Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National Survey of Health and Development in the UK.
Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National Survey of Health and Development in the UK.
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DOI：
10.1371/journal.pmed.1003775
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发表时间：
2021-09
期刊：
影响因子：
15.8
通讯作者：
Patalay P
中科院分区：
文献类型：
--
作者：
Khanolkar AR;Chaturvedi N;Kuan V;Davis D;Hughes A;Richards M;Bann D;Patalay P
我们的目的是估计多Mortocell轨迹和量化的社会经济不平等的基础上，儿童和成年的社会经济地位（SEP）的风险和率的多Mortocell积累在成年。来自英国1946年全国健康与发展调查（NSHD）出生队列研究的参与者，他们在1982年参加了36岁评估，并在43岁、53岁、63岁和69岁时参加了任何一次随访评估（N = 3，723，51%男性）。关于18种健康状况的信息是基于自我报告、生物标志物、健康记录和处方药物的组合。我们估计了每个年龄段和纵向轨迹的多死亡率轨迹，并描绘了社会经济不平等（基于儿童和成年的社会阶层和最高教育）。随着年龄的增长，多发病率增加（36岁时为0.7，69岁时为3.7）。多药耐药累积呈非线性，随着年龄的增长而加速，36 - 43岁时为0.08例/年（95% CI 0.07 - 0.09，p < 0.001），63 - 69岁时为0.19例/年（95% CI 0.18 - 0.20，p < 0.001）。在所有年龄段，社会经济处境最不利的人的疾病数量平均比最贫穷的人多1.2至1.4倍。根据每一项社会经济指标，最弱势群体在69岁时经历了额外的0.39种情况（儿童社会阶层）、0.83种情况（成人社会阶层）和1.08种情况（成人教育），这与所有其他社会经济指标无关。不利的成年SEP与更快的积累多morphine，导致0.49多余的条件，部分/非熟练相比，专业/中间的个人之间63和69岁。独立于成年SEP的discourageous童年社会阶层，与53岁起的加速多发病轨迹相关。研究的局限性包括NSHD队列仅由白色欧洲血统的个体组成，研究结果可能无法推广到同一代的非白色英国人口，并且没有考虑SEP的其他重要方面，如收入和财富。在这项研究中，我们发现，社会经济上处于不利地位的个人有更早的发病和更快的积累，导致老年不平等的扩大，与独立的贡献，从儿童和成年SEP. Amal Khanolkar和同事研究之间的关联多morphine和社会经济地位在英国。多发性硬化症--一个人有2种或2种以上的慢性病--有几种后果，包括生活质量下降、预期寿命缩短和复杂的医疗保健需求。社会经济上的不利条件与多发性硬化症的早期发病（年龄较小）和更大的负担有关。然而，较少有人知道，多Morphine如何在成年期发展，并进入老年，在同一个人和儿童和成年期的社会经济地位（SEP）在其发展的差异。纵向multimorbidity轨迹估计年龄在36岁和69岁之间，这些轨迹是否不同的童年（父亲的社会阶层）和成年SEP（参与者自己的社会阶层和教育水平）。我们发现，在整个随访过程中，社会经济地位最不利的人的健康状况平均是最贫穷的人的1.2至1.4倍。平均而言，在社会经济弱势群体和弱势群体中，多死亡率在整个成年期和进入老年后都有所增加。然而，多死亡率在整个成年期的增长率与SEP不同，那些来自最弱势背景的人有更差的轨迹。换句话说，不良SEP与多吗啡的更快蓄积相关。儿童期和成年期SEP与成年期的多发性硬化独立相关。这表明，儿童时期的社会经济不利地位在以后的生活中仍然明显超过成年的社会经济情况。儿童SEP对晚年经历和多病累积率的独立和持久的阴影突出了在生命早期进行干预以最大限度地减少晚年健康不平等的必要性。这就要求在生命早期和整个生命过程中采取基于人口的干预措施，以减少儿童和成年期不平等的影响，同时沿着更好地为弱势群体提供医疗保健，以帮助减轻多重死亡的负担。
We aimed to estimate multimorbidity trajectories and quantify socioeconomic inequalities based on childhood and adulthood socioeconomic position (SEP) in the risks and rates of multimorbidity accumulation across adulthood. Participants from the UK 1946 National Survey of Health and Development (NSHD) birth cohort study who attended the age 36 years assessment in 1982 and any one of the follow-up assessments at ages 43, 53, 63, and 69 years (N = 3,723, 51% males). Information on 18 health conditions was based on a combination of self-report, biomarkers, health records, and prescribed medications. We estimated multimorbidity trajectories and delineated socioeconomic inequalities (based on childhood and adulthood social class and highest education) in multimorbidity at each age and in longitudinal trajectories. Multimorbidity increased with age (0.7 conditions at 36 years to 3.7 at 69 years). Multimorbidity accumulation was nonlinear, accelerating with age at the rate of 0.08 conditions/year (95% CI 0.07 to 0.09, p < 0.001) at 36 to 43 years to 0.19 conditions/year (95% CI 0.18 to 0.20, p < 0.001) at 63 to 69 years. At all ages, the most socioeconomically disadvantaged had 1.2 to 1.4 times greater number of conditions on average compared to the most advantaged. The most disadvantaged by each socioeconomic indicator experienced an additional 0.39 conditions (childhood social class), 0.83 (adult social class), and 1.08 conditions (adult education) at age 69 years, independent of all other socioeconomic indicators. Adverse adulthood SEP was associated with more rapid accumulation of multimorbidity, resulting in 0.49 excess conditions in partly/unskilled compared to professional/intermediate individuals between 63 and 69 years. Disadvantaged childhood social class, independently of adulthood SEP, was associated with accelerated multimorbidity trajectories from age 53 years onwards. Study limitations include that the NSHD cohort is composed of individuals of white European heritage only, and findings may not be generalizable to the non-white British population of the same generation and did not account for other important dimensions of SEP such as income and wealth. In this study, we found that socioeconomically disadvantaged individuals have earlier onset and more rapid accumulation of multimorbidity resulting in widening inequalities into old age, with independent contributions from both childhood and adulthood SEP. Amal Khanolkar and co-workers study associations between multimorbidity and socioeconomic position in the UK. Multimorbidity—2 or more chronic conditions in an individual—has several consequences including reduced quality of life, reduced life expectancy, and complex healthcare needs. Socioeconomic disadvantage is associated with both earlier onset (at younger ages) and greater burden of multimorbidity. However, less is known about how multimorbidity develops across adulthood and into older ages in the same individuals and differences in its development by childhood and adulthood socioeconomic position (SEP). Longitudinal multimorbidity trajectories were estimated between ages 36 and 69 years, and whether these trajectories differed by childhood (father’s social class) and adulthood SEP (participant’s own social class and educational level). We found that throughout follow-up, the most socioeconomically disadvantaged had 1.2 to 1.4 times greater number of health conditions on average compared to the most advantaged. On average, multimorbidity increased across adulthood and into older ages in both socioeconomically disadvantaged and advantaged groups. However, the rate at which multimorbidity increased across adulthood differed by SEP, with those from the most disadvantaged backgrounds having worse trajectories. In other words, adverse SEP was associated with more rapid accumulation of multimorbidity. Childhood and adulthood SEP were independently associated with multimorbidity across adulthood. This indicates that childhood socioeconomic disadvantage is still evident in later life over and above adulthood socioeconomic circumstances. The independent and long-lasting shadow of childhood SEP on the experience and the rate of accumulation of multimorbidities in later life highlight the need for interventions early in life to minimise inequalities in later life health. This calls for population-based interventions in early life and through the lifecourse to reduce the impact of childhood and adulthood inequalities, along with better access and delivery of healthcare for the more vulnerable to help reduce the burden of multimorbidity.
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影响因子：
2.3
作者：
Howe LD;Tilling K;Matijasevich A;Petherick ES;Santos AC;Fairley L;Wright J;Santos IS;Barros AJ;Martin RM;Kramer MS;Bogdanovich N;Matush L;Barros H;Lawlor DA
通讯作者：
Lawlor DA
DOI：
10.1016/s0140-6736(17)30402-6
发表时间：
2017-03-04
期刊：
Lancet (London, England)
影响因子：
--
作者：
Mendenhall E;Kohrt BA;Norris SA;Ndetei D;Prabhakaran D
通讯作者：
Prabhakaran D
影响因子：
4.4
作者：
Mercer, Stewart W.;Zhou, Yuefang;Watt, Graham C. M.
通讯作者：
Watt, Graham C. M.
影响因子：
3.9
作者：
Hsu, Hui-Chuan
通讯作者：
Hsu, Hui-Chuan
影响因子：
2.9
作者：
Johnston, Marjorie C.;Black, Corrinda;Crilly, Michael A.
通讯作者：
Crilly, Michael A.