{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:48:59Z","timestamp":1791251339364,"version":"4.1.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"8","funder":[{"DOI":"10.13039\/100006379","name":"VA Office of Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006379","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Cooperative Studies Program","award":["1R33AG057806"],"award-info":[{"award-number":["1R33AG057806"]}]},{"name":"Harvard Translational Research in Aging Training Program"},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32AG023480"],"award-info":[{"award-number":["T32AG023480"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"VA Merit Review Award","award":["1I01BX001584"],"award-info":[{"award-number":["1I01BX001584"]}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["P01-155258\u201307"],"award-info":[{"award-number":["P01-155258\u201307"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["P50-100707"],"award-info":[{"award-number":["P50-100707"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"VA Health Services Research and Development Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"name":"VA Information Resource Center","award":["SDR 02\u2013237"],"award-info":[{"award-number":["SDR 02\u2013237"]}]},{"name":"VA Information Resource Center","award":["98\u2013004"],"award-info":[{"award-number":["98\u2013004"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\u00a0Traditional count-based measures of comorbidity are unlikely to capture the complexity of multiple chronic conditions (multimorbidity) in older adults with cancer. We aimed to define patterns of multimorbidity and their impact in older United States veterans with multiple myeloma (MM).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\u00a0We measured 66 chronic conditions in 5076 veterans aged 65\u2009years and older newly treated for MM in the national Veterans Affairs health-care system from 2004 to 2017. Latent class analysis was used to identify patterns of multimorbidity among these conditions. These patterns were then assessed for their association with overall survival, our primary outcome. Secondary outcomes included emergency department visits and hospitalizations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Five patterns of multimorbidity emerged from the latent class analysis, and survival varied across these patterns (log-rank 2-sided P\u2009&amp;lt;\u2009.001). Older veterans with cardiovascular and metabolic disease (30.9%, hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.21 to 1.45), psychiatric and substance use disorders (9.7%, HR = 1.58, 95% CI = 1.39 to 1.79), chronic lung disease (15.9%, HR = 1.69, 95% CI = 1.53 to 1.87), and multisystem impairment (13.8%, HR = 2.25, 95% CI = 2.03 to 2.50) had higher mortality compared with veterans with minimal comorbidity (29.7%, reference). Associations with mortality were maintained after adjustment for sociodemographic variables, measures of disease risk, and the count-based Charlson Comorbidity Index. Multimorbidity patterns were also associated with emergency department visits and hospitalizations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our findings demonstrate the need to move beyond count-based measures of comorbidity and consider cancer in the context of multiple chronic conditions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jnci\/djab007","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T12:38:28Z","timestamp":1610973508000},"page":"1084-1093","source":"Crossref","is-referenced-by-count":21,"title":["Defining Multimorbidity and Its Impact in Older United States Veterans Newly Treated for Multiple Myeloma"],"prefix":"10.1093","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8058-3423","authenticated-orcid":false,"given":"Nathanael R","family":"Fillmore","sequence":"first","affiliation":[{"name":"VA Boston CSP Center, Boston, MA, USA"},{"name":"Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA"},{"name":"VA Boston Healthcare System, Boston, MA, USA"},{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2582-7816","authenticated-orcid":false,"given":"Clark","family":"DuMontier","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Division of Aging, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cenk","family":"Yildirim","sequence":"additional","affiliation":[{"name":"VA Boston CSP Center, Boston, MA, 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Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-581X","authenticated-orcid":false,"given":"Diana","family":"Cirstea","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarvari","family":"Yellapragada","sequence":"additional","affiliation":[{"name":"Michael E Debakey VA Medical Center and Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1100-2813","authenticated-orcid":false,"given":"Gregory A","family":"Abel","sequence":"additional","affiliation":[{"name":"Divisions of Hematologic Malignancy and Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Michael","family":"Gaziano","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA"},{"name":"VA Boston Healthcare System, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"},{"name":"Division of Aging, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhan","family":"Do","sequence":"additional","affiliation":[{"name":"VA Boston CSP Center, Boston, MA, USA"},{"name":"Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA"},{"name":"Boston University School of Medicine, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Brophy","sequence":"additional","affiliation":[{"name":"VA Boston CSP Center, Boston, MA, USA"},{"name":"Massachusetts Veterans Epidemiology 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