Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
J Epidemiol Community Health. 2023 Oct;77(10):617-624. doi: 10.1136/jech-2022-219507. Epub 2023 Aug 4.
Multimorbidity has emerged as a major healthcare challenge in low/middle-income countries (LMICs) such as India and Brazil. Life course epidemiology suggests that adverse events in early life contribute to an individual's later health in adulthood. However, little is known about the influence of early life health and social factors on the development of multimorbidity in adulthood in LMICs. We aimed to explore the association of adult multimorbidity with childhood health and social disadvantages among two LMICs, India and Brazil.
We conducted a secondary data analysis of older adults aged ≥50 years using nationally representative surveys from Longitudinal Ageing Study in India, 2017-2018 (n=51 481) and 'Estudo Longitudinal da Saude e Bem-Estar dos Idosos Brasileirous', 2015-2016 (n=8730). We estimated the prevalence of multimorbidity along with 95% CI as a measure of uncertainty for all weighted proportions. Log link in generalised linear model was used to assess the association between childhood health and disadvantages with multimorbidity, reported as adjusted prevalence ratio (APR).
The prevalence of multimorbidity was 25.53% and 55.24% in India and Brazil, respectively. Participants who perceived their childhood health as poor and missed school for a month or more due to illness had the highest level of multimorbidity across both countries. After adjusting for age and gender, a significant association between adult multimorbidity and poor self-rated childhood health (APR: (India: 1.38, 1.16 to 1.65) and (Brazil: 1.19, 1.09 to 1.30)); and missed school for a month due to illness (AOR: (India: 1.73, 1.49 to 2.01) and (Brazil: 1.16, 1.08 to 1.25)) was observed.
Early life health, educational and economic disadvantages are associated with adult multimorbidity and appear to contribute to the later course of life. A life course approach to the prevention of multimorbidity in adulthood in LMICs may be useful in health programmes and policies.
在印度和巴西等中低收入国家（LMICs），多种疾病已经成为一个主要的医疗保健挑战。生命历程流行病学表明，早期生活中的不良事件会影响一个人成年后的健康状况。然而，关于生命早期的健康和社会因素对 LMIC 成年后多种疾病的发展的影响，我们知之甚少。我们旨在探讨印度和巴西这两个 LMIC 中成年多种疾病与儿童期健康和社会劣势之间的关系。
我们使用来自印度 2017-2018 年纵向老龄化研究（n=51481）和巴西“老年人健康和福祉纵向研究”（n=8730）的全国代表性调查，对年龄≥50 岁的老年人进行了二次数据分析。我们使用广义线性模型中的对数链接来评估儿童期健康和劣势与多种疾病之间的关系，报告为调整后患病率比（APR）。
印度和巴西的多种疾病患病率分别为 25.53%和 55.24%。在两个国家中，认为自己童年健康状况较差和因病缺课一个月或以上的参与者的多种疾病患病率最高。在调整了年龄和性别后，成人多种疾病与较差的自我评估儿童健康状况之间存在显著关联（印度：1.38，1.16 至 1.65；巴西：1.19，1.09 至 1.30））；以及因病缺课一个月（印度：1.73，1.49 至 2.01；巴西：1.16，1.08 至 1.25））。
生命早期的健康、教育和经济劣势与成年多种疾病有关，似乎会影响生命后期的发展。在 LMICs 中，采用生命历程方法预防成年多种疾病可能对卫生计划和政策有用。
