eprintid: 10134773
rev_number: 19
eprint_status: archive
userid: 608
dir: disk0/10/13/47/73
datestamp: 2021-09-22 07:56:50
lastmod: 2021-12-13 01:36:55
status_changed: 2021-09-22 07:56:50
type: article
metadata_visibility: show
creators_name: Khanolkar, AR
creators_name: Chaturvedi, N
creators_name: Kuan, V
creators_name: Davis, D
creators_name: Hughes, A
creators_name: Richards, M
creators_name: Bann, D
creators_name: Patalay, P
title: 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
ispublished: inpress
divisions: UCL
divisions: B16
divisions: B14
divisions: J81
divisions: B02
divisions: D14
divisions: GA3
divisions: G17
divisions: DD4
divisions: J73
note: © 2021 Khanolkar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
abstract: Background: 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. //

Methods and findings: 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. //

Conclusions: 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.
date: 2021-09-14
date_type: published
official_url: https://doi.org/10.1371/journal.pmed.1003775
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1888408
doi: 10.1371/journal.pmed.1003775
medium: Print-Electronic
lyricists_name: Bann, David
lyricists_name: Chaturvedi, Nishi
lyricists_name: Davis, Daniel
lyricists_name: Hughes, Alun
lyricists_name: Khanolkar, Amal
lyricists_name: Kuan Po Ai, Valerie
lyricists_name: Patalay, Praveetha
lyricists_name: Richards, Marcus
lyricists_id: DBANN02
lyricists_id: NCHAT95
lyricists_id: DDAVI19
lyricists_id: ADHUG42
lyricists_id: AKHAB50
lyricists_id: VKUAN51
lyricists_id: PATAL55
lyricists_id: MRICH78
actors_name: Flynn, Bernadette
actors_id: BFFLY94
actors_role: owner
full_text_status: public
publication: PLoS medicine
volume: 18
number: 9
article_number: e1003775
issn: 1549-1676
citation:        Khanolkar, AR;    Chaturvedi, N;    Kuan, V;    Davis, D;    Hughes, A;    Richards, M;    Bann, D;           Khanolkar, AR;  Chaturvedi, N;  Kuan, V;  Davis, D;  Hughes, A;  Richards, M;  Bann, D;  Patalay, P;   - view fewer <#>    (2021)    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.                   PLoS medicine , 18  (9)    , Article e1003775.  10.1371/journal.pmed.1003775 <https://doi.org/10.1371/journal.pmed.1003775>.    (In press).    Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10134773/1/journal.pmed.1003775.pdf