The impact of chronic diseases on all-cause mortality in Spain: A population-based cohort study.

Objective: Our study aimed to assess the association between all-cause mortality and the most prevalent chronic diseases in Spain, including diabetes mellitus.

Design: Population-based retrospective cohort study. SITE: Spanish population (Spanish National Health Survey).

Participants: A population numbering 14,584 respondents of both sexes aged 40 years or older was selected.

Main Measurements: The outcome variable was all-cause mortality over 6-year follow-up, measured by probabilistic cross-matching with the national death registry. Socioeconomic variables, health indicators, service use, and behavioral factors were collected. The main data source was the National Statistics Institute.

Results: Of the 14584 people included, 1346 (9.2%) died over 6-year follow-up. Regarding the most prevalent chronic diseases, those showing the strongest association with mortality were cancer (HR 1.74, 95% CI 1.40-2.16); chronic lung diseases (chronic obstructive pulmonary disease, bronchitis, or emphysema; HR 1.44, 95% CI 1.19-1.70); acute myocardial infarction (HR 1.33, 95% CI 1.08-1.65); and diabetes (HR 1.23, 95% CI 1.06-1.42). Less prevalent chronic diseases also increased mortality risk, including cirrhosis/liver disease (prevalence 1.5%; HR 1.67, 95% CI 1.22-2.29) and cerebrovascular diseases, including embolism and stroke (prevalence 2%; HR 1.39, 95% CI 1.07-1.81).

Conclusions: Chronic diseases affect over half the population aged 40 years and older in Spain. Some of the most prevalent conditions are closely associated with all-cause mortality. These include chronic lung diseases, acute myocardial infarction, and diabetes. Given their impact on mortality in the population, more efforts are needed in chronic disease prevention and management.