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Original Articles
Trends and all-cause mortality associated with multimorbidity of non-communicable diseases among adults in the United States, 1999-2018: a retrospective cohort study
Mengzi Sun, Ling Wang, Xuhan Wang, Li Tong, Lina Jin, Bo Li
Epidemiol Health. 2023;45:e2023023.   Published online February 14, 2023
DOI: https://doi.org/10.4178/epih.e2023023
  • 3,775 View
  • 106 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. However, the patterns, temporal trends, and all-cause mortality associated with NCD multimorbidity over time have not been well described in the United States.
METHODS
All adult participants were sourced from nationally representative data from the National Health and Nutrition Examination Survey. In total, 55,081 participants were included in trend analysis, and 38,977 participants were included in Cox regression.
RESULTS
The 5 NCDs with the largest increases over the study period were diabetes, osteoporosis, obesity, liver conditions, and cancer. The estimated prevalence of multimorbidity increased with age, especially for middle-aged participants with 5 or more NCDs; in general, the prevalence of NCD multimorbidity was higher among females than males. Participants with 5 or more NCDs were at 4.49 times the risk of all-cause mortality of participants without any diseases. Significant interactions were found between multimorbidity and age group (p for interaction <0.001), race/ethnicity (p for interaction<0.001), and educational attainment (p for interaction=0.010).
CONCLUSIONS
The prevalence of multiple NCDs significantly increased from 1999 to 2018. Those with 5 or more NCDs had the highest risk of all-cause mortality, especially among the young population. The data reported by this study could serve as a reference for additional NCD research.
Summary
Key Message
This study included a series-cross sectional study and a retrospective cohort study, utilizing nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. This study aimed to explore the patterns, temporal trends, and all-cause mortality of multimorbidity of NCDs in the United States from 1999 to 2018, by gender-specific and age-specific. The data reported by this study could serve as a reference for additional NCD research.
Multimorbidity patterns by health-related quality of life status in older adults: an association rules and network analysis utilizing the Korea National Health and Nutrition Examination Survey
Thi-Ngoc Tran, Sanghee Lee, Chang-Mo Oh, Hyunsoon Cho
Epidemiol Health. 2022;44:e2022113.   Published online November 29, 2022
DOI: https://doi.org/10.4178/epih.e2022113
  • 5,235 View
  • 182 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Improved life expectancy has increased the prevalence of older adults living with multimorbidity which likely deteriorates their health-related quality of life (HRQoL). However, relatively little is known about patterns and the relationships of multimorbidity by HRQoL status in older adults.
METHODS
Individuals aged 65 or older from the Korea National Health and Nutrition Examination Survey V-VII (2010-2018) were analyzed. HRQoL was assessed by the EuroQoL-5 dimensions questionnaire and categorized as poor, normal, or good. The impact of multimorbidity on HRQoL was evaluated using logistic regression. The patterns and inter-relationships between multimorbidity, stratified by HRQoL groups, were analyzed using the association rules and network analysis approach.
RESULTS
Multimorbidity was significantly associated with poor HRQoL (3 or more diseases vs. none; adjusted odds ratio, 2.70; 95% confidence interval, 2.10 to 3.46). Hypertension, arthritis, hyperlipidemia, and diabetes were the most prevalent diseases across all HRQoL groups. Complex interrelationships of morbidities, higher prevalence, and node strengths in all diseases were observed in the poor HRQoL group, particularly for arthritis, depression, and stroke, compared to other groups (1.5-3.0 times higher, p<0.05 for all). Apart from hypertension, arthritis and hyperlipidemia had a higher prevalence and stronger connections with other diseases in females, whereas this was the case for diabetes and stroke in males with poor HRQoL.
CONCLUSIONS
Multimorbidity patterns formed complicatedly inter-correlated disease networks in the poor HRQoL group with differences according to sex. These findings enhance the understanding of multimorbidity connections and provide information on the healthcare needs of older adults, especially those with poor HRQoL.
Summary
Korean summary
기대 수명의 증가에 따라 고령인구에서 건강관련 삶의 질을 저하시킬 수 있는 복합질환의 유병률도 함께 증가하고 있다. 본 연구에서는 국민건강영양조사 자료를 이용하여 65세 이상 우리나라 고령인구에서 건강관련 삶의 질 (HRQoL)에 따른 복합만성질환 패턴을 분석하였다. 복합만성질환은 건강관련 삶의 질 저하와 통계적으로 유의하게 연관되어 있으며, 연관성 및 네크워크 분석 결과 건강관련 삶의 질이 낮을수록 복합질환의 패턴이 복잡한 것으로 나타났다. 전체적으로 고혈압, 관절염, 고지혈증, 당뇨병이 가장 높은 발생률을 보였다. 건강관련 삶의 질이 낮은 그룹에서는 관절염, 우울증, 뇌졸중 등의 질병이 높은 발생률과 상호관련성을 보였으며, 이는 성별에 따라 차이가 있었다. 연구 결과는 고령자, 특히 건강관련 삶의 질이 낮은 노인의 의료 서비스 요구에 대해 정보를 제공해 줄 수 있을 것이다,
Key Message
Network analysis of older adults (65 or older) in Korea showed that hypertension, arthritis, hyperlipidemia, and diabetes were the most common multimorbidity regardless of HRQoL status. However, as HRQoL deteriorated, multimorbidity patterns formed complicatedly inter-correlated disease networks; the prevalence and the node strength of arthritis, depression, and stroke increased considerably and be diversified by sex.

Citations

Citations to this article as recorded by  
  • Chronic Disease Patterns and Their Relationship With Health-Related Quality of Life in South Korean Older Adults With the 2021 Korean National Health and Nutrition Examination Survey: Latent Class Analysis
    Mi-Sun Lee, Hooyeon Lee
    JMIR Public Health and Surveillance.2024; 10: e49433.     CrossRef
  • Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach
    Je-Yeon Yun, Young Ho Yun
    Scientific Reports.2023;[Epub]     CrossRef
Multimorbidity adjusted years lost to disability rates calculated through Monte-Carlo simulation in Korea
Yoonhee Shin, Eun Jeong Choi, Bomi Park, Hye Ah Lee, Eun-Kyung Lee, Hyesook Park
Epidemiol Health. 2022;44:e2022090.   Published online October 17, 2022
DOI: https://doi.org/10.4178/epih.e2022090
  • 2,961 View
  • 125 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
To efficiently utilize limited health and medical resources, it is necessary to accurately measure the level of health, which requires estimating the multimorbidity-corrected burden of disease.
METHODS
This study used 2015 and 2016 data from the National Health Insurance Service, and employed the list of diseases defined in a Korean study of the burden of disease, the criteria for prevalence, and the “cause–sequelae–health state” disease system. When calculating the years lost to disability (YLD), multimorbidity was corrected using Monte-Carlo simulation.
RESULTS
Correcting for multimorbidity changed YLD at all ages in Korea by -1.2% (95% confidence interval [CI], -24.1 to 3.6) in males and -12.4% (95% CI, -23.0 to 0.3) in females in 2015, and by -10.8% (95% CI, -24.1 to 4.6) in males and -11.1% (95% CI, -22.8 to 1.7) in females in 2016. The YLD rate for non-communicable diseases in males decreased more than that of other disease groups in both years, by -11.8% (95% CI, -19.5 to 3.6) and -11.5% (95% CI, -19.3 to -3.0), respectively. The overall YLD rate changed by -1.3% in the 5-year to 9-year age group, and the magnitude of this change remained similar until the 10-19-year age group, gradually decreased after 20 years of age, and steeply increased to more than 10% in those aged 60 and older.
CONCLUSIONS
Calculations of YLD should adjust for multimorbidity, as the disease burden can otherwise be overestimated for the elderly, who tend to exhibit a high prevalence of multimorbidity.
Summary
Korean summary
복합질환 유병률이 증가됨에 따라 인구의 건강수준 측정 시 복합질환을 고려하는 것은 중요하다. 이에 본 연구에서는 복합질환 유병상태를 고려한 YLD(장애로 인한 손실년수)를 산출하고, 복합질환 유병상태를 고려하지 않고 산출한 YLD값과 비교하여 질병부담 산출 시 복합질환 유병상태를 보정하는 것의 효과 크기를 추정하였다. 복합질환의 유병률이 높은 노령층에서 복합질환을 고려하지 않고 YLD를 계산 할 경우 질병부담이 과대 추정될 수 있어, 복합질환을 보정하여 YLD를 산출하는 것이 필요하다.
Key Message
For the elderly whose disease burden can be overestimated, the multimorbidity should be adjusted during YLD calculations.
Gender differences in the association between multimorbidity and depression in older Korean adults: an analysis of data from the National Survey of Older Koreans (2011-2017)
SeoYeon Hwang, Jin Young Nam, Jeong Hyun Ahn, Soojin Park
Epidemiol Health. 2022;44:e2022049.   Published online May 24, 2022
DOI: https://doi.org/10.4178/epih.e2022049
  • 8,717 View
  • 386 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Previous studies have shown that people with multimorbidity have a higher risk of depression than those without multimorbidity. However, few studies have examined the association between depression and multimorbidity in men and women separately. Since the rates of depression and multimorbidity are different in men and women, it is necessary to examine whether gender differences affect their association.
METHODS
This study included 30,138 participants (aged ≥ 65 years) from the National Survey of Older Koreans (2011-2017). Depression was defined using the Korean version of the Geriatric Depression Scale (SGDS-K). Multimorbidity was defined as people who had 2 or more chronic diseases, including arthritis, diabetes, heart disease, hypertension, pulmonary disease, cancer, stroke, or osteoporosis. Multiple logistic regression analysis was performed to determine the association between depression and multimorbidity.
RESULTS
In total, 22.2% and 30.7% of men and women, respectively, had depression. Those with multimorbidity had a higher risk of depression than those without chronic conditions; specifically, the difference in risk among men was greater than that among women. Age was considered a moderator for women. While the effects of pulmonary disease, stroke, and cancer were especially substantial in the integrated analysis, gender differences were observed related to various chronic conditions comorbid with heart disease.
CONCLUSIONS
There are gender differences in the association between multimorbidity and depression among older Korean adults. Therefore, gender-specific care should be provided to reduce depression in older adults with multimorbidity.
Summary
Korean summary
복합만성질환을 가진 남성 노인이 복합만성질환을 가진 여성 노인보다 우울증을 경험할 위험이 높았다. 특히 심장질환을 가진 남성 노인과 여성 노인은 심장질환을 포함한 만성질환의 개수에 따라 우울증 위험에 차이가 있었다. 노인들의 수명 향상을 위해 성별 차이를 고려한 치료 방안과 정책이 마련되어야 한다.
Key Message
Multimorbidity was associated with a high-risk of depression in older Korean adults and the effects of multimorbidity differed by gender.

Citations

Citations to this article as recorded by  
  • Inter- and intrapopulation differences in the association between physical multimorbidity and depressive symptoms
    Haiyang Yu, Yike Zhang, Mengxiao Hu, Bowen Xiang, Sijia Wang, Qing Wang
    Journal of Affective Disorders.2024; 354: 434.     CrossRef
  • Exploring Factors Associated With Resilience and Physical Activity in Older Men and Women Post-Hip Fracture
    Hohyun Seong, Barbara Resnick, Sarah Holmes, Elizabeth Galik, Rachel Blankstein Breman, Richard H. Fortinsky, Shijun Zhu
    Journal of Applied Gerontology.2023;[Epub]     CrossRef
Elder abuse/mistreatment and associated covariates in India: results from the Longitudinal Aging Study in India wave 1, 2017-2018
Thennavan Sathya, Yesuvadian Selvamani, Rangasamy Nagarajan
Epidemiol Health. 2022;44:e2022017.   Published online January 18, 2022
DOI: https://doi.org/10.4178/epih.e2022017
  • 10,089 View
  • 439 Download
  • 5 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Elder abuse has significant adverse consequences for the overall health and well-being of the elderly, including premature mortality. Using cross-sectional data, we assessed the prevalence of elder abuse in India, its variation across states, and associated factors.
METHODS
Nationally representative data from the first wave of the Longitudinal Aging Study in India were analyzed. Bivariate and multivariate analyses were used to study the prevalence, state variations, and associated factors of elder abuse.
RESULTS
Overall, 5.2% of elderly adults (≥60 years) had experienced abuse in the year prior to the survey and 3% had experienced abuse within their own household. Verbal abuse or disrespect was the most common form of abuse. Considerable variation was observed in the prevalence of elder abuse across states and union territories, with the highest prevalence observed in Bihar (11.6%) and Karnataka (10.1%). In regression analysis, education level emerged as a protective factor against elder abuse, particularly among women. Older adults who lived alone, had functional limitations, had multiple morbidities, and had been hospitalized in the past year were more likely to experience abuse. Older adults who experienced abuse were 2 times more likely to experience depressive symptoms.
CONCLUSIONS
Cross-state variation in the prevalence of elder abuse and subgroup differences suggest that state-specific interventions and essential monitoring of older adults with functional limitations, chronic diseases, and recent hospitalization can further reduce the prevalence and consequences of elder abuse in India.
Summary
Key Message
Elder abuse is one of the common forms of violence among the elderly. This study finds a significant proportion (5.2%) of Indian elderly reported elder abuse with considerable state-variations. The prevalence of elder abuse is higher in the states of Bihar (11.6%) and Karnataka (10.1%). Gender differences in elder abuse is notable where women is more likely to experience abuse than men. Education is a key protective factor of abuse. Elderly with multimorbidity and functional limitations are more likely to experience abuse. The elder abuse is positively associated with depressive symptoms.

Citations

Citations to this article as recorded by  
  • Association between Multimorbidity and Psychological Distress among Older Adults in India: The Moderating Role of Elder Abuse
    T Sathya, Y Selvamani, R. Nagarajan, M. Mathew Arumai
    Clinical Gerontologist.2024; : 1.     CrossRef
  • Prevalence and risk factors of elder abuse in survivors of stroke: A cross‐sectional study
    Guifen Zhang, Minyuan Chen, Peiyi Xiao, Zhibo Peng
    Health Science Reports.2023;[Epub]     CrossRef
  • Elder Mistreatment as a Risk Factor for Depression and Suicidal Ideation in Korean Older Adults
    Min-So Paek, Mi Jin Lee, Yu-Seon Shin
    International Journal of Environmental Research and Public Health.2022; 19(18): 11165.     CrossRef
  • Understanding Elder Abuse in India: Contributing Factors and Policy Suggestions
    Priya Maurya, Aparajita Chattopadhyay, Smitha Rao, Palak Sharma
    Journal of Population Ageing.2022;[Epub]     CrossRef
Comorbidity network analysis related to obesity in middle-aged and older adults: findings from Korean population-based survey data
Hye Ah Lee, Hyesook Park
Epidemiol Health. 2021;43:e2021018.   Published online March 5, 2021
DOI: https://doi.org/10.4178/epih.e2021018
  • 15,499 View
  • 425 Download
  • 16 Web of Science
  • 16 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
We conducted a comorbidity network analysis using data from the seventh Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities.
METHODS
The study included 11,712 subjects aged 45 to 80 (5,075 male and 6,637 female). A prevalent disease was defined as a specific disease for which a subject had been diagnosed by a doctor and was being treated. Comorbidity network analysis was performed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-to-expected ratio of all possible disease pairs with comorbidity strength and visualized the network of obesity-related comorbidities.
RESULTS
In subjects over 45 years old, 37.3% of people had a body mass index over 25.0 kg/m<sup>2</sup>. The most common prevalent disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). Overweight and obese subjects were 2.1 times (95% confidence interval, 1.9 to 2.3) more likely to have a comorbidity (i.e., 2 or more diseases) than normal-weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity. The probability of coexistence for each of those 4 diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese female along with other diseases. In obese male, dyslipidemia and diabetes were the major diseases in the comorbidity network.
CONCLUSIONS
Our results provide evidence justifying the management of metabolic components in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction as a public health goal.
Summary
Korean summary
본 연구는 비만 관련 동반질환을 체계적으로 정량화하기 위해, 제7차 (2016-2018) 국민건강영양조사 자료를 이용하여 동반질환 네트워크 분석을 수행하였습니다. 45세 이상 성인에서 비만(체질량지수≥25.0 kg/m2)은 정상체중에 비해 동반질환에 대한 위험이 2.1배 높은 것으로 나타났습니다. 동반질환 네트워크에서는 고혈압과 이상지질혈증이 비만 여성의 주요 질환 이였으며, 이상지질혈증과 당뇨병은 비만 남성의 주요 질환인 것으로 나타났습니다. 본 연구결과는 비만 관련 동반질환 감소를 위한 중재의 우선 순위를 정하는데 도움이 될 것이라고 생각됩니다.
Key Message
We conducted a comorbidity network analysis using data from the seventh (2016-2018) Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities. In subjects over 45 years old, obese (body mass index ≥ 25.0 kg/m2) subjects were 2.1 times more likely to have a comorbidity than normal-weight subjects. In the comorbidity network, hypertension and dyslipi¬demia were the major diseases in obese females, and dyslipidemia and diabetes were the major diseases in obese males. Our results will help prioritize interventions for reducing obesity-related comorbidities.

Citations

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  • Metabolically healthy obese individuals are still at high risk for diabetes: Application of the marginal structural model
    Hye Ah Lee, Hyesook Park
    Diabetes, Obesity and Metabolism.2024; 26(2): 431.     CrossRef
  • Comorbidity Patterns in Older Patients Undergoing Hip Fracture Surgery: A Comorbidity Network Analysis Study
    Chiyoung Lee, Sijia Wei, Eleanor S. McConnell, Hideyo Tsumura, Tingzhong (Michelle) Xue, Wei Pan
    Clinical Nursing Research.2024; 33(1): 70.     CrossRef
  • Interaction between depressive symptoms and obesity-related anthropometric measures on multimorbidity among community-dwelling older adults: evidence from India
    Waquar Ahmed, T. Muhammad, CV Irshad
    BMC Public Health.2024;[Epub]     CrossRef
  • Chronic disease and multimorbidity in the Chinese older adults’ population and their impact on daily living ability: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)
    Ye Chen, Huixia Ji, Yang Shen, Dandan Liu
    Archives of Public Health.2024;[Epub]     CrossRef
  • Comorbidity increases the risk of pulmonary tuberculosis: a nested case-control study using multi-source big data
    Bao-Yu Wang, Ke Song, Hai-Tao Wang, Shan-Shan Wang, Wen-Jing Wang, Zhen-Wei Li, Wan-Yu Du, Fu-Zhong Xue, Lin Zhao, Wu-Chun Cao
    BMC Pulmonary Medicine.2024;[Epub]     CrossRef
  • Charting Paths to Recovery: Navigating Traumatic Brain Injury Comorbidities through Graph Theory–Exploring Benefits and Challenges
    Shyam Kumar Sudhakar, Kaustav Mehta
    Brain Organoid and Systems Neuroscience Journal.2024;[Epub]     CrossRef
  • Changes in Clinical Manifestations Due to AFLD Retyping Based on the New MAFLD Criteria: An Observational Study Based on the National Inpatient Sample Database
    Xiaoshan Feng, Ruirui Xuan, Yingchun Dong, Xiaoqin Wu, Yiping Cheng, Zinuo Yuan, Hang Dong, Junming Han, Fang Zhong, Jiajun Zhao, Xiude Fan
    Diagnostics.2023; 13(3): 488.     CrossRef
  • The impact of obesity: a narrative review
    BenjaminChih Chiang Lam, AmandaYuan Ling Lim, SooLing Chan, MabelPo Shan Yum, NatalieSi Ya Koh, EricAndrew Finkelstein
    Singapore Medical Journal.2023; 64(3): 163.     CrossRef
  • Prevalence of comorbidities post mild traumatic brain injuries: a traumatic brain injury model systems study
    Shyam Kumar Sudhakar, Shreya Sridhar, Satvika Char, Kathan Pandya, Kaustav Mehta
    Frontiers in Human Neuroscience.2023;[Epub]     CrossRef
  • BMI trajectories, associations with outcomes and predictors in elderly gastric cancer patients undergoing radical gastrectomy: a prospective longitudinal observation study
    Yinning Guo, Yimeng Chen, Xueyi Miao, Jieman Hu, Kang Zhao, Lingyu Ding, Li Chen, Ting Xu, Xiaoman Jiang, Hanfei Zhu, Xinyi Xu, Qin Xu
    Journal of Cancer Survivorship.2023;[Epub]     CrossRef
  • Factors associated with the combination of general and abdominal obesity in middle-aged and older Korean women: a cross-sectional study
    Jin Suk Ra
    Osong Public Health and Research Perspectives.2023; 14(5): 379.     CrossRef
  • Progression and trajectory network of age-related functional impairments and their combined associations with mortality
    Hui Chen, Binghan Wang, Rongxia Lv, Tianjing Zhou, Jie Shen, Huan Song, Xiaolin Xu, Yuan Ma, Changzheng Yuan
    iScience.2023; 26(12): 108368.     CrossRef
  • Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study
    Mika Kivimäki, Timo Strandberg, Jaana Pentti, Solja T Nyberg, Philipp Frank, Markus Jokela, Jenni Ervasti, Sakari B Suominen, Jussi Vahtera, Pyry N Sipilä, Joni V Lindbohm, Jane E Ferrie
    The Lancet Diabetes & Endocrinology.2022; 10(4): 253.     CrossRef
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    Kyung Hwan Jegal, Mi Mi Ko, Bo-Young Kim, Mi Ju Son, Sungha Kim, Alessandro de Sire
    PLOS ONE.2022; 17(3): e0266034.     CrossRef
  • Multimorbidity and combined interventions for patients with coronary heart disease in Chinese population: Latent class analysis of a multi-center study
    Yuanyuan Chen, Junru Wu, Yan Tang, Zhengxin Li, Qing Wen, Xuejing Sun, Hong Yuan, Yao Lu, Jingjing Cai
    International Journal of Cardiology.2022; 368: 17.     CrossRef
  • Multimorbidity patterns by health-related quality of life status in older adults: an association rules and network analysis utilizing the Korea National Health and Nutrition Examination Survey
    Thi-Ngoc Tran, Sanghee Lee, Chang-Mo Oh, Hyunsoon Cho
    Epidemiology and Health.2022; 44: e2022113.     CrossRef
Socio-demographic and lifestyle factors associated with multimorbidity in New Zealand
Nayyereh Aminisani, Christine Stephens, Joanne Allen, Fiona Alpass, Seyed Morteza Shamshirgaran
Epidemiol Health. 2020;42:e2020001.   Published online December 27, 2019
DOI: https://doi.org/10.4178/epih.e2020001
  • 14,435 View
  • 362 Download
  • 20 Web of Science
  • 16 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
The incidence of multimorbidity (MM) and its correlates among older adults remain poorly understood. This study aimed to examine the socio-demographic and lifestyle factors associated with MM in New Zealand.
METHODS
People aged 55-70 years were invited to participate in a population-based cohort study, the Health Work and Retirement Study, in 2006. Those who accepted the invitation and completed the baseline questionnaire were followed up on a biennial basis. Data on socio-demographic factors, health and lifestyle behaviours, and diagnoses of chronic diseases were obtained from baseline and 6 waves of follow-up. Generalised estimating equations (GEE) adjusted for both time-constant and time-varying factors were used to model factors associated with the onset of MM.
RESULTS
A total of 1,673 participants (with 0 or 1 chronic condition) contributed to an overall 8,616 person-years of observation. There were 590 new cases of MM over 10 years of follow-up, corresponding to an overall incidence of 68.5 per 1,000 person-years. The results of the age- and sex-adjusted GEE analysis showed that age, ethnicity, living alone, obesity, hypertension, and having 1 chronic condition at baseline were significant predictors of MM onset. Higher education, income, physical activity, and regular alcohol consumption were protective factors. In a fully adjusted model, marital status (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01 to 1.37; p=0.039), hypertension (OR, 1.23; 95% CI, 1.02 to 1.48; p=0.032) and having 1 chronic condition at baseline (OR, 2.92; 95% CI, 2.33 to 3.67; p<0.001) remained significant.
CONCLUSIONS
The higher incidence of MM among Māori people, socioeconomically disadvantaged groups, those with low physical activity, and obese individuals highlights the importance of targeted prevention strategies.
Summary

Citations

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