Impact of prenatal and childhood adversity\xa0effects around World War II on multimorbidity: results from the KORA-Age study

Ava Arshadipour,Birgit Linkohr,Karl-Heinz Ladwig,Annette Peters,Margit Heier,Susanne Rospleszcz,Barbara Thorand

doi:10.1186/s12877-022-02793-2

Abstract

BackgroundWhile risk factors for age-related diseases may increase multimorbidity (MM), early life deprivation may also accelerate the development of chronic diseases and MM.MethodsThis study explores the prevalence and pattern of MM in 65–71 year-old individuals born before, during, and after World War II in Southern Germany based on two large cross-sectional KORA (Cooperative Health Research in the Region of Augsburg) -Age studies in 2008/9 and 2016. MM was defined as having at least two chronic diseases, and birth periods were classified into five phases: pre-war, early war, late war, famine, and after the famine period. Logistic regression models were used to analyze the effect of the birth phases on MM with adjustment for sociodemographic and lifestyle risk factors. Furthermore, we used agglomerative hierarchical clustering to investigate the co-occurrence of diseases.ResultsParticipants born during the late war phase had the highest prevalence of MM (62.2%) and single chronic diseases compared to participants born during the other phases. Being born in the late war phase was significantly associated with a higher odds of MM (OR = 1.83, 95% CI: 1.15–2.91) after adjustment for sociodemographic and lifestyle factors. In women, the prevalence of joint, gastrointestinal, eye diseases, and anxiety was higher, while heart disease, stroke, and diabetes were more common in men. Moreover, three main chronic disease clusters responsible for the observed associations were identified as: joint and psychosomatic, cardiometabolic and, other internal organ diseases.ConclusionsOur findings imply that adverse early-life exposure may increase the risk of MM in adults aged 65–71 years. Moreover, identified disease clusters are not coincidental and require more investigation.

Highlights

Parallel to the worldwide increase in life expectancy in the last decades, the prevalence of age-related chronic diseases has risen
Data collection and study sample Data originated from two population-based cross-sectional KORA-Age study arms: KORA-Age 1 conducted from 01.12.2008 to 06.11.2009 and KORA-Age 3 conducted from 01.02.2016 to 07.10.2016, which are follow-ups of four independent cross-sectional studies (S1 1984/5, S2 1989/90, S3 1994/5, and S4 1999- 2001)
Educational levels increased over time with the lowest level of high education for people born before the war (26% high education) and higher levels later (37% high education in after famine)

Summary

Introduction

Parallel to the worldwide increase in life expectancy in the last decades, the prevalence of age-related chronic diseases has risen. Multimorbidity (MM), defined as the presence of at least two chronic diseases has become increasingly prevalent especially. Based on a systematic literature review of 41 articles from different countries, the prevalence of MM ranges from 55 to 98% in those aged ≥ 65 years [2]. In Germany, based on the cross-sectional national telephone health interview survey "German Health Update" (GEDA 2012–2013), the MM prevalence ranged from 61.7% (95% CI: 59.3 -64.1) for 60 to year-old to 72.9% (95% CI: 70.4–75.2) for to 79 year-old individuals [3]. While risk factors for age-related diseases may increase multimorbidity (MM), early life deprivation may accelerate the development of chronic diseases and MM

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