Cardiovascular Multimorbidity in Older Adults in the United States by Race and Sex.
Date
2025-11
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Abstract
Background
It is essential to understand the prevalence of cardiovascular multimorbidity and to recognize disparities by race and sex to promote health equity.Objectives
The objectives of the study are to investigate disparities in the development and progression of cardiovascular multimorbidity among older adults in the United States and estimate relative life expectancies among patients with cardiovascular multimorbidity.Methods
This was a nationwide study of a 5% nationwide sample of fee-for-service Medicare beneficiaries aged 65 or older from 2010 to 2020. Multistate survival models were employed to estimate cardiovascular disease (CVD) progression and a microsimulation approach was used to derive life tables. Primary outcome was development and progression of cardiovascular multimorbidity.Results
Of 2,189,633 beneficiaries, the median age was 69 (IQR: 66-78), median follow-up duration was 6 years (IQR: 3-9). Initially healthy males and females had similar risks for developing CVD (aHR: 1.00; 95% CI: 0.99-1.00), with males facing higher risks of progressing to multimorbidity (aHR: 1.29; 95% CI: 1.24-1.35). Males with CVD were more likely to advance to multimorbidity (aHR: 1.16; 95% CI: 1.15-1.17). Black beneficiaries showed greater risks of moving from a healthy state to CVD (aHR: 1.10; 95% CI: 1.09-1.11). Life table analysis showed that Black adults had lower chances of progressing to worse multimorbidity states or death from a healthy state. However, as their disease burden increased, they were more likely to die compared to White adults.Conclusions
These findings illuminate sex differences and racial disparities in cardiovascular multimorbidity progression, identifying a target for the promotion of health equity.Type
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Publication Info
Green, Michael D, Robert J Mentz, Stephen J Greene, Bradley G Hammill, Utibe R Essien, Ying Xian, Erin D Michos, Roland J Thorpe, et al. (2025). Cardiovascular Multimorbidity in Older Adults in the United States by Race and Sex. JACC. Advances, 4(11 Pt 1). p. 102103. 10.1016/j.jacadv.2025.102103 Retrieved from https://hdl.handle.net/10161/34024.
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Scholars@Duke
Robert John Mentz
I am a cardiologist with a clinical and research interest in heart failure (going from Failure to Function), including advanced therapies such as cardiac transplantation and mechanical assist devices or “heart pumps."
I serve our group as Chief of the Heart Failure Section.
I became a heart failure cardiologist in order to help patients manage their chronic disease over many months and years. I consider myself strongly committed to compassionate patient care with a focus on quality of life and patient preference.
I am the Co-Editor in Chief of the Journal of Cardiac Failure - The official journal of the Heart Failure Society of America.
My research interests are focused on treating co-morbid diseases in heart failure patients and improving outcomes across the cardiovascular spectrum through clinical trials and outcomes research. Below, you will find my specific research interests:
- Cardiometabolic disease
- Co-morbidity characterization (diabetes, sleep apnea, renal failure) in heart failure
- Phenotypic characterization and risk prognostication of patients with heart failure
- Role of surrogate and nonfatal endpoints in clinical heart failure trials
- Biomarkers in heart failure
- Novel pharmacological and non-pharmacological approaches to heart failure
- Improving site-based heart failure research
I am a leading clinical trialist in both traditional and pragmatic studies having served as a trial leader for HEART-FID, TRANSFORM-HF and PARAGLIDE-HF.
I serve as a Co-PI for the FDA’s Research Triangle CERSI (Center of Excellence in Regulatory Science and Innovation).
Stephen Greene
I am a cardiologist with a clinical and research interest in heart failure. I take care of patients with various types of heart failure, including patients who are best treated with medications and patients who receive advanced therapies like heart transplantation and mechanical assist devices. I became a heart failure cardiologist to help patients manage their heart conditions and best achieve their goals for their health. I am strongly committed to helping patients thoroughly understand their medical conditions and helping them make informed medical decisions aligned with their preferences.
My research interests are focused on strategies and therapies to improve outcomes and quality of life for patients with heart failure. This involves research through clinical trials and through examining data from real-world clinical practice. Below, you will find my specific research interests:
- Use and dosing of evidence-based heart failure medications
- Management of worsening heart failure outside the hospital
- Novel pharmacological and non-pharmacological approaches to heart failure
- Improving outcomes following a hospitalization for heart failure
- Surrogate and nonfatal endpoints in heart failure clinical trials
- Clinical trial design and operations
- Improving site-based heart failure research
Bradley Gordon Hammill
Brad Hammill, DrPH, is an Associate Professor in the Department of Population Health Sciences within the School of Medicine and a member of the Duke Clinical Research Institute. Dr. Hammill received his DrPH in Biostatistics from The University of North Carolina at Chapel Hill. His research is focused on leveraging real-world data—including electronic health record data, health insurance claims data, and registry data—for clinical research.
Areas of expertise: Biostatistics, Real-World Data, Health Services Research, Health Policy, and Epidemiology
Ying Xian
Matthew E. Dupre
Dr. Dupre is a Professor in the Department of Population Health Sciences and the Department of Sociology. He is also a Senior Fellow at the Center for Aging and Human Development. Dr. Dupre is a medical sociologist who specializes in research on aging and the life course, health disparities, and cardiovascular disease (CVD) outcomes in older adults. As an interdisciplinary researcher, he has focused on several lines of work: (i) race and socioeconomic disparities in trajectories of chronic disease and mortality, (ii) the role of social stressors in the onset and progression of CVD, (iii) the development of adaptive risk-assessment models, and (iv) the social determinants of healthy aging in China. A unifying thread in his program of research is the application of life course theory to clinical outcomes research, the integration of population- and patient-level data, and the use of innovative statistical methods to better understand how exposure to social factors shape inequalities in health and aging. Dr. Dupre is the Editor-in-Chief of the Encyclopedia of Gerontology and Population Aging (2021), co-editor of the book Disability Trends at Older Ages (in press), and has published in the leading journals of medicine, epidemiology, sociology, and public health. He has served as an advisor to the National Academy of Sciences' Committee on Population Aging and currently serves on the editorial boards for multiple journals.
Areas of Expertise:
Medical Sociology; Population Health; Social Epidemiology; Cardiovascular Disease; Aging; and Quantitative Methods
Brian C. Mac Grory
Dr. Brian Mac Grory, MB BCh BAO, MHSc, MRCP, FAHA, FANA is an Associate Professor of Neurology & Ophthalmology at the Duke University School of Medicine and a Staff Neurologist at Duke University Medical Center. He received his medical degree from University College Dublin in Dublin, Ireland in 2011. After an internship at St. Vincent's University Hospital, Dublin, he completed a neurology residency and vascular neurology fellowship at the Yale School of Medicine/Yale-New Haven Hospital in New Haven, Connecticut. Upon completion of his training, he served for 3 years on the faculty of Brown University/Rhode Island Hospital before being recruited to Duke University in 2020.
His clinical practice encompasses both vascular and general neurology in the emergency, inpatient, outpatient, and telemedicine settings. He has a particular clinical interest in central retinal artery occlusion (CRAO or "eye stroke") and has developed a center of excellence for the treatment of this condition at Duke. He led the development of the first ever American Heart Association (AHA) scientific consensus statement on the management of CRAO which was endorsed by six professional medical societies in the United States representing neurology, neurosurgery, cardiology, ophthalmology, neuro-ophthalmology, and optometry.
Dr. Mac Grory has published over 150 peer-reviewed scientific articles appearing in JAMA, British Medical Journal, Circulation, Stroke, Annals of Neurology, JAMA Neurology, and Neurology. His research on retinal vascular disease is funded by the National Institutes of Health/National Heart, Lung, and Blood Institute (K23 HL161426), the AHA (23MRFSCD1077188 & 25GLP1450119), and the Duke Office of Physician-Scientist Development (FRCS #2835124). Additionally, he serves as Clinical Lead for the Get With The Guidelines-Stroke Data Analytic Program at the Duke Clinical Research Institute (DCRI) and Associate Program Director for the vascular neurology fellowship program at Duke. His research has been recognized with the Stroke Progress and Innovation Award, Stroke Care in Emergency Medicine Award, and Early Career Investigator Award from the AHA/American Stroke Association and the Young Physician-Scientist Award from the American Society for Clinical Investigation. He is a member of the AHA's Stroke Systems of Care Advisory Group, the Stroke Emergency Neurovascular Care Committee, and the Royal College of Physicians of the United Kingdom (MRCP(UK)).
Emily O'Brien
Dr. Emily O’Brien is Associate Professor in Population Health Sciences, Associate Professor in Neurology, Core Faculty Member at Duke-Margolis Center for Health Policy, and Co-Director of Population Health Sciences at the Duke Clinical Research Institute. Her research focuses on comparative effectiveness, patient-centered outcomes, and pragmatic health systems research in cardiovascular and pulmonary disease. Her areas of expertise include: Epidemiology, Pragmatic Clinical Trials, and Clinical Decision Sciences. Dr. O’Brien received her PhD in Epidemiology from the University of North Carolina in Chapel Hill. As principal investigator for projects funded by the FDA, NIH, and PCORI, she has extensive experience working with diverse data sources including registries, epidemiologic cohorts, electronic health records, and administrative claims data. Dr. O’Brien teaches Analytic Methods in the Department of Population Health Sciences PhD program and has co-authored over 200 manuscripts in peer-reviewed journals on topics ranging from epidemiologic methods, comparative effectiveness, and pragmatic clinical trials. She is an associate editor for Circulation: Cardiovascular Quality and Outcomes, Chair of the AHA QCOR Scientific & Clinical Education Lifelong Learning Committee, social media editor for the Journal of the American Heart Association, and a fellow of the American Heart Association.
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