Mortality among older adults across multimorbidity categories and lifestyle patterns.

Background:
Multimorbidity is common in older adults, and certain combinations of chronic conditions may carry higher mortality risk than others. Unhealthy lifestyle behaviours are also associated with shorter life expectancy. This study examined whether lifestyle patterns influence the association between multimorbidity configurations and mortality risk.
Methods:
We analysed data from 20,853 adults aged 60 years and older in the Northern Netherlands Lifelines cohort, followed for a mean of 12 years. Five lifestyle patterns were previously identified using latent class analysis, based on diet, physical activity, substance use, sleep, social connection, and stress. Multimorbidity was assessed both as a disease count (≥2 non-communicable diseases [NCDs]) and as five latent multimorbidity configurations (MCs) reflecting distinct combinations of ≥2 NCDs. All-cause mortality risk was estimated using Kaplan–Meier plots and Cox models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs), stratified by lifestyle pattern. Statistical significance was set at p<0.05.
Findings:
Compared with having no NCDs, differences in mortality risk were observed across MCs, and these associations varied across lifestyle patterns. Among participants with a ‘Healthy in a balanced way’ lifestyle, the ‘Complex Treatment’ (HR 3.18, 95% CI 2.24–4.51) and ‘CVD & Vascular’ (HR 2.35, 95% CI 1.97–2.79) configurations showed the highest mortality risks. In the ‘Unhealthy but no substance use’ group, mortality risk across MCs was more heterogeneous and effect sizes were larger. In contrast, the effect size for cumulative multimorbidity showed minimal variation relative to MCs across the other lifestyle patterns.
Interpretation:
Lifestyle patterns influence the mortality risk associated with multimorbidity. Variability in risk across multimorbidity configurations was more pronounced among participants with healthier lifestyles. These findings highlight the importance of specific multimorbidity profiles—beyond disease count—for improving prognostic assessment and informing targeted interventions in ageing populations.
Funding:
The Lifelines initiative has been made possible through funding provided by the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen (UMCG), Groningen University, and the Provinces in the North of the Netherlands (Drenthe, Friesland, Groningen).
Keywords:
Multimorbidity, Lifestyle patterns, older adults, mortality risk, healthy ageing and chronic diseases.