Licher S, et al. - Using long-term data from a community-based, prospective cohort study, researchers quantified the occurrence and multimorbidity of non-communicable diseases (NCDs), leading causes of premature disability, and death worldwide. According to findings, 9 out of 10 people aged ≥ 45 years develop an NCD in this Western European community during their remaining lifetime. Among those with an NCD, at least one-third may develop multiple subsequent NCDs. Compression of NCD morbidity was related to the absence of three common shared risk factors: smoking, hypertension, and being overweight. These findings underlined the importance of avoiding these risk factors in reducing NCD's attributable premature morbidity and mortality.

Methods

• Investigators followed participants from the prospective Rotterdam Study who were free from NCDs at baseline for incident stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease between July 6, 1989, and January 1, 2012.
• In a competing risk framework, they quantified occurrence/co-occurrence and remaining lifetime risk of any NCD.
• In addition, they studied the lifetime risk of any NCD, age at onset, and overall life expectancy for strata of three shared risk factors at baseline: smoking, hypertension, and overweight status.

Results

• Of 9,061 participants (mean age 63.9 years, 60.1% women), 814 received a diagnosis of stroke, 1,571 had heart disease, 625 had diabetes, 1,004 had chronic respiratory disease, 1,538 had cancer, and 1,065 received a diagnosis of neurodegenerative disease during 75,354 person-year follow-up years.
• A total of 33.7% of those who developed an NCD received a diagnosis of multiple subsequent NCDs during follow-up.
• From the age of 45 years onward, the lifetime risk of any NCD was 94.0% for men and 92.8% for women.
• Even for those without the three shared risk factors, these risks remained high (> 90.0%).
• Absence of smoking, hypertension, and overweight was related to a 9.0-year delay in the age at onset of any NCD.
• In addition, participants without these risk factors had an overall life expectancy of 6.0 years longer than those with all three risk factors.
• Participants aged ≥ 45 years without the three shared risk factors spent 21.6% of their remaining lifespan with ≥ 1 NCDs vs 31.8% of their remaining lifespan for participants with all these baseline risk factors.
• This difference translated to a 2-year compression of morbidity.
• Limitations included potential residual confounding, unmatched changes in risk factor profiles during follow-up, and potentially limited generalizability to various healthcare settings and non-European descent populations.