{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T02:01:39Z","timestamp":1780970499034,"version":"3.54.1"},"reference-count":34,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["JACC: Advances"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.jacadv.2025.102103","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T11:15:47Z","timestamp":1761131747000},"page":"102103","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"special_numbering":"P1","title":["Cardiovascular Multimorbidity in Older Adults in the United States by Race and Sex"],"prefix":"10.1016","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4982-8154","authenticated-orcid":false,"given":"Michael D.","family":"Green","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Mentz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Greene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley G.","family":"Hammill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4494-5028","authenticated-orcid":false,"given":"Utibe R.","family":"Essien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5547-5084","authenticated-orcid":false,"given":"Erin D.","family":"Michos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Roland J.","family":"Thorpe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Dupre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Mac Grory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Tsun","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily C.","family":"O'Brien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5728-8872","authenticated-orcid":false,"given":"Jay B.","family":"Lusk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"5","key":"10.1016\/j.jacadv.2025.102103_bib1","first-page":"1","article-title":"Trends in cancer and heart disease death rates among adults aged 45-64: united States, 1999-2017","volume":"68","author":"Curtin","year":"2019","journal-title":"Natl Vital Stat Rep"},{"issue":"8","key":"10.1016\/j.jacadv.2025.102103_bib2","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1161\/CIR.0000000000000950","article-title":"Heart disease and stroke statistics\u20142021 update","volume":"143","author":"Virani","year":"2021","journal-title":"Circulation"},{"key":"10.1016\/j.jacadv.2025.102103_bib3","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.arr.2017.05.003","article-title":"Evidence on multimorbidity from definition to intervention: an overview of systematic reviews","volume":"37","author":"Xu","year":"2017","journal-title":"Ageing Res Rev"},{"issue":"2","key":"10.1016\/j.jacadv.2025.102103_bib4","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.cger.2016.01.013","article-title":"Epidemiology of multimorbidity in older adults with cardiovascular disease","volume":"32","author":"Bell","year":"2016","journal-title":"Clin Geriatr Med"},{"issue":"3","key":"10.1016\/j.jacadv.2025.102103_bib5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002545","article-title":"Cardiovascular disease and multimorbidity: a call for interdisciplinary research and personalized cardiovascular care","volume":"15","author":"Rahimi","year":"2018","journal-title":"PLOS Medicine"},{"issue":"19","key":"10.1016\/j.jacadv.2025.102103_bib6","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.jacc.2018.03.022","article-title":"Multimorbidity in older adults with cardiovascular disease","volume":"71","author":"Forman","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"9699","key":"10.1016\/j.jacadv.2025.102103_bib7","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/S0140-6736(09)61863-8","article-title":"Multimorbidity: another key issue for cardiovascular medicine","volume":"374","author":"Glynn","year":"2009","journal-title":"Lancet"},{"issue":"1","key":"10.1016\/j.jacadv.2025.102103_bib8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s12916-020-1508-1","article-title":"High-risk multimorbidity patterns on the road to cardiovascular mortality","volume":"18","author":"Haug","year":"2020","journal-title":"BMC Med"},{"issue":"586","key":"10.1016\/j.jacadv.2025.102103_bib9","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.3399\/bjgp11X572454","article-title":"Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management","volume":"61","author":"Rohini","year":"2011","journal-title":"Br J Gen Pract"},{"issue":"3","key":"10.1016\/j.jacadv.2025.102103_bib10","doi-asserted-by":"crossref","first-page":"238","DOI":"10.2174\/1573403X11666141122220003","article-title":"Disparities in cardiovascular disease risk in the United States","volume":"11","author":"Graham","year":"2015","journal-title":"Curr Cardiol Rev"},{"issue":"2","key":"10.1016\/j.jacadv.2025.102103_bib12","first-page":"61","article-title":"Accuracy and bias of Race\/Ethnicity codes in the medicare enrollment database","volume":"26","author":"Waldo","year":"2004","journal-title":"Health Care Financ Rev"},{"issue":"3","key":"10.1016\/j.jacadv.2025.102103_bib13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0092286","article-title":"Validity of myocardial infarction diagnoses in administrative databases: a systematic review","volume":"9","author":"McCormick","year":"2014","journal-title":"PLoS One"},{"issue":"8","key":"10.1016\/j.jacadv.2025.102103_bib14","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1161\/01.STR.0000174293.17959.a1","article-title":"Coding of stroke and stroke risk factors using international classification of diseases, revisions 9 and 10","volume":"36","author":"Kokotailo","year":"2005","journal-title":"Stroke"},{"issue":"4","key":"10.1016\/j.jacadv.2025.102103_bib15","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.ahj.2006.12.022","article-title":"Epidemiology of angina pectoris: role of natural language processing of the medical record","volume":"153","author":"Pakhomov","year":"2007","journal-title":"Am Heart J"},{"issue":"4","key":"10.1016\/j.jacadv.2025.102103_bib16","first-page":"141","article-title":"Myocardial infarction and the validation of physician billing and hospitalization data using electronic medical records","volume":"30","author":"Tu","year":"2010","journal-title":"Chronic Dis Can"},{"issue":"0 1","key":"10.1016\/j.jacadv.2025.102103_bib17","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/pds.2317","article-title":"A systematic review of validated methods for identifying atrial fibrillation using administrative data","volume":"21 Suppl 1","author":"Jensen","year":"2012","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"7","key":"10.1016\/j.jacadv.2025.102103_bib18","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.023237","article-title":"Identification of incident atrial fibrillation from electronic medical records","volume":"11","author":"Chamberlain","year":"2022","journal-title":"J Am Heart Assoc"},{"issue":"3","key":"10.1016\/j.jacadv.2025.102103_bib19","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s10985-006-9009-x","article-title":"Nonparametric estimation of transition probabilities in a non-Markov illness-death model","volume":"12","author":"Meira-Machado","year":"2006","journal-title":"Lifetime Data Anal"},{"issue":"1","key":"10.1016\/j.jacadv.2025.102103_bib20","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1353\/dem.2008.0013","article-title":"The multistate life table method: an application to contraceptive switching behavior","volume":"45","author":"Kuo","year":"2008","journal-title":"Demography"},{"issue":"6","key":"10.1016\/j.jacadv.2025.102103_bib21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4054\/DemRes.2010.22.6","article-title":"Estimation of multi-state life table functions and their variability from complex survey data using the SPACE program","volume":"22","author":"Cai","year":"2010","journal-title":"Demogr Res"},{"issue":"11","key":"10.1016\/j.jacadv.2025.102103_bib22","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1056\/NEJMsa020614","article-title":"Health, life expectancy, and health care spending among the elderly","volume":"349","author":"Lubitz","year":"2003","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jacadv.2025.102103_bib23","author":"Chiu"},{"issue":"2","key":"10.1016\/j.jacadv.2025.102103_bib24","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/s41371-020-00457-5","article-title":"Ethnic variation, socioeconomic status, and factors associated with cardio-metabolic multi-morbidity among uncontrolled hypertension in multiethnic Singapore","volume":"36","author":"Wang","year":"2022","journal-title":"J Hum Hypertens"},{"key":"10.1016\/j.jacadv.2025.102103_bib25","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.953886","article-title":"Prevalence of multimorbidity combinations and their association with medical costs and poor health: a population-based study of U.S. adults","volume":"10","author":"Schiltz","year":"2022","journal-title":"Front Public Health"},{"issue":"3","key":"10.1016\/j.jacadv.2025.102103_bib26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-024476","article-title":"Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study","volume":"9","author":"Zhang","year":"2019","journal-title":"BMJ Open"},{"issue":"20 Suppl 1","key":"10.1016\/j.jacadv.2025.102103_bib27","first-page":"2901","article-title":"Multimorbidity in a selected cohort compared to a representative sample: does selection bias influence outcomes?","volume":"20","author":"Hanlon","year":"2022","journal-title":"Ann Fam Med"},{"issue":"3","key":"10.1016\/j.jacadv.2025.102103_bib28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003931","article-title":"Associations between multimorbidity and adverse health outcomes in UK Biobank and the SAIL Databank: a comparison of longitudinal cohort studies","volume":"19","author":"Hanlon","year":"2022","journal-title":"PLoS Med"},{"issue":"10","key":"10.1016\/j.jacadv.2025.102103_bib29","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.38361","article-title":"Associations of cardiometabolic multimorbidity with all-cause and coronary heart disease mortality among Black adults in the Jackson heart study","volume":"5","author":"Joseph","year":"2022","journal-title":"JAMA Network Open"},{"issue":"1","key":"10.1016\/j.jacadv.2025.102103_bib30","doi-asserted-by":"crossref","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106162","article-title":"Predicting stroke complications in hospital and functional status at discharge by clustering of cardiovascular diseases a multi-centre registry-based study of acute stroke","volume":"31","author":"Han","year":"2022","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"1","key":"10.1016\/j.jacadv.2025.102103_bib31","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.amjmed.2020.05.040","article-title":"Sex differences in outcomes after myocardial infarction in the community","volume":"134","author":"Asleh","year":"2021","journal-title":"Am J Med"},{"issue":"1","key":"10.1016\/j.jacadv.2025.102103_bib32","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.hlc.2020.06.025","article-title":"Sex disparities in myocardial infarction: biology or bias?","volume":"30","author":"Stehli","year":"2021","journal-title":"Heart Lung Circ"},{"issue":"10","key":"10.1016\/j.jacadv.2025.102103_bib33","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.120.007154","article-title":"Sex disparities in the management and outcomes of cardiogenic shock complicating acute myocardial infarction in the young","volume":"13","author":"Vallabhajosyula","year":"2020","journal-title":"Circ Heart Fail"},{"issue":"31","key":"10.1016\/j.jacadv.2025.102103_bib34","doi-asserted-by":"crossref","first-page":"2811","DOI":"10.1093\/eurheartj\/ehae435","article-title":"Coronary artery disease management in older adults: revascularization and exercise training","volume":"45","author":"Pavasini","year":"2024","journal-title":"Eur Heart J"},{"issue":"2","key":"10.1016\/j.jacadv.2025.102103_bib35","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/jgs.15784","article-title":"AGS report on engagement related to the NIH inclusion across the lifespan policy","volume":"67","author":"Vaughan","year":"2019","journal-title":"J Am Geriatr Soc"}],"container-title":["JACC: Advances"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772963X25005289?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772963X25005289?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T18:25:01Z","timestamp":1775067901000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2772963X25005289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":34,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["S2772963X25005289"],"URL":"https:\/\/doi.org\/10.1016\/j.jacadv.2025.102103","relation":{},"ISSN":["2772-963X"],"issn-type":[{"value":"2772-963X","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Cardiovascular Multimorbidity in Older Adults in the United States by Race and Sex","name":"articletitle","label":"Article Title"},{"value":"JACC: Advances","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacadv.2025.102103","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.","name":"copyright","label":"Copyright"}],"article-number":"102103"}}