failure with diabetes (r = 0.16, p < 0.01). Patients with either one or two or more comorbidities had 40% higher overall mortality risk than those without comorbidities (aHR for comorbidity: 1.4, 95%CI: 1.1-1.7; aHR for multimorbidity: 1.4, 95%CI: 1.1-1.8), when relevant confounding factors were considered.


CONCLUSIONS
The presence of comorbid diseases, rather than the number of comorbidities, was associated with increasing the risk of short-term lung cancer mortality in Spain. Comorbidity was a consistent and independent predictor of mortality among lung cancer patients, six months after diagnosis. The most common comorbid conditions were age-, obesity- and tobacco-related diseases. Our findings highlight the need to develop targeted preventive interventions and more personalised clinical guidelines to address the needs of lung cancer patients with one or more comorbidities in Spain.
['Niksic|Maja|M|', 'Redondo-Sanchez|Daniel|D|', 'Chang|Yoe-Ling|YL|', 'Rodriguez-Barranco|Miguel|M|', 'Exposito-Hernandez|Jose|J|', 'Marcos-Gragera|Rafael|R|', 'Oliva-Poch|Ester|E|', 'Bosch-Barrera|Joaquim|J|', 'Sanchez|Maria-Jose|MJ|', 'Luque-Fernandez|Miguel Angel|MA|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D002908:Chronic Disease D015331:Cohort Studies D015897:Comorbidity D003920:Diabetes Mellitus D057286:Electronic Health Records D005260:Female D006333:Heart Failure D006801:Humans D007674:Kidney Diseases D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D000076322:Multimorbidity D009765:Obesity D015995:Prevalence D029424:Pulmonary Disease, Chronic Obstructive D012042:Registries D012737:Sex Factors D013030:Spain D013997:Time Factors D014029:Tobacco Use Disorder
Multimorbidity Mortality Comorbidity Lung neoplasms cancer epidemiology