Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences: A Cohort Study

Abstract

Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life—childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network—and the speed of chronic disease accumulation. We followed 2,589 individuals aged ≥60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001–2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, β × time = −0.065, 95% CI: −0.126, −0.004; for university, β × time = −0.118, 95% CI: −0.185, −0.050); for active occupations compared with high-strain jobs (β × time = −0.078, 95% CI: −0.138, −0.017); and for richer social networks (for moderate tertile, β × time = −0.102, 95% CI: −0.149, −0.055; for highest tertile, β × time = −0.135, 95% CI: −0.182, −0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging.

Working Life Psychosocial Conditions in Relation to Late-Life Cognitive Decline: A Population-Based Cohort Study

“…In the mediation analyses, demand-control status was treated as an ordinal variable according to the magnitude of the associations between demand-control combinations and the annual change in total disability (i.e., the slopes shown in Figure 10), that is, the detrimental effects of demand-control categories followed an order from the lowest to the highest: active jobs, high strain, low strain, and passive jobs. Such dose-response pattern was also seen in the changes in MMSE score (Figure 6-A) and number of chronic diseases over time (95) in relation to these job categories. The mediation analyses revealed that 38.5% of the total association between demand-control status and disability trajectories was mediated by the decline in cognitive function, while 18.4% was mediated by the accumulation of medical conditions that occurred during the follow-up period (Figure 11).…”

Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence

“…The modelling strategy was sequential, including additional variables and complexity. Dekhtyar et al (2019) Multimorbidity (chronic disease accumulation)…”

“…The rationale for choosing a specific list of diseases was usually described. For example, some studies explained that they included chronic diseases with high prevalence and high risk of disability and mortality (Fabbri et al, 2015;Fabbri et al, 2016) and others included diseases that were assessed and validated by clinical consensus (Calderon-Larranaga et al, 2019;Calderón-Larrañaga et al, 2018;Dekhtyar et al, 2019;Perez et al, 2019;Strauss et al, 2014). Some studies included diseases based on the common Charlson and Elixhauser multimorbidity indices (Fraccaro et al, 2016;Gellert et al, 2018;Hanson et al, 2015;Hiyoshi et al, 2017;Kim et al, 2018;Lindhagen et al, 2015;Zeng et al, 2014) but lists were sometimes adapted, either by augmenting with extra (perceived relevant) conditions (Hiyoshi et al, 2017) or by removing diseases due to data sensitivity restrictions (Fraccaro et al, 2016).…”

Psychosocial job strain and polypharmacy: a national cohort study

“…Thus, passive jobs can also lead to chronic stress. Passive jobs have previously been demonstrated to be associated with disability, multimorbidity and other outcomes (41,42).…”