Association between behavioral-environmental risk patterns and multimorbidity of chronic non-communicable diseases among Chinese adolescents at schools.

Low parental education level and parental smoking are major risk factors for household secondhand smoke (SHS) exposure among adolescents. We investigated the trend in household SHS exposure according to sex, school, and parental education level to determine whether the decline in household SHS exposure over time depends on parental education level. We used cross-sectional Korea Youth Risk Behavior datasets (2006-2020; 806829 subjects were eligible). We applied binary logistic regression to assess household SHS exposure trends and evaluated the interaction between period and parental education level. Household SHS exposure over 15 years has declined. The difference (0.121) was the smallest for male middle school students with low-educated parents. The slope for the estimated probability of household SHS exposure among students with high-educated parents was steeper than that for those with low-educated parents, except for female high school students (difference=0.141). Students with low-educated parents were at higher risk of household SHS exposure (male middle school students, adjusted odds ratio, AOR=1.52; 95% CI: 1.47-1.56; male high school students, AOR=1.42; 95% CI: 1.38-1.47; female middle school students, AOR=1.62; 95% CI: 1.58-1.67; female high school students, AOR=1.62; 95% CI: 1.57-1.67). The interaction between parental education level and period was significant. We also found a significant interaction between parental education level and parental smoking (other × present interaction, AOR=0.64; 95% CI: 0.60-0.67; low-low × present interaction, AOR=0.89; 95% CI: 0.83-0.95). Changes in parental education level over time mainly contributed to changes in adolescents' household SHS exposure. Adolescents with low-educated parents were at higher risk of household SHS exposure, with a slower decline. These gaps must be considered when creating and implementing interventions. Campaigns and community programs to prevent household SHS need to be emphasized among vulnerable adolescents.

This study explores the impact of multimorbidity and types of chronic diseases on self-rated memory in older adults in the United States. Data were drawn from the 2011 wave of the National Health and Aging Trends Study (NHATS, N = 6,481). Logistic regressions were used to examine the associations between multimorbidity and types of chronic diseases and fair/poor self-rated memory. Compared to respondents with no or one chronic disease, respondents with multimorbidity showed 35% higher odds of reporting fair/poor self-rated memory. Also, stroke, osteoporosis, and arthritis were identified as increasing the odds of reporting fair/poor self-rated memory by 41%, 20%, and 30%, respectively. Demonstrating the importance of both multimorbidity and types of chronic diseases in self-reporting of memory, our findings suggest the need to educate older adults with multimorbidity and certain types of diseases regarding negative self-rated memory and its consequences.

BackgroundNon-communicable chronic diseases (NCCDs) multi-morbidity is becoming one of the public health problems in Ethiopia. The objective of this study was to describe the prevalence of NCCDs and multi-morbidity among adult patients at Hawassa University Comprehensive Specialized Hospital (HUCSH).MethodsBetween January and February 2016, a cross-sectional study was carried out among patients aged ⩾ 18 years attending the outpatient department of the hospital. Trained nurses interviewed patients and reviewed medical records. Multi-morbidity was defined as the coexistence of two or more NCCDs in an individual.ResultsTwo hundred twenty seven (55.2%) of the respondents had at least one of the NCCDs and 73 (17.8%) of them had multi-morbidity. The commonest diseases that affected the patients were diseases of the musculoskeletal system. The risk of having NCCDs was highest among patients aged above 44 years (Adjusted odds ratio (AOR) = 2.7, 95% CI 1.5–4.8). Non educated patients (AOR = 1.7, 95% CI 1.0–2.7) and patients with high household income (AOR = 1.6, 95% CI 1.0–2.5) and patients with a body mass index (BMI) of at least 25 (AOR = 2.0, 95% CI 1.1–3.7) had higher odds of having NCCDs. Highest odds of multi-morbidity was observed among patients aged above 44 years (AOR = 4.4, 95% CI 2.2–8.8).ConclusionThe prevalence of NCCDs and multi-morbidity among the study population was high. Identifying and addressing modifiable risk factors; screening, treatment and follow-up of patients with NCCDs could help in reducing the burden of NCCDs multi-morbidity and its effect.

BackgroundAs the population ages, chronic non-communicable diseases (NCDs) multimorbidity has emerged as a major public health issue globally. This study examines ethnic disparities in prevalence of NCDs and its multimorbidity among rural southwest Chinese older adults.MethodsA cross-sectional survey was conducted in rural southwest population aged ≥ 60 years consisting of 5,642 consenting participants of Han and three ethnic minority groups (Dai, Ha Ni, and Bai). Information about participants’ demographic characteristics and lifestyle behaviors was obtained using a standard questionnaire. Anthropometric measurements including height, weight, and waist circumference, fasting blood sugar and blood pressure measurement, as well as post-bronchodilator spirometry test were recorded for each participant.ResultsThe age-standardized prevalence of five common chronic NCDs– hypertension, diabetes, coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD) – and its multimorbidity was 72.8%, 15.9%, 4.0%, 10.0%, 9.8%, and 27.6%, respectively. Bai participants had both the highest overall and sex-specific prevalence rates of hypertension, diabetes, stroke, and COPD, whereas Han participants had the highest rates of CHD (P < 0.01). The results of multivariate logistic regression analysis indicated that female and older participants had a higher probability of chronic NCDs multimorbidity than their counterparts (P < 0.01). Bai ethnic minority participants were more likely to have NCDs multimorbidity while Ha Ni and Dai ethnic minority participants were less likely to have NCD multimorbidity relative to the Han participants (P < 0.05). Older adults with a higher level of education and family history of chronic NCDs, and who were also current smokers, current drinkers, obese, centrally obese, and physically inactive had a greater probability of developing chronic NCDs multimorbidity (P < 0.01).ConclusionsEthnicity and individual demographic and lifestyle factors significantly impact prevalence of chronic NCDs multimorbidity. Future chronic NCDs prevention and control strategies must be tailored to address ethnicity, and culturally tailored lifestyle interventions may reduce the prevalence of chronic NCDs multimorbidity in rural southwest China.

Introduction Due to their linkages in the social ecology of adolescents, adolescents’ cigarette smoking involvement is correlated with other health risk behaviours such as unsafe sexual behaviour and nonsexual risk behaviours, which can damage their health and well-being. This study focuses on examining whether socio-demographic factors and health risk and problem behaviours explain the prevalence of cigarette smoking among Chinese adolescents. Methods Based on the data from 1st National Youth Reproductive Health Survey in 2009, using binominal and ordered probit models with a Heckman’s two-stage estimation procedure, this study examines the socio-demographic and health risk and problem behaviours explaining both cigarette smoking and its frequency, respectively. Results The results indicate that both the occurrence of cigarette smoking and the frequency of cigarette smoking are mainly associated with health risk and problem behaviours covering other nonsexual risk behaviours and sexual behaviour. The prevalence of smoking was highest among male, rural adolescents, and who had lower education, from one-child family, broken family, or lived in the west. When we adjusted for socio-demographic factors and health risk and problem behaviours, smoking was associated with having premarital sex, having multiple sexual partners, binge drinking, and porn-reading addiction among Chinese adolescent. Conclusion Unsafe sexual behaviours, binge drinking, and porn-reading addiction are correlates of cigarette smoking suggest clustering to form a risk behaviour syndrome among Chinese adolescents. It reflects an urgent need for further exploring the relationship between cigarette smoking and other health risk behaviours will be helpful for designing further tobacco control interventions among Chinese youth.

Gender differences in the clustering patterns of risk behaviours associated with non-communicable diseases in Brazilian adolescents

The main health problems faced by children and adolescents in China are constantly changing. Myopia, overweight and obesity, abnormal spinal curvature, and mental health issues have become the main health problems for children and adolescents. However, multidimensional health problems such as infectious diseases, chronic non-communicable diseases and injuries still coexist and present regional imbalances. Since these coexisting health problems usually have common behavioral and environmental factors, implementing joint prevention works for children and adolescents could improve the efficiency of monitoring and intervention of multimorbidity among students. School health standards are an important component of China's school health regulations and a crucial technical basis for implementing various school health laws and regulations. Carrying out high-quality revision, preliminary research, implementation evaluation, and promotion of school health standards could provide important technical support for monitoring, comprehensive intervention, and evaluation of common diseases among students, implementing the policy of joint prevention of multimorbidity of common diseases among students, and promoting the high-quality development of disease prevention and control in the field of school health in the new era.

This study aimed to investigate the environmental factors associated with attention deficit hyperactivity disorder (ADHD) in Chinese children and adolescents with adiposity (obesity or overweight). A total of 130 children and adolescents with adiposity and 130 age- and sex-matched controls with normal weight were enrolled in this cross-sectional study. Children with ADHD were identified based on International Classification of Diseases (ICD-10) codes. The severity for psychiatric and behavioral problems, ADHD symptoms, and oppositional defiant disorder was compared between the groups. Multivariable logistic regression analysis was performed to identify factors associated with the comorbidity of ADHD in children and adolescents with adiposity. The detection rate of ADHD was significantly higher in the adiposity group compared to control group (15.4% vs. 6.2%; p = 0.016). Children and adolescents with adiposity exhibiting higher scores in learning problems, impulsivity/hyperactivity, anxiety, and hyperactivity indices. Exploratory analyses indicated a positive correlation was found between BMI percentile (BMI-P) and inattention symptoms scores in individuals with ADHD (r = 0.512, p = 0.005). Logistic regression results showed that factors associated with ADHD in children and adolescents with adiposity included prolonged adiposity duration (> 3 years) (OR = 5.61, 95% CI: 1.79–17.59, p = 0.003) and excessive screen time (> 3 h/day) (OR = 6.45, 95% CI: 1.59–26.11, p = 0.009). Prolonged adiposity duration and excessive daily screen time were found to be associated with ADHD among children and adolescents with adiposity.

Background Due to the wide implementation of antiretroviral therapy (ART), people living with HIV (PLWHIV) are now living longer. This increased the risk of developing noncommunicable chronic diseases (NCCDs) among them. Objective We aimed to describe prevalence of NCCDs multimorbidity among PLWHIV at Hawassa University Comprehensive Specialized Hospital (HUCSH). Method In April 2016, institution-based cross-sectional study was conducted among PLWHIV, aged ≥ 18 years at the ART unit of HUCSH. A nurse working in the ART unit interviewed patients and reviewed medical records. Data on the NCCDs and its risk factors were obtained. List of diseases considered in this study were arthritis, diabetes mellitus, hypertension, congestive heart failure (CHF), rheumatic heart diseases (RHD), chronic bronchitis, asthma, and cancer. Results More than half of the respondents (196) had at least one of the NCCDs and 34 (8.9%) had multimorbidity. The main system of the body affected were the musculoskeletal system, 146 (38.2%) and respiratory system, 46 (12.0%). There was no significant difference in the prevalence of individual NCCDs by gender. Patients aged above 44 years, patients with ART duration of at least 6 years, and patients with higher CD4 counts had increased odds of having any one of the NCCDs. Multimorbidity patients with a longer ART duration had an increased risk. Conclusion The prevalence of NCCD multimorbidity among PLWHIV was high. Monitoring the occurrence of NCCDs among PLWHIV and noncommunicable disease care is recommended.

Chronic disease multimorbidity is influenced by multiple factors, but with little knowledge on the impact of biochemical indicators. This study aims to investigate the prevalence of multimorbidity of chronic diseases among older adult individuals in the community, as well as the factors related to biochemical indicators associated with chronic disease multimorbidity. The study included 19,624 older adult individuals aged 60 and above in Jindong District, Jinhua City, Zhejiang Province, China. Participants completed a national standardized older adult health examination in the community. Chi-square tests and logistic regression were employed to evaluate the potential factors of biochemical indicators related to multimorbidity of chronic diseases. The multimorbidity rate of chronic diseases in older adult patients is 70.3%. Each chronic disease coexists with one or more other chronic diseases in over 75% of cases. Among the biochemical indicators, hemoglobin (Hb) (OR = 1.46, 95%CI: 1.13-1.90), white blood cell count (WBC) (OR = 1.25, 95%CI: 1.02-1.54), red blood cell count (RBC) (OR = 1.36, 95%CI: 1.10-1.69), urinary protein (U-PRO) (OR = 1.10, 95%CI: 1.02-1.19), urinary glucose (U-GLU) (OR = 1.44, 95%CI: 1.23-1.67), alanine aminotransferase (ALT) (OR = 1.71, 95%CI: 1.39-2.10), aspartate aminotransferase (AST) (OR = 1.22, 95%CI: 1.05-1.41), creatinine (Cr) (OR = 1.28, 95%CI: 1.16-1.42), uric acid (UA) (OR = 1.36, 95%CI: 1.22-1.51), total cholesterol (TC) (OR = 1.76, 95%CI: 1.59-1.95), triglycerides (TG) (OR = 2.63, 95%CI: 2.46-2.82), low-density lipoprotein cholesterol (LDL-C) (OR = 1.84, 95%CI: 1.60-2.11), high-density lipoprotein cholesterol (HDL-C) (OR = 10.99, 95%CI: 8.12-14.90), and fasting blood glucose (FBG) (OR = 1.89, 95%CI: 1.74-2.05) are associated with the risk of multimorbidity of chronic diseases (p < 0.05). Among these, lipid parameters demonstrated the strongest associations with multimorbidity risk, with low HDL-C showing an 11-fold increase and elevated TG a 2.63-fold increase. This study found that the prevalence of multimorbidity among older adult individuals in this region reached 70.3%. Multiple biochemical indicators were significantly associated with multimorbidity, particularly lipid parameters (low HDL-C and elevated TG), glucose parameters (elevated FBG and positive U-GLU), liver function (elevated ALT), and hemoglobin levels. These findings provide important evidence for research on factors associated with multimorbidity in the older adult population.

INTRODUCTIONDetrimental effects of secondhand smoke (SHS) exposure are well established; however, data on SHS exposure among adolescents in Kuwait are lacking. Hence, this study sought to estimate the prevalence of household SHS exposure among two samples of adolescents in Kuwait and assess its variation by socioeconomic status and parental education level.METHODSData from two large school-based cross-sectional studies were analyzed. Adolescents attending public middle (n=3864; aged 11–14 years) and high (n=1959; aged 14–19 years) schools throughout Kuwait were enrolled in 2016-2017, and parental self-reported household SHS exposure was ascertained. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were estimated.RESULTSOverall, 45.8% (1755/3836; 95% CI: 44.2–47.3%) of the enrolled middle school students and 51.6% (998/1936; 95% CI: 49.3–53.8%) of the enrolled high school students were exposed to household SHS. Among middle and high school students, the prevalence of household SHS exposure increased as maternal/paternal education level and family income decreased. Among middle school students, paternal educational attainment of middle school or less compared to bachelor’s degree or higher was associated with 1.60 times (95% CI: 1.44–1.79) higher household SHS exposure. Similarly, in the sample of middle school students, the prevalence of household SHS exposure significantly increased from 35.8% among children from families reporting the highest household income to 50.5% among children from families with the lowest reported household income (p-trend<0.001).CONCLUSIONSHousehold SHS exposure is substantially high among adolescents in Kuwait. Enrolled adolescents from families with low socioeconomic status or with low parental education level have the highest household SHS exposure. These findings highlight the need for national comprehensive tobacco control policies and increasing parental awareness of the impact of SHS exposure on children.

Background:Multimorbidity, often defined as having two or more chronic conditions is a global phenomenon. This study examined the association between key determinants identified by the chronic disease indicator framework and multimorbidity by rural and urban settings. The prevalence of individual diseases was also investigated by age and sex.Methods:The Canada Community Health Survey and linked health administrative databases were used to examine the association between multimorbidity, sociodemographic, behavioral, and other risk factors in the province of Ontario. A multivariable logistic regression model was used to conduct the main analysis.Results:Analyses were stratified by age (20–64 and 65–95) and area of residence (rural and urban). A total sample of n = 174,938 residents between the ages of 20–95 were examined in the Ontario province, of which 18.2% (n = 31,896) were multimorbid with 2 chronic conditions, and 23.4% (n = 40,883) with 3+ chronic conditions. Females had a higher prevalence of 2 conditions (17.9% versus 14.6%) and 3+ conditions (19.7% vs. 15.6%) relative to males. Out of all examined variables, poor self-perception of health, age, Body Mass Index, and income were most significantly associated with multimorbidity. Smoking was a significant risk factor in urban settings but not rural, while drinking was significant in rural and not urban settings. Income inequality was associated with multimorbidity with greater magnitude in rural areas. Prevalence of multimorbidity and having three or more chronic conditions were highest among low-income populations.Conclusion:Interventions targeting population weight, age/sex specific disease burdens, and additional focus on stable income are encouraged.

Lifestyle behaviors need to be more explored within the context of chronic noncommunicable disease (NCD) multimorbidity. This study aimed to investigate the association of multimorbidity with physical activity and sedentary behavior in a representative Brazilian population (n = 52,929). A cross-sectional survey (VIGITEL in the Portuguese acronym) was conducted in 2013 in the 27 Brazilian federal units. Multimorbidity is defined as the presence of two or more NCDs, that is, the outcome variable; and physical activity (commuting, domestic chores, leisure, and work domains) and sedentary behavior (television time < 2 hours/day and ≥ 2 hours/day) were the exposure variables. Poisson and multinomial logistic regressions (odds ratio - OR) stratified by age and their respective 95% confidence intervals were used, adopting a significance level of 5%. Among 37,947 adults, the presence of three chronic diseases was less frequent in subjects active in the work domain (OR = 0.60) and more frequent among those with longer daily television time (OR = 1.25). The presence of four diseases was less frequent in subjects active in the commuting (OR = 0.52) and work (OR = 0.42) domains. Among 14,982 older adults, the presence of two, three, and four chronic diseases was consistently more frequent in those with longer daily television time (OR = 1.33; 1.55 and 1.93, respectively). Finally, interactions between total physical activity level and daily television time were statistically significant in the multimorbidity in both age groups. Physical activity and sedentary behavior are associated with multimorbidity and should be considered independent factors for health promotion and for the treatment of patients with multimorbidity.

BackgroundThe burden of chronic diseases in China is substantial now. Data on patterns of chronic diseases and multimorbidity among older adults, especially among those living in rural areas, are sparse.ObjectiveWe aim to investigate the prevalence and patterns of chronic disease pairs and multimorbidity in elderly people living in rural China.MethodsThis population-based study included 1480 adults aged 60 years and over (mean age 68.5 years, 59.4% women) living in a rural community. Data were derived from the Confucius Hometown Aging Project in Shandong, China (June 2010-July 2011). Chronic diseases were diagnosed through face-to-face interviews, clinical examinations, and laboratory tests. Patterns of chronic disease pairs and multimorbidity were explored using logistic regression and exploratory factor analyses.ResultsThe prevalence of individual chronic diseases ranged from 3.0% for tumor to 76.4% for hypertension, and each disease was often accompanied with three or more other chronic diseases. The observed prevalence of pairs of chronic conditions exceeded the expected prevalence for several conditions, such as cardiovascular diseases and metabolic disorders, as well as pulmonary diseases and degenerative disorders. Chronic multimorbidity (≥2 chronic diseases) affected more than 90% of subjects, and two patterns of chronic multimorbidity were identified: cardiopulmonary-mental-degenerative disorder pattern (overall prevalence, 58.2%), and cerebrovascular-metabolic disorder pattern (62.6%). Prevalence of the cardiopulmonary-mental-degenerative disorder pattern increased with age, and was higher in men than women; whereas prevalence of the cerebrovascular-metabolic disorder pattern was higher in women than in men but did not vary by age.ConclusionChronic multimorbidity was highly prevalent among older Chinese adults living in rural areas, and there were specific patterns of the co-occurrence of chronic diseases. Effort is needed to identify possible preventative strategies based on the potential clustering of chronic diseases.

BackgroundMultimorbidity is the co-occurrence of two or more chronic diseases.ObjectiveThis study, based on self-reported medical diagnosis, aims to investigate the dynamic distribution of multimorbidity across sociodemographic levels and its impacts on health-related issues over 15 years in Brazil using national data.MethodsData were analyzed using descriptive statistics, hypothesis tests, and logistic regression. The study sample comprised 679,572 adults (18-59 years of age) and 115,699 elderly people (≥60 years of age) from the two latest cross-sectional, multiple-cohort, national-based studies: the National Sample Household Survey (PNAD) of 1998, 2003, and 2008, and the Brazilian National Health Survey (PNS) of 2013.ResultsOverall, the risk of multimorbidity in adults was 1.7 times higher in women (odds ratio [OR] 1.73, 95% CI 1.67-1.79) and 1.3 times higher among people without education (OR 1.34, 95% CI 1.28-1.41). Multiple chronic diseases considerably increased with age in Brazil, and people between 50 and 59 years old were about 12 times more likely to have multimorbidity than adults between 18 and 29 years of age (OR 11.89, 95% CI 11.27-12.55). Seniors with multimorbidity had more than twice the likelihood of receiving health assistance in community services or clinics (OR 2.16, 95% CI 2.02-2.31) and of being hospitalized (OR 2.37, 95% CI 2.21-2.56). The subjective well-being of adults with multimorbidity was often worse than people without multiple chronic diseases (OR=12.85, 95% CI: 12.07-13.68). These patterns were similar across all 4 cohorts analyzed and were relatively stable over 15 years.ConclusionsOur study shows little variation in the prevalence of the multimorbidity of chronic diseases in Brazil over time, but there are differences in the prevalence of multimorbidity across different social groups. It is hoped that the analysis of multimorbidity from the two latest Brazil national surveys will support policy making on epidemic prevention and management.