What is already known on this topic?
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Due to differences in the outcome definition, estimates of multimorbidity prevalence in mid-life (age 40–60) have varied extensively in high-income countries—from 15 to 80% between 1961 and 2013.
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There is a lack of contemporary national data in Great Britain describing the burden and nature of multimorbidity.
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The association between early-life risk factors and individual health conditions have been widely studied, however, it is unknown if they are associated with multimorbidity.
What this study adds
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Prevalence of multimorbidity in mid-life (age 46–48) was 33.8% in a nationally representative birth cohort in 2016–2018.
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Disadvantaged early-life parental social class, lower birthweight, lower cognitive ability, higher childhood body-mass index, and a higher number of internalising and externalising problems were found to be associated with a higher mid-life multimorbidity.
Introduction
Methods
Participants
Measures
Multimorbidity
Exposures
Potential confounding
Missing data
Analysis
Exposures—multimorbidity association
Exploratory analysis – multimorbidity as clusters of conditions
Ethical considerations
Results
Prevalence of multimorbidity
Outcomes (age) | N = 7951 |
% | |
Multimorbidity (46–48)* | 33.8 (32.6, 35.0) |
Chronic fatigue syndrome (46–48) | 1.5 (1.2, 1.7) |
Arthritis (46–48) | 7.7 (7.1, 8.3) |
Stroke (46–48) | 0.5 (0.4, 0.7) |
Heart problems (46–48) | 3.0 (2.6, 3.4) |
Eyes problems (46–48) | 4.9 (4.5, 5.4) |
Hearing problems (46–48) | 5.8 (5.2, 6.3) |
Recurrent back problems (46–48) | 20.9 (20.0, 21.8) |
Drinking problems (46–48) | 26.3 (25.3, 27.4) |
Hypertension (46–48) | 15.7 (14.8, 16.6) |
Diabetes (46–48) | 4.7 (4.1, 5.2) |
Mental health morbidity (46–48) | 19.1 (18.3, 20.0) |
Asthma/bronchitis (46–48) | 11.6 (10.9, 12.3) |
Convulsion, fit, epileptic seizure (46–48) | 1.1 (0.8, 1.3) |
Cancer or leukaemia (46–48) | 1.6 (1.4, 1.8) |
Mean (standard error) | |
Mean number of conditions (46–48) | 1.24 (0.02) |
Systolic blood pressure, mmHg (46–48) | 125.39 (0.19) |
Diastolic blood pressure, mmHg (46–48) | 77.73 (0.13) |
HbA1C, % (46–48) | 5.59 (0.01) |
Malaise Inventory (46–48) | 1.76 (2.12) |
AUDIT-PC (46–48) | 3.88 (2.58) |
Exposures (age) | Mean (standard error) |
Birthweight (0) | 3.31 (0.01) |
Cognitive ability (10) | 0.16 (0.01) |
Body mass index (10) | 16.9 (0.03) |
Internalising problems (16) | 0.93 (0.02) |
Externalising problems (16) | 0.68 (0.02) |
% | |
Father’s social class at birth (0) | |
I – professional | 6.1 |
II – managerial and technical | 13.8 |
III – skilled non-manual/manual | 60.8 |
IV – partly-skilled | 13.9 |
V – unskilled | 5.5 |
Exposures—mid-life multimorbidity association
N = 7951 | Relative risk (95%CI) | |
---|---|---|
Gender-adjusted | Confounding-adjusted | |
Father’s social class at birth (age 0) | N/Aa | |
I – professional | 1.00 | 1.00 |
II – managerial and technical | 1.14 (0.94, 1.40) | – |
III – skilled non-manual/manual | 1.30 (1.09, 1.55) | – |
IV – partly-skilled | 1.43 (1.18, 1.74) | – |
V – unskilled | 1.43 (1.15, 1.77) | – |
Birthweight (age 0) | 0.86 (0.80, 0.91) | 0.90 (0.84, 0.96)b |
Cognitive ability (age 10) | 0.91 (0.87, 0.95) | 0.96 (0.91, 1.00)c |
BMI (age 10) | 1.03 (1.01, 1.05) | 1.03 (1.01, 1.05)d |
Internalising problems (age 16) | 1.07 (1.04, 1.11) | 1.04 (1.00, 1.08)e |
Externalising problems (age 16) | 1.09 (1.07, 1.12) | 1.06 (1.03, 1.09)f |
Exploratory analysis—multimorbidity as clusters of conditions
N = 7951 | MH + hypertension | MH + arthritis | MH + diabetes | MH + asthma | Diabetes + hypertension |
---|---|---|---|---|---|
Relative risk (95%CI) | |||||
Father’s social class at birtha | |||||
I – professional (reference) | 1.00* | 1.00* | 1.00 | 1.00 | 1.00 |
II – managerial and technical | 1.27 (0.53, 3.04) | 1.19 (0.51, 2.80) | 2.69 (0.35, 20.83) | 1.67 (0.78, 3.56) | 2.04 (0.52, 7.99) |
III – skilled non-manual/manual | 2.32 (1.11, 4.87) | 1.53 (0.72, 3.26) | 4.40 (0.67, 29.13) | 1.68 (0.83, 3.40) | 3.01 (0.85, 10.61) |
IV – partly-skilled | 2.96 (1.36, 6.44) | 1.92 (0.85, 4.35) | 5.13 (0.56, 30.32) | 2.03 (0.97, 4.26) | 3.59 (0.97, 13.35) |
V – unskilled | 2.92 (1.23, 6.94) | 3.41 (1.46, 7.95) | 5.92 (0.78, 44.64) | 2.04 (0.85, 4.89) | 3.60 (0.92, 14.09) |
Birthweightb | 0.83 (0.65, 1.05) | 0.85 (0.64, 1.12) | 1.03 (0.66, 1.61) | 0.83 (0.65, 1.07) | 0.72 (0.49, 1.06) |
Cognitive ability (age 10)c | 0.85 (0.72, 1.00) | 0.75 (0.63, 0.89)* | 0.80 (0.61, 1.06) | 0.85 (0.72, 1.00) | 0.91 (0.73, 1.12) |
BMI (age 10)d | 1.11 (1.05, 1.18)* | 1.03 (0.96, 1.12) | 1.16 (1.06, 1.28)* | 1.04 (0.98, 1.11) | 1.25 (1.16, 1.34)* |
Internalising problems (age 16)e | 1.21 (1.09, 1.34)* | 1.17 (1.03, 1.33)* | 1.09 (0.87, 1.38) | 1.25 (1.12, 1.39)* | 0.97 (0.79, 1.19) |
Externalising problems (age 16)f | 1.00 (0.90, 1.11) | 1.06 (0.95, 1.19) | 1.04 (0.87, 1.24) | 1.02 (0.91, 1.14) | 1.04 (0.89, 1.22) |
N = 7951 | Mental health | Arthritis | Diabetes | Asthma | Hypertension |
---|---|---|---|---|---|
Relative risk (95%CI) | |||||
Father’s social class at birtha | |||||
I – professional (reference) | 1.00 | 1.00* | 1.00 | 1.00 | 1.00* |
II – managerial and technical | 1.15 (0.89, 1.50) | 0.86 (0.56, 1.36) | 2.11 (0.83, 5.36) | 1.31 (0.96, 1.80) | 1.05 (0.75, 1.48) |
III – skilled non-manual/manual | 1.28 (1.01, 1.61) | 1.29 (0.89, 1.86) | 2.94 (1.22, 7.10) | 1.16 (0.87, 1.54) | 1.41 (1.05, 1.88) |
IV – partly-skilled | 1.47 (1.14, 1.89) | 1.25 (0.83, 1.89) | 3.38 (1.37, 8.35) | 1.15 (0.83, 1.58) | 1.66 (1.22, 2.27) |
V – unskilled | 1.54 (1.14, 2.10) | 1.86 (1.19, 2.91) | 3.29 (1.26, 8.56) | 1.09 (0.73, 1.63) | 1.52 (1.05, 2.20) |
Birthweightb | 0.96 (0.87, 1.06) | 0.95 (0.81, 1.10) | 0.71 (0.55, 0.91) | 0.85 (0.75, 0.96) | 0.80 (0.72, 0.89)* |
Cognitive ability (age 10)c | 0.90 (0.84, 0.96)* | 0.92 (0.84, 1.02) | 0.93 (0.79, 1.08) | 0.98 (0.90, 1.06) | 0.93 (0.87, 1.00) |
BMI (age 10)d | 1.02 (1.00, 1.05) | 1.03 (0.99, 1.07) | 1.19 (1.13, 1.25)* | 1.00 (0.97, 1.04) | 1.10 (1.06, 1.13)* |
Internalising problems (age 16)e | 1.18 (1.13, 1.24)* | 1.06 (0.97, 1.15) | 0.97 (0.85, 1.12) | 1.05 (0.98, 1.12) | 1.02 (0.95, 1.09) |
Externalising problems (age 16)f | 1.01 (0.97, 1.06) | 1.08 (1.00, 1.15) | 1.07 (0.95, 1.20) | 1.03 (0.96, 1.10) | 1.02 (0.96, 1.08) |