Risk Factors For Multimorbidity Research Articles

Association between reproductive lifespan and multimorbidity among Chinese postmenopausal women.

Although menopause is considered a risk factor for multimorbidity, few studies have explored the association between reproductive lifespan and multimorbidity. This study aimed to explore the association between reproductive lifespan and multimorbidity in postmenopausal Chinese women. This cross-sectional study selected postmenopausal women as study participants. The reproductive lifespan refers to the interval between menarche and menopause. Multimorbidity refers to having two or more self-reported chronic diseases. We used a logistic regression model to explore potential associations based on the adjustment of a set of covariates. In total, 1,310 postmenopausal women with an average reproductive lifespan of 34 years were included in this study. The prevalence of multimorbidity was 22.2% (291/1,310) in postmenopausal women. Our findings showed that compared with postmenopausal women with the Q1 of reproductive lifespan (≤32 reproductive years), those with Q3 (35-37 reproductive years) and Q4 (≥38 reproductive years) were less likely to have multimorbidity (ORQ3 = 0.529, 95% CIQ3 = 0.347-0.805, ORQ4 = 0.510, 95% CIQ4 = 0.308-0.842), whereas those with Q2 (33-34 reproductive years) were not (OR = 0.700, 95% CI = 0.446-1.098). This study also revealed a linear trend in the association between the reproductive lifespan and multimorbidity; that is, the longer the reproductive lifespan, the lower the risk of multimorbidity. In postmenopausal Chinese women, a longer reproductive lifespan was associated with a lower prevalence of multimorbidity. This study suggests that for the prevention and intervention of multimorbidity in postmenopausal women, healthcare professionals should screen and assess reproductive factors to identify high-risk individuals.

Prevalence of chronic conditions and multimorbidity among healthcare workers in Zimbabwe: Results from a screening intervention.

The burden of non-communicable diseases (NCDs) in southern Africa is expanding and is superimposed on high HIV prevalence. Healthcare workers are a scarce resource; yet are vital to health systems. There are very limited studies on the burden of chronic conditions among healthcare workers in Africa, and none exploring multimorbidity (≥2 chronic conditions). We describe the epidemiology of infectious (HIV) and non-communicable chronic conditions, and multimorbidity, among Zimbabwean healthcare workers. Healthcare workers (≥18 years) in eight Zimbabwean provinces were invited to a voluntary, cross-sectional health-check, including HIV, diabetes, hypertension and mental health screening. Statistical analyses described the prevalence and risk factors for multimorbidity (two or more of HIV, diabetes, hypertension or common mental disorder) and each condition. Missing data were handled using multiple imputation. Among 6598 healthcare workers (July 2020-July 2022) participating in the health-check, median age was 37 years (interquartile range 29-44), 79% were women and 10% knew they were living with HIV. Half had at least one chronic condition: 11% were living with HIV, 36% had elevated blood pressure, 12% had elevated HbA1c and 11% had symptoms of common mental disorder. The overall prevalence of multimorbidity was 15% (95% CI: 13-17%); 39% (95% CI: 36-43%) among people aged 50 and older. Whilst most HIV was diagnosed and treated, other chronic conditions were usually undiagnosed or uncontrolled. Limiting our definition of multimorbidity to two or more screened conditions sought to reduce bias due to access to diagnosis, however, may have led to a lower reported prevalence than that found using a wider definition. Half of healthcare workers screened were living with a chronic condition; one in seven had multimorbidity. Other than HIV, most conditions were undiagnosed or untreated. Multisectoral action to implement contextually relevant, chronic disease services in Africa is urgently needed. Specific attention on health workers is required to protect and retain this critical workforce.

Risk factors for multimorbidity in adulthood: a systematic review.

Multimorbidity, the coexistence of multiple chronic diseases in an individual, is highly prevalent and challenging for healthcare systems. However, its risk factors remain poorly understood. To systematically review studies reporting multimorbidity risk factors. A PRISMA-compliant systematic review was conducted, searching electronic databases (MEDLINE, EMBASE, Web of Science, Scopus). Inclusion criteria were studies addressing multimorbidity transitions, trajectories, continuous disease counts, and specific patterns. Non-human studies and participants under 18 were excluded. Associations between risk factors and multimorbidity onset were reported. Of 20,806 identified studies, 68 were included, with participants aged 18-105 from 23 countries. Nine risk factor categories were identified, including demographic, socioeconomic, and behavioral factors. Older age, low education, obesity, hypertension, depression, low pysical function were generally positively associated with multimorbidity. Results for factors like smoking, alcohol consumption, and dietary patterns were inconsistent. Study quality was moderate, with 16.2% having low risk of bias. Several risk factors seem to be consistently associated with an increased risk of accumulating chronic diseases over time. However, heterogeneity in settings, exposure and outcome, and baseline health of participants hampers robust conslusions.

Prevalence of and factors associated with multimorbidity among 18 101 adults in the South East Asia Community Observatory Health and Demographic Surveillance System in Malaysia: a population-based, cross-sectional study of the MUTUAL consortium

ObjectivesTo assess the prevalence and factors associated with multimorbidity in a community-dwelling general adult population on a large Health and Demographic Surveillance System (HDSS) scale.DesignPopulation-based cross-sectional study.SettingSouth East Asia Community...

Multimorbidity and multi-disability among the elderly in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

We report prevalence and risk factors for multimorbidity and multi-disability among elderly people in residential care in the Hyderabad region in South India. In total, 1182 elderly (aged ≥ 60) participants were examined in 41 homes for the aged centres. Detailed interviews were conducted by trained personnel to collect personal and demographic information. A questionnaire was used to assess the history of non-communicable diseases and Washington Disability Questionnaire (WDQ) was administered to assess disabilities. The mean age of the participants was 75.0 years (SD 8.8 years; range: 60–108 years), 35.4% were men, 20.3% had no formal education, 60.7% had school education and 19% had higher education. The prevalence of multimorbidity was 37.6% (95% CI: 34.8–40.4). Prevalence of multi-disability was 23.6% (95% CI: 21.2–26.3; n = 270). In total, 857 (72.5%) participants reported using at least one medication for NCDs. Over a third of the elderly in residential care had multimorbidity, and a quarter of them had multi-disability. A holistic health care system that comprises health and wellness coupled with rehabilitation to address disabilities is needed to achieve healthy aging in elderly in homes for the aged in India.

Evaluating the Role of Probiotics in the Prevention and Management of Age-Related Diseases.

The human lifespan has been significantly increased due to scientific advancements in the management of disease; however, the health span of the aging population does not follow the same trend. Aging is the major risk factor for multimorbidity that is derived from the progressive loss of homeostasis, immunological and stem cell exhaustion, as well as exacerbated inflammation responses. Age-related diseases presenting with high frequencies include neurodegenerative, musculoskeletal, cardiovascular, metabolic diseases and cancer. These diseases can be co-morbid and are usually managed using a disease-specific approach that can eventually lead to polypharmacy, low medication adherence rates and undesired drug-drug interactions. Novel studies suggest targeting the shared biological basis of age-related diseases to retard the onset and manage their manifestations. Harvesting the anti-inflammatory and immunomodulatory capacity of probiotics to tackle the root cause of these diseases, could pose a viable alternative. In this article, a comprehensive review of the effects of probiotic supplementation on the molecular pathogenesis of age-related diseases, and the potential of probiotic treatments as preventative or alleviatory means is attempted. Furthermore, issues on the safety and efficiency of probiotic supplementation, as well as the pitfalls of current clinical studies are discussed, while new perspectives for systematic characterization of probiotic benefits on aged hosts are outlined.

Association between body mass index, multi-morbidity and activities of daily living among New Zealand nursing home older adults: a retrospective analysis of nationwide InterRAI data

BackgroundObesity is a well-established risk factor for multi-morbidity and disability among older adults in the community and acute care settings. However, nursing home residents with body mass index (BMI) below 18.5 kg/m2 and above 25.0 kg/m2 have been understudied. We examined the prevalence of multi-morbidity and disability in activities of daily living (ADL) by BMI category and further investigated the association between BMI, multi-morbidity, and disability of ADL in a large cohort of older adults in nursing homes in New Zealand.MethodsA retrospective review of nursing home residents’ data obtained from the New Zealand International Resident Assessment Instrument national dataset from 2015 to 2018. One hundred ninety-eight thousand seven hundred ninety older adults (≥60 years) living in nursing homes were included. BMI was calculated as weight in kilograms (kg) divided by height in meters squared (m2). Multimorbidity was defined as the presence of ≥2 health conditions. The risk of disability was measured by a 4-item ADL self-performance scale. The prevalence ratio (PR) of the association between BMI and multi-morbidity and between BMI and disability in ADL was assessed using Poisson regression with robust variance.ResultsOf the 198,790 residents, 10.6, 26.6, 11.3 and 5.4% were underweight, overweight, obese, and extremely obese, respectively. 26.4, 31.3 and 21.3% had one, two and three disease conditions, respectively, while 14.3% had four or more conditions. 24.1% could perform only one ADL, and 16.1% could perform none. The prevalence of multi-morbidity increased with increasing BMI, whereas mean disability in ADL decreased with increasing BMI. The risk of multi-morbidity was higher for the overweight (PR, 95%CI: 1.03, 1.02–1.03) and obese (PR, 95% CI: 1.07, 1.06–1.08) compared to normal weight after controlling for age, sex, ethnicity, and region. BMI was inversely associated with mean ADL; β, 95% CI for overweight (− 0.30, − 0.32, − 0.28) and obese − 0.43, − 0.45, − 0.40 compared to normal weight.ConclusionBeing underweight was associated with a decline in the performance of ADL in nursing home residents. In contrast, being overweight and obese positively affected functional performance, demonstrating that the obesity paradox plays an important role in this population. The observed associations highlight areas where detection and management of underweight and healthy aging initiatives may be merited.

Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women.

This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil. We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20-69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity. The prevalence of multimorbidity was 21.7% (95%CI 19.3-24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51-2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09-2.15) and 76% (PR 1.76; 95%CI 1.27-2.45) more likely to have multimorbidity than eutrophic women. Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.

Impact of neighbourhood walkability on the onset of multimorbidity: a cohort study

Multimorbidity has become highly prevalent around the globe and been associated with adverse health outcomes and cost of care. The built environment has become an important dimension in response to...

The rising complexity and burden of multimorbidity in a middle-income country.

The limited knowledge on aetiology, epidemiology and risk factors for multimorbidity especially evident from low and middle-income countries curtail the development and implementation of sustainable healthcare models. Sri Lanka, boasting for one of South Asia's most efficient public health systems that is accessible free-of-charge by the citizens is presently transitioning from lower-middle to upper-middle-income tier. Faced with the triple burden of disease, it is imperative for Sri Lanka to incorporate an integrated model to manage multimorbidity. A descriptive cross-sectional study was carried out in medical clinics of a tertiary care hospital and a University primary care department. Data were extracted on to a form from the clinical records of patients over the age of 20 years with at least one non-communicable disease (NCD) and analysed. Multimorbidity was present among 64.1% of patients (n = 1600). Nearly 44.44% of the patients aged 20-35 years have a minimum of two disorders, and by the time they reach 50 years, nearly 64% of the patients have two or more non-communicable diseases. Nearly 7% of those aged over 65 years were diagnosed with four or more disorders. A fourth of the sample was affected by co-morbid diabetes mellitus and hypertension, whereas the combinations of coronary heart disease with hypertension and diabetes mellitus were also found to be significantly prevalent. A salient revelation of the binomial logistic regression analysis was that the number of disorders was positively correlated to the presence of mental disorders 7.25 (95% CI = 5.82-8.68). Multimorbidity is highly prevalent among this population and seemingly has a detrimental effect on the psychological wellbeing of those affected. Therefore, the need for horizontal integration of all primary to tertiary care disciplines, including mental health, to manage multimorbidity by policymakers is emphasized as a priority task.

Prevalence and risk factors for multimorbidity in older US patients with late-stage melanoma

IntroductionPresence of multimorbidity can affect prognosis, treatment, and outcomes of individuals with cancer. However, the prevalence and factors associated with multimorbidity among older late-stage melanoma is not well studied. We estimated the prevalence of any type of pre-existing multimorbidity (autoimmune disorder (AD), physical health conditions (PHC), and mental health conditions (MHC)) among older adults with late-stage melanoma in the United States. We further examined the association of patient-level factors to multimorbidity in late-stage melanoma. MethodsWe derived data on older fee-for-service Medicare beneficiaries (age ≥ 66 years) diagnosed with late-stage melanoma between 2011 and 2015 (N = 4,519) from the linked Surveillance, Epidemiology, and End Results cancer registry and Medicare claims. We defined multimorbidity as the prevalence of two or more chronic conditions prior to the diagnosis of melanoma. We used unadjusted and adjusted logistic regressions to examine the association of patient-level factors to multimorbidity. ResultsAn overwhelming majority (85%) of older patients with late-stage melanoma had multimorbidity. Pre-existing PHC multimorbidity (84%) was the most prevalent, followed by AD (12%), and MHC (6%). Age and region were associated with any and PHC multimorbidity. Sex, marital status, and region were factors associated with pre-existing AD while sex, marital status, and dual eligibility were associated with MHC multimorbidity. ConclusionsPre-existing multimorbidity was highly prevalent among older individuals with late-stage melanoma; prevalence rates and factors associated with multimorbidity varied by type of chronic conditions. This highlights the need for developing systematic approaches to optimizing care of older patients with late-stage melanoma and multimorbidity.

Sleep behaviours and multimorbidity occurrence in middle-aged and older adults: findings from the Canadian Longitudinal Study on Aging (CLSA)

ObjectivePoor sleep quality and reduced sleep duration impact over half of older adults and are associated with adverse health outcomes, such as multiple chronic conditions (multimorbidity) and reduced longevity. Our objective was to examine the relationship between sleep behaviours and multimorbidity in Canada. MethodsWe analysed data from the Canadian Longitudinal Study on Aging (CLSA), a cross-sectional national health survey of community-dwelling adults over the age of 45 years. A total of 30,011 participants had physiological and psychosocial data collected at baseline. Sleep measures included self-reported sleep duration (short: <6 h; normal: 6–8 h; long: >8 h) and sleep quality (dissatisfied/very dissatisfied; neutral; satisfied/very satisfied). Multimorbidity was defined using two definitions (public health and primary care) and two cut-points (2 or more and 3 or more chronic conditions). ResultsApproximately 70% were living with multimorbidity using the primary care definition (females: 67.9%; males 57.9%), whereas approximately 30% were living with multimorbidity using the public health definition (females: 30.9%; males: 24.0%). Adjusted analyses indicated that the odds of multimorbidity were higher for participants who selfreported either short or long sleep duration, as well as dissatisfaction with sleep quality. Associations were stronger among younger age groups (45–54 years and 55–64 years). ConclusionsDisrupted sleep may be a risk factor for multimorbidity across sexes and age groups. It is necessary to understand the potential impact of sleep on the risk of multimorbidity to inform both clinical and public health guidelines for the prevention and management of this major health issue.

Discrimination and Multimorbidity Among Black Americans: Findings from the National Survey of American Life.

There is a notable lack of research on the risk factors for multimorbidity, which has become more common over recent decades. Black Americans experience discrimination more often than their White counterparts, and also have significantly higher prevalence of multimorbidity. This paper examines the associations between discrimination and multimorbidity among Black Americans. We analyzed data from the National Survey of American Life to calculate the prevalence of two types of discrimination (everyday discrimination, major discriminatory events) and multimorbidity (physical, psychiatric, mixed, any). Using multivariable logistic regression, we examined the associations between discrimination and multimorbidity, adjusting for age, sex, years of education, income-to-poverty ratio, and ethnicity. The everyday discrimination scale was discretized into five categories (none, low, medium, high, very high), but was also treated as a continuous variable. The major discriminatory events were analyzed in separate adjusted models, and as a count of events. When compared with those who did not experience any discrimination, people who experienced everyday discrimination were significantly more likely to report all types of multimorbidity in a dose-response fashion at a conventional level of statistical significance. Most major discriminatory events were associated with greater odds of reporting all types of multimorbidity, as were the counts of major discriminatory events, in a dose-response fashion. We found strong evidence to suggest that discrimination was associated with greater odds of reporting multimorbidity. Future studies can expand on these findings using longitudinal data to capture the relations between discrimination and health over time, or by testing preventive interventions that allay the damaging health effects of discrimination.

M82. GROWING BURDEN OF DISEASE: THE PREVALENCE OF CHRONIC HEALTH CONDITIONS AFTER A FIRST EPISODE OF PSYCHOSIS

BackgroundOver 12% of Canadians live with two or more (2+) co-occurring chronic physical health conditions or multimorbidity. This proportion is expected to rise with increased exposure to risk factors for these diseases. People with psychotic disorders often have co-occurring chronic physical health conditions; however, to date there has been a paucity of research on the prevalence of multimorbidity among people with psychosis. The objective of our study was to examine the prevalence of multimorbidity ten years after a first episode of psychosis (FEP) utilizing data from a retrospective cohort study based on health administrative data.MethodsThe health administrative dataset has been linked to data from the Prevention and Early Intervention Program for Psychoses in London, Canada to enable identification of FEP patients (n=455). FEP patients were compared to a randomly selected comparison group from the general population (n=1,783), matched on age, gender, and neighbourhood. This cohort has been followed for a 10-year period in the health administrative data to ascertain the prevalence of physical comorbidities.ResultsPreliminary analyses on 2,238 patients (557 females, 1,681 males) at 10-year follow-up, reveals that 32.1% (95% CI 28.0%, 36.5%) of FEP patients have 2+ conditions, as compared to 15.1% (95% CI 13.6%, 16.9%) of people without psychosis. Full results on risk factors for multimorbidity will be presented.DiscussionThe findings from this study will facilitate increased surveillance and recognition of the common physical health conditions faced by people with psychosis, including those contributing to premature mortality of this patient population. This information aims to assist decision-makers in creating tailored intervention plans to improve the physical health of patients with psychotic disorders, and integrate care across multiple specialties to reduce the growing burden of disease to the Canadian health system.

Pain and Multimorbidity in Late Life

To characterize pain prevalence in older adults, particularly high-impact chronic pain, and examine the presence of multimorbidity and its relationship with and impact on chronic pain. This review found that chronic pain is highly prevalent in older adults; however, high-impact pain appears to be less prevalent based on recent studies. In addition, it was found that risk factors for multimorbidity and chronic pain experiences include causal factors (e.g., lifestyle, injury, medications and treatments, and/or surgery) and contributing factors (e.g., biological, psychological, and environmental). The consequences of both multimorbidity and chronic pain experiences include functional impairment, psychological distress, symptom severity and burden, medication use, decreased quality of life, and sleep disturbance. This article addressed pain prevalence in older adults and the relationship between pain and multimorbidity. Risk factors and consequences of pain and multimorbidity were identified and recommendations for future research were provided.

EDUCATION, RACE-ETHNICITY, AND MULTI-MORBIDITY AMONG ADULTS AGES 30-64 IN THE NATIONAL HEALTH INTERVIEW STUDY

Demographic risk factors for multimorbidity (living with 2+ chronic conditions) have been identified in numerous population-based studies of older adults; however, there is less data on younger populations, despite the fact that approximately 24% of US adults age 18+ have multimorbidity. To examine the associations of education and race/ethnicity with mutimorbidity among adults aged 30-64 using cross-sectional data from the 2002-2014 National Health Interview Surveys. Compared to having a bachelor’s degree or higher, completing less than HS (OR=1.58, 95% CI = 1.50-1.66) or HS/some college (OR=1.32, 95% CI = 1.27-1.37) were both associated with increased odds of multimorbidity. Non-Hispanic Blacks had greater odds of multimorbidity (OR=1.07, 95% CI = 1.02-1.11) compared to Non-Hispanic Whites with comparable characteristics. Reducing multimorbidity through health promotion efforts across the socioeconomic spectrum and earlier in the life course will be a requirement to age successfully and support overall well-being in the aging US population.

Self-Assessed Health Status among Ethnic Elderly of Tea Garden Workers in Bangladesh

The proportion of elderly has been increased gradually over the past years and this has created many causes for concerns particularly in individual’s health status. Relatively little is known about health status of older ethnic group across the world. The study aims to explore the health status of ethnic elderly among Tea Garden workers in Bangladesh. A total of 229 elderly were interviewed from different tea gardens. Prevalence ratio and adjusted prevalence ratio were calculated using simple and multiple Poisson regression analysis. The study revealed that more than 90% of the elderly had suffered from multi-morbidity. Gender, age, family behavior, number of meals in a day, taking milk or milk products and taking sugar were highly associated factor to lead healthy life for elderly. Female and unemployed elderly were in more risk to suffer from multi-morbidity, illiterate were also a risk factor for multi-morbidity but effected by confounding factors. An elderly who rated himself as unhealthy was 1.75 times more risk in compare to healthy elderly. In addition, the ethnic elderly who were suffering from difficulties of seeing, getting up, standing, remembering and others disability were in more risk of suffering from multi-morbidity.

Familial liability to psychosis is a risk factor for multimorbidity in people with psychotic disorders and their unaffected siblings

BackgroundMultimorbidity may impose an overwhelming burden on patients with psychosis and is affected by gender and age. Our aim is to study the independent role of familial liability to psychosis as a risk factor for multimorbidity. MethodsWe performed the study within the framework of the Genetic Risk and Outcome of Psychosis (GROUP) project. Overall, we compared 1024 psychotic patients, 994 unaffected siblings and 566 controls on the prevalence of 125 lifetime diseases, and 19 self-reported somatic complaints. Multimorbidity was defined as the presence of two or more complaints/diseases in the same individual. Generalized linear mixed model (GLMM) were used to investigate the effects of gender, age (adolescent, young, older) and familial liability (patients, siblings, controls) and their interactions on multimorbidity. ResultsFamilial liability had a significant effect on multimorbidity of either complaints or diseases. Patients had a higher prevalence of multimorbidity of complaints compared to siblings (OR 2.20, 95% CI 1.79–2.69, P<0.001) and to controls (3.05, 2.35–3.96, P<0.001). In physical health multimorbidity, patients (OR 1.36, 95% CI 1.05–1.75, P=0.018), but not siblings, had significantly higher prevalence than controls. Similar finding were observed for multimorbidity of lifetime diseases, including psychiatric diseases. Significant results were observed for complaints and disease multimorbidity across gender and age groups. ConclusionMultimorbidity is a common burden, significantly more prevalent in patients and their unaffected siblings. Familial liability to psychosis showed an independent effect on multimorbidity; gender and age are also important factors determining multimorbidity.

Multimorbidity: What do we know? What should we do?

Multimorbidity, which is defined as the co-occurrence of two or more chronic conditions, has moved onto the priority agenda for many health policymakers and healthcare providers. Patients with multimorbidity are high utilizers of healthcare resources and are some of the most costly and difficult-to-treat patients in Europe. Preventing and improving the way multimorbidity is managed is now a key priority for many countries, and work is at last underway to develop more sustainable models of care. Unfortunately, this effort is being hampered by a lack of basic knowledge about the aetiology, epidemiology, and risk factors for multimorbidity, and the efficacy and cost-effectiveness of different interventions. The European Commission recognizes the need for reform in this area and has committed to raising awareness of multimorbidity, encouraging innovation, optimizing the use of existing resources, and coordinating the efforts of different stakeholders across the European Union. Many countries have now incorporated multimorbidity into their own healthcare strategies and are working to strengthen their prevention efforts and develop more integrated models of care. Although there is some evidence that integrated care for people with multimorbidity can create efficiency gains and improve health outcomes, the evidence is limited, and may only be applicable to high-income countries with relatively strong and well-resourced health systems. In low- to middle-income countries, which are facing the double burden of infectious and chronic diseases, integration of care will require capacity building, better quality services, and a stronger evidence base.

Risk factors for multimorbidity: A multilevel analysis of a longitudinal cohort from Scotland

Background Multimorbidity (2+ chronic conditions) is increasing across Europe. Little is known about risk factors for its onset across the lifecourse. We aimed to investigate the relationships between different dimensions of socioeconomic position and health behaviours with future multimorbidity (MM). Method Data were from the Twenty-07 study (1987-2007), which employed a two-stage stratified random sample from three cohorts (baseline age 15, 35, 55). Multilevel logistic …