Associations between socioeconomic status and dynamic development of physical,psychological and cognitive degenerative multimorbidity among middle aged and older adults in China

Abstract

Objective: To analyze the dynamic development of physical, psychological, and cognitive degenerative multimorbidity among middle-aged and older Chinese adults (≥45 years old) while estimating the longitudinal association between socioeconomic status (SES) and the progression of multimorbidity. Methods: Based on data from the China Health and Retirement Longitudinal Study (2011-2020), the Sankey diagram was used to show the dynamic development of physical, psychological, and cognitive degenerative multimorbidity from 2011 to 2020. SES was constructed based on the level of education and total household wealth. Logistic regression was used to estimate OR and 95%CI to evaluate the association between SES and the progression of multimorbidity. Results: Of the 5 393 participants included, 4 484 (83.14%) of them developed new diseases, and the prevalence of physical, psychological, and cognitive degenerative multimorbidity increased from 38.04% to 74.23%. Compared to those with no reported disorders at baseline, participants with psychological disorder (for newly developed physical-cognitive multimorbidity: OR=4.59,95%CI: 2.89-7.29), cognitive disorder (for newly developed physical-psychological multimorbidity: OR=2.24,95%CI: 1.40-3.60), or their multimorbidity at baseline were more likely to progress to physical, psychological, and cognitive degenerative multimorbidity. After adjusting covariates, individuals with low SES were more likely to develop physical diseases (OR=1.45, 95%CI: 1.11-1.89), cognitive disorder (OR=1.84, 95%CI: 1.16-2.91), physical-psychological multimorbidity (OR=1.87, 95%CI: 1.37-2.56), physical-cognitive multimorbidity (OR=3.58, 95%CI: 2.54-5.06), psychological-cognitive multimorbidity (OR=5.66, 95%CI: 3.04-10.55), and physical-psychological-cognitive multimorbidity (OR=3.21, 95%CI: 2.06-5.01) in comparison to those with high SES. There is a dose-response relationship between SES and the multimorbidity progression (all trend P<0.001). Conclusions: The prevalence of physical, psychological, and cognitive degenerative multimorbidity increased significantly among middle-aged and older Chinese adults. Lower SES was associated with multiple patterns of physical, psychological, and cognitive disorders progression.