Multidimensional Prognostic Index in Association with Future Mortality and Number of Hospital Days in a Population-Based Sample of Older Adults: Results of the EU Funded MPI_AGE Project

<div><p>Background</p><p>The Multidimensional Prognostic Index (MPI) has been found to predict mortality in patients with a variety of clinical conditions. We aimed to assess the association of the MPI with future mortality and number of in-hospital days for the first time in a population-based cohort.</p><p>Methods</p><p>The study population consisted of 2472 persons, aged 66–99 years, from the Swedish National Study on Aging and Care in Kungsholmen, Sweden, who underwent the baseline visit 2001–4, and were followed up >10 years for in-hospital days and >12 years for mortality. The MPI was a modified version of the original and aggregated seven domains (personal and instrumental activities of daily living, cognitive function, illness severity and comorbidity, number of medications, co-habitation status, and nutritional status). The MPI score was divided into risk groups: low, medium and high. Number of in-hospital days (within 1, 3 and 10 years) and mortality data were derived from official registries. All analyses were age-stratified (sexagenarians, septuagenarians, octogenarians, nonagenarians).</p><p>Results</p><p>During the follow-up 1331 persons (53.8%) died. Laplace regression models, suggested that median survival in medium risk groups varied by age from 2.2–3.6 years earlier than for those in the corresponding low risk groups (p = 0.002-p<0.001), and median survival in high risk groups varied by age from 3.8–9.0 years earlier than for corresponding low risk groups (p<0.001). For nonagenarians, the median age at death was 3.8 years earlier in the high risk group than for the low risk group (p<0.001). The mean number of in-hospital days increased significantly with higher MPI risk score within 1 and 3 years for people of each age group.</p><p>Conclusion</p><p>For the first time, the effectiveness of MPI has been verified in a population-based cohort. Higher MPI risk scores associated with more days in hospital and with fewer years of survival, across a broad and stratified age range.</p></div

Odds ratios (95% confidence interval) of mobility limitation associated with cardiovascular risk factors and vascular diseases (n = 2725).

*<p>Model 1 was adjusted for demographics, and Model 2 included all vascular factors and cardiovascular diseases as well as demographics and APOE genotype.</p

Characteristics of the study participants by mobility status (n = 2725).

*<p>Data were missing for 231 subjects.</p

Odds ratios (95% confidence interval) of mobility limitation associated with clustering of CRFs and CVDs in the total sample (n = 2725).

<p>CRF  =  cardiovascular risk factor; CVD  =  cardiovascular disease.</p>*<p>Model 1 was adjusted for demographics and APOE genotype, and Model 2 included CRF and CVDs as well as demographics and APOE genotype.</p>†<p>The aggregation of CRFs included stage 2 hypertension, high C-reactive protein, obesity, diabetes and smoking.</p>‡<p>The aggregation of CVDs included ischemic heart disease, atrial fibrillation, heart failure and stroke.</p

Mean Number of In-Hospital Days within 1, 3 and 10 Years Since Baseline, by Multidimensional Prognostic Index (MPI) Status and Age.

<p>Multidimensional Prognostic Index (MPI) aggregated six domains (personal and instrumental activities of daily living, cognitive function, illness severity and comorbidity, the number of medications, co-habitation status). Age group 66 with high risk MPI omitted, due to only one participant in this category.</p><p>Mean Number of In-Hospital Days within 1, 3 and 10 Years Since Baseline, by Multidimensional Prognostic Index (MPI) Status and Age.</p

Odds ratios (95% confidence interval) of ADL disability in relation to occupational physical activity, from multi-nomial logistical regression analyses.

<p>Independency in personal ADL or instrumental ADL is the reference category, respectively.</p><p>Model A: Adjusted for age, gender, education, socioeconomic status, number of years in longest held occupation.</p><p>Model B: Based on model A with additional adjustment for multi-morbidity, cognitive function, leisure physical exercise and instrumental ADL in the personal ADL analyses.</p

Odds ratios (95% confidence interval) of mobility limitation associated with clustering of CRFs by APOE ε4 status.

<p>CRF  =  cardiovascular risk factor.</p>*<p>The aggregation of CRFs included stage 2 hypertension, high C-reactive protein, obesity, diabetes and smoking.</p>†<p>Model 1 was adjusted for demographics and APOE genotype, and in Model 2 additional adjustment was made for CVDs.</p

Odds ratios and 95% confidence interval of PADL disability in relation to occupational physical activity stratified by occupation, from multinomial logistic regression models, with light occupational physical activity (OPA) as reference, controlling for demographic and health-related factors.

<p>*The upper limit for the confidence interval for white collar/strenuous OPA is 11.90 as designated in the figure.</p

Characteristics of the study population in relation to occupational physical activity, n (%).

<p>n = number of subjects, ADL = Activities in Daily Living, m = mean, sd = standard deviation, MMSE = Mini Mental State Examination, PA = physical activity.</p>*<p>p<0.01, ¤p<0.05.</p>#<p>There were missing data for socioeconomic status (n = 1), Multi-morbidity (n = 5), MMSE (n = 9).</p><p>All proportions are weighted and the weighted variable is included in the chi square analyses.</p

Median Time to Death in Years, by Multidimensional Prognostic Index (MPI) Status and Age.

<p>Multidimensional Prognostic Index (MPI) aggregated six domains (personal and instrumental activities of daily living, cognitive function, illness severity and comorbidity, the number of medications, co-habitation status). Age 66 excluded because too few had died to estimate median time to death. Mortality data until 2014-06-26. Analysis used Laplace regression.</p><p>Median Time to Death in Years, by Multidimensional Prognostic Index (MPI) Status and Age.</p