Abstract
ObjectivesThis study aims to estimate the losses of quality-adjusted life expectancy (QALE) due to the joint effects of cognitive impairment and multimorbidity, and to further confirm additional losses attributable to this interaction among middle-aged and elderly Chinese people.MethodsThe National Cause of Death Monitoring Data were linked with the China Health and Retirement Longitudinal Study (CHARLS). A mapping and assignment method was used to estimate health utility values, which were further used to calculate QALE. Losses of QALE were measured by comparing the differences between subgroups. All the losses of QALE were displayed at two levels: the individual and population levels.ResultsAt age 45, the individual-level and population-level losses of QALE attributed to the combination of cognitive impairment and multimorbidity were 7.61 (95% CI: 5.68, 9.57) years and 4.30 (95% CI: 3.43, 5.20) years, respectively. The losses for cognitive impairment alone were 3.10 (95% CI: 2.29, 3.95) years and 1.71 (95% CI: 1.32, 2.13) years at the two levels. Similarly, the losses for multimorbidity alone were 3.53 (95% CI: 2.53, 4.56) years and 1.91 (95% CI: 1.24, 2.63) years at the two levels. Additional losses due to the interaction of cognitive impairment and multimorbidity were indicated by the 0.98 years of the individual-level gap and 0.67 years of the population-level gap.ConclusionAmong middle-aged and elderly Chinese people, cognitive impairment and multimorbidity resulted in substantial losses of QALE, and additional QALE losses were seen due to their interaction at both individual and population levels.
Highlights
Age-associated cognitive impairment is a transitional link between healthy ageing and dementia, featuring declines in memory, attention, and cognitive function, with a 10% conversion rate from impaired status to the diagnosis of dementia [1]
Based on the availability of the China Health and Retirement Longitudinal Study (CHARLS) data, this study aims to 1) estimate the losses of Quality-adjusted life expectancy (QALE) attributed to the combination of cognitive impairment and multimorbidity at both the individual and population levels; and 2) confirm the additional losses of QALE due to the interaction of cognitive impairment and multimorbidity
Characteristics of participants According to the receiver operating characteristic (ROC) curve results, the optimal cut-off value for judging cognitive impairment was 8.25, and the AUC for this value was 0.613
Summary
Age-associated cognitive impairment is a transitional link between healthy ageing and dementia, featuring declines in memory, attention, and cognitive function, with a 10% conversion rate from impaired status to the diagnosis of dementia [1]. A largesample, multi-region study showed that the prevalence of total dementia in the population aged 65 years and older in China was approximately 5 % in 2019 [3]. Multimorbidity, which is defined as the cooccurrence of two or more chronic diseases in an individual, is widely observed beyond two-thirds of older adults [9, 10]. Multimorbidity was defined as the total number of self-reported chronic conditions we could collect, except for memory-related problems to avoid overlapping estimates. Many clinical studies have suggested that older adults with at least two diseases are more susceptible to developing cognitive impairment, than those without multimorbidity [11,12,13,14,15]. The hypothesis that multimorbidity may increase the risk of cognitive impairment has been verified in population-based studies [16,17,18,19]
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