Abstract
BackgroundWe sought to: [1] estimate the prevalence of multimorbidity at age 46–48 in the 1970 British Cohort Study—a nationally representative sample in mid-life; and [2] examine the association between early-life characteristics and mid-life multimorbidity. MethodA prospective longitudinal birth cohort of a community-based sample from the 1970 British Cohort Study (BCS70). Participants included all surviving children born in mainland Britain in a single week in April 1970; the analytical sample included those with valid data at age 46–48 (n = 7951; 2016–2018). The main outcome was multimorbidity, which was operationalised as a binary indicator of two or more long-term health conditions where at least one of these conditions was of physical health. It also included symptom complexes (e.g., chronic pain), sensory impairments, and alcohol problems.ResultsPrevalence of mid-life multimorbidity was 33.8% at age 46–48. Those with fathers from unskilled social occupational class (vs professional) at birth had 43% higher risk of mid-life multimorbidity (risk ratio = 1.43, 95% confidence interval 1.15 to 1.77). After accounting for potential child and family confounding, an additional kilogram of birthweight was associated with 10% reduced risk of multimorbidity (risk ratio = 0.90, 95% confidence interval 0.84 to 0.96); a decrease of one body mass index point at age 10 was associated with 3% lower risk (risk ratio = 1.03, 95% confidence interval 1.01 to 1.05); one standard deviation higher cognitive ability score at age 10 corresponded to 4% lower risk (risk ratio = 0.96, 95% confidence interval 0.91 to 1.00); an increase of one internalising problem at age 16 was equated with 4% higher risk (risk ratio = 1.04, 95% confidence interval 1.00 to 1.08) and of one externalising problem at age 16 with 6% higher risk (risk ratio = 1.06, 1.03 to 1.09).ConclusionPrevalence of multimorbidity was high in mid-life (33.8% at age 46–48) in Britain. Potentially modifiable early-life exposures, including early-life social circumstances, cognitive, physical and emotional development, were associated with elevated risk of mid-life multimorbidity.
Highlights
The prevalence of multimorbidity has increased over the last two decades in high-income countries and this trend is projected to continue [1,2,3]
After accounting for potential child and family confounding, an additional kilogram of birthweight was associated with 10% reduced risk of multimorbidity; a decrease of one body mass index point at age 10 was associated with 3% lower risk; one standard deviation higher cognitive ability score at age 10 corresponded to 4% lower risk; an increase of one internalising problem at age 16 was equated with 4% higher risk and of one externalising problem at age 16 with 6% higher risk
Exposures—mid-life multimorbidity association In gender-adjusted models, all exposures were associated with a greater risk of multimorbidity at age 46–48: lower birthweight, lower cognitive ability at age 10, higher body-mass index (BMI) at age 10, more internalising and externalising problems at age 16 as well as a more disadvantaged father’s social classes at birth (p < 0.001): with unskilled class having 43% higher risk of multimorbidity (Table 2)
Summary
The prevalence of multimorbidity has increased over the last two decades in high-income countries and this trend is projected to continue [1,2,3]. This presents a challenge to population health, as multimorbidity is linked to polypharmacy and complex health needs [3]. We identified exposures that are potentially modifiable, commonly measured, span multiple domains of early-life development and have been linked to adult morbidity. These were birthweight, socioeconomic circumstances, cognitive ability, and body-mass index (BMI), internalising and externalising problems. We sought to: [1] estimate the prevalence of multimorbidity at age 46–48 in the 1970 British Cohort Study—a nationally representative sample in mid-life; and [2] examine the association between early-life characteristics and mid-life multimorbidity
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