Patterns of Multimorbidity among Older Adults with Colorectal Cancer Living in Puerto Rico

Abstract

Background: Multimorbidity among Hispanic colorectal cancer (CRC) patients in Puerto Rico remain poorly understood despite their potential impact on patient outcomes. We examined patterns of chronic conditions at CRC diagnosis and their associations with sociodemographic factors, stage at diagnosis, and tumor location. Methods: We used the Puerto Rico Central Cancer Registry–Health Insurance Linkage Database (2012–2020). Adults aged ≥50 years with a first CRC diagnosis were included. Chronic conditions were identified using Medicare & Medicaid Chronic Conditions Warehouse algorithms. Latent class analysis and regression models assessed multimorbidity patterns and associations with sociodemographic and tumor characteristics. Results: Among 6,543 adults with CRC (67.7 years mean age; 45.7% female), 52.7% had no additional chronic conditions, 18.7% had one, and 28.6% had ≥2 conditions. The most prevalent comorbidities were hypertension (20.6%), diabetes (14.4%), and hyperlipidemia (12.2%). Three multimorbidity patterns were identified: Hypertensive Vision–Joint, Diabetic Renal, and Cardiopulmonary Severe. Advanced age, female sex, and Medicare insurance predicted class membership. Older age was associated with membership in the Cardiopulmonary Severe group (aPR=1.75 for ages 76–85 years; aPR=2.86 for ≥86 years). Females were more likely to belong to the Hypertensive Vision–Joint group (aPR=1.42). Multimorbidity patterns were not associated with tumor location or stage at diagnosis. Conclusions: Multimorbidity is common among older Hispanic adults with CRC in Puerto Rico and forms distinct patterns associated with sociodemographic factors, highlighting heterogeneity in medical complexity. Impact: Identifying multimorbidity patterns among older CRC patients in Puerto Rico underscores the need for integrated, patient-centered care for aging Hispanics.