Cited by 202Chronic Disease Management StrategiesHealth, psychology, and well-beingCardiac Health and Mental Health

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The Association Between Perceived Stress and Mortality Among People With Multimorbidity: A Prospective Population-Based Cohort Study

Prior, Anders, Fenger-Grøn, Morten, Larsen, Karen Kjær, Larsen, Finn Breinholt, Robinson, Kirstine Magtengaard, Nielsen, Marie Germund, Christensen, Kaj Sparle, Mercer, Stewart W., Vestergaard, Mogens·2016·American Journal of Epidemiology

DOI 10.1093/aje/kwv324

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Abstract

Multimorbidity is common and is associated with poor mental health and high mortality. Nevertheless, no studies have evaluated whether mental health may affect the survival of people with multimorbidity. We investigated the association between perceived stress and mortality in people with multimorbidity by following a population-based cohort of 118,410 participants from the Danish National Health Survey 2010 for up to 4 years. Information on perceived stress and lifestyle was obtained from the survey. We assessed multimorbidity using nationwide register data on 39 conditions and identified 4,229 deaths for the 453,648 person-years at risk. Mortality rates rose with increasing levels of stress in a dose-response relationship (P-trend < 0.0001), independently of multimorbidity status. Mortality hazard ratios (highest stress quintile vs. lowest) were 1.51 (95% confidence interval (CI): 1.25, 1.84) among persons without multimorbidity, 1.39 (95% CI: 1.18, 1.64) among those with 2 or 3 conditions, and 1.43 (95% CI: 1.18, 1.73) among those with 4 or more conditions, when adjusted for disease severities, lifestyle, and socioeconomic status. The numbers of excess deaths associated with high stress were 69 among persons without multimorbidity, 128 among those with 2 or 3 conditions, and 255 among those with 4 or more conditions. Our findings suggested that perceived stress contributes significantly to higher mortality rates in a dose-response pattern, and more stress-associated deaths occurred in people with multimorbidity.

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Authors: Prior, A., Fenger-Grøn, M., Larsen, K. K., Larsen, F. B., Robinson, K. M., Nielsen, M. G., Christensen, K. S., Mercer, S. W., & Vestergaard, M.
Affiliations: Aarhus University (DK)
Corresponding author: Prior, Anders
ORCID: Prior, Anders
Larsen, Finn Breinholt
Nielsen, Marie Germund
Christensen, Kaj Sparle
Mercer, Stewart W.
Vestergaard, Mogens
Venue: American Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2016-07-11
Volume: 184
Issue: 3
Pages: 199-210
ISSN: 0002-9262 (ISSN-L)
1476-6256
DOI: 10.1093/aje/kwv324
OpenAlex: W2471218679
Cited by: 202
References: 54
Citations by year: 2026: 17 · 2025: 24 · 2024: 28 · 2023: 27 · 2022: 23 · 2021: 31 · 2020: 19 · 2019: 11 · 2018: 13 · 2017: 7 · 2016: 1
FWCI: 9.99
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Epidemiology (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
HighWire Press Open Archive (submittedVersion)
Scopus (Elsevier) (submittedVersion)
Funders: Aarhus Universitet
University of Glasgow
Lundbeckfonden (R155-2012-11280)
Region Hovedstaden
Syddansk Universitet
Region Sjælland
Region Midtjylland
H. Lundbeck A/S
Topics: Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords: perceived stress, multimorbidity, mortality, mental health, dose-response relationship, excess mortality, chronic disease burden, socioeconomic status, lifestyle factors
MeSH terms: Multiple Chronic Conditions, Adult, Aged, Alcohol Drinking, Cause of Death, Denmark, Feeding Behavior, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Perception, Registries, Smoking, Stress, Psychological, Health Behavior, Incidence, Prevalence, Proportional Hazards Models, Sex Distribution, Sedentary Behavior

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The Association Between Perceived Stress and Mortality Among People With Multimorbidity: A Prospective Population-Based Cohort Study

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