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Multimorbidity is associated with risk of incident venous thromboembolism – A nationwide proof-of-concept study

Ahrén, Jonatan LU orcid ; Pirouzifard, Mir Nabi LU ; Holmquist, Björn LU orcid ; Sundquist, Jan LU ; Sundquist, Kristina LU and Zöller, Bengt LU orcid (2025) In Thrombosis Update 18.
Abstract

Background: Multimorbidity, i.e. two or more non-communicable diseases (NCDs), has been associated with venous thromboembolism (VTE), but whether multimorbidity is a predictor for incident VTE is unknown. Aims: To examine the associations between multimorbidity and its severity with risk of incident VTE, and examine the association between nine different disease clusters and incident VTE. Methods: A cohort study using landmark analysis of 2,694,442 individuals. Swedish national registers were linked and three landmarks (L1, L2, L3), i.e. baselines, were created with 14-, nine- and four-year follow-up times, respectively. Two or more NCDs defined multimorbidity and ≥5 marked multimorbidity severity. A hazard ratio (HR) with 95 %... (More)

Background: Multimorbidity, i.e. two or more non-communicable diseases (NCDs), has been associated with venous thromboembolism (VTE), but whether multimorbidity is a predictor for incident VTE is unknown. Aims: To examine the associations between multimorbidity and its severity with risk of incident VTE, and examine the association between nine different disease clusters and incident VTE. Methods: A cohort study using landmark analysis of 2,694,442 individuals. Swedish national registers were linked and three landmarks (L1, L2, L3), i.e. baselines, were created with 14-, nine- and four-year follow-up times, respectively. Two or more NCDs defined multimorbidity and ≥5 marked multimorbidity severity. A hazard ratio (HR) with 95 % confidence interval (CI) for VTE was calculated and adjusted for sex, education and year of birth. Death and emigration were treated as competing events. Results: A total of 2,694,442 individuals were included. Multimorbidity was associated with incident VTE in all three analyzed landmarks: adjusted HR for VTE was 2.47 (95%CI 2.24–2.72) for L1, HR was 2.23 (95%CI 2.11–2.36) for L2, and HR was 2.16 (95%CI 2.03–2.29) for L3. HR increased with multimorbidity severity. For instance, HRs for multimorbidity with five or more NCDs was 4.29 (95%CI 2.53–7.28) in L1 analysis, 4.45 (95%CI 3.64–5.45) in L2 analysis and 4.83 (95%CI 4.20–5.55) in L3 analysis. Moreover, seven of nine different multimorbidity disease clusters were predictors for VTE. Conclusion: This study demonstrated proof-of-concept that multimorbidity is a novel dose-graded predictor for VTE. Further studies will determine the usefulness of multimorbidity for VTE prediction in different clinical settings.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Epidemiology, Medicine, Multimorbidity, Public health, Venous thromboembolism
in
Thrombosis Update
volume
18
article number
100198
publisher
Elsevier
external identifiers
  • scopus:85216645074
DOI
10.1016/j.tru.2025.100198
language
English
LU publication?
yes
id
e50a378b-6737-44df-a5dd-f3e4d2a6982b
date added to LUP
2025-03-21 10:41:13
date last changed
2025-03-21 10:41:39
@article{e50a378b-6737-44df-a5dd-f3e4d2a6982b,
  abstract     = {{<p>Background: Multimorbidity, i.e. two or more non-communicable diseases (NCDs), has been associated with venous thromboembolism (VTE), but whether multimorbidity is a predictor for incident VTE is unknown. Aims: To examine the associations between multimorbidity and its severity with risk of incident VTE, and examine the association between nine different disease clusters and incident VTE. Methods: A cohort study using landmark analysis of 2,694,442 individuals. Swedish national registers were linked and three landmarks (L1, L2, L3), i.e. baselines, were created with 14-, nine- and four-year follow-up times, respectively. Two or more NCDs defined multimorbidity and ≥5 marked multimorbidity severity. A hazard ratio (HR) with 95 % confidence interval (CI) for VTE was calculated and adjusted for sex, education and year of birth. Death and emigration were treated as competing events. Results: A total of 2,694,442 individuals were included. Multimorbidity was associated with incident VTE in all three analyzed landmarks: adjusted HR for VTE was 2.47 (95%CI 2.24–2.72) for L1, HR was 2.23 (95%CI 2.11–2.36) for L2, and HR was 2.16 (95%CI 2.03–2.29) for L3. HR increased with multimorbidity severity. For instance, HRs for multimorbidity with five or more NCDs was 4.29 (95%CI 2.53–7.28) in L1 analysis, 4.45 (95%CI 3.64–5.45) in L2 analysis and 4.83 (95%CI 4.20–5.55) in L3 analysis. Moreover, seven of nine different multimorbidity disease clusters were predictors for VTE. Conclusion: This study demonstrated proof-of-concept that multimorbidity is a novel dose-graded predictor for VTE. Further studies will determine the usefulness of multimorbidity for VTE prediction in different clinical settings.</p>}},
  author       = {{Ahrén, Jonatan and Pirouzifard, Mir Nabi and Holmquist, Björn and Sundquist, Jan and Sundquist, Kristina and Zöller, Bengt}},
  keywords     = {{Epidemiology; Medicine; Multimorbidity; Public health; Venous thromboembolism}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Thrombosis Update}},
  title        = {{Multimorbidity is associated with risk of incident venous thromboembolism – A nationwide proof-of-concept study}},
  url          = {{http://dx.doi.org/10.1016/j.tru.2025.100198}},
  doi          = {{10.1016/j.tru.2025.100198}},
  volume       = {{18}},
  year         = {{2025}},
}