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Prevalence and trends of multimorbidity clusters in Belgian assisted dying practice: a health registry study

par Jacques, Wels ;Hamarat, Natasia ;Gonzalez Hijon, Juan ;Proot, Luc
Référence Age and ageing, 55, 5
Publication Publié, 2026-05-01

Article révisé par les pairs

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Résumé :

Abstract Background Population ageing is accompanied by a rise in complex multimorbidity, i.e. the co-occurrence of two or more chronic or acute conditions. For a growing number of people, this cumulative disease burden results in unbearable suffering. Using 22 years of national data from Belgium, we investigated the prevalence and clinical profiles of such suffering at the end of life, as reflected in requests for voluntary assisted dying (VAD). Methods We analysed all anonymised VAD cases reported to the Federal Commission for Control and Evaluation of Euthanasia between 2003 and 2024 (N = 6153). Conditions severity was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G, 1–4 scale). Sex-specific multimorbidity clusters were identified and temporal trends were modelled with negative binomial regression incorporating population-adjusted offsets, testing interactions with sex, cluster, age group and language region and with and without spline to address nonlinear trends. Results Patients had a mean age of 83.1 years, with 58.2% female, an average of 2.79 comorbid conditions and a mean CIRS-G of 3.43. Five sex-specific clusters were identified, with females exhibiting musculoskeletal, psychiatric and cardiovascular burdens, and males demonstrating cardio-respiratory and neurological profiles. Overall incidence increased over time, particularly among the oldest age groups. Cluster-specific trends revealed rapid growth in female musculoskeletal-psychiatric profiles and dynamic temporal changes in male cardiac-dominant clusters. Language region and age modified these trends, with Dutch-speaking males showing initially high but declining incidence in cardiac-dominant clusters. Conclusions VAD for multimorbidity is heterogeneous, evolving and strongly influenced by ageing and cluster-specific disease patterns.