Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom.
Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
PLoS One. 2023 Sep 8;18(9):e0291295. doi: 10.1371/journal.pone.0291295. eCollection 2023.
The progression of long-term conditions (LTCs) from zero-to-one (initiation), and from one-to-many (progression)are common trajectories that impact a person's quality of life including their ability to work. This study aimed to explore the demographic, socioeconomic, psychosocial, and health-related determinants of LTC initiation and progression, with a focus on work participation.
Data from 622 working-age adults who had completed two waves (baseline and follow-up) of the South-East London Community Health survey were analysed. Chi square tests and multinomial logistic regression were used to describe the associations between self-reported demographic, socioeconomic, psychosocial, and health-related variables, and the progression of LTCs.
Small social networks, an increased number of stressful life events, low self-rated health, functional impairment, and increased somatic symptom severity were all associated with both the progression from zero-to-one LTC and from one LTC to multimorbidity (two or more LTCs). Renting accommodation (RRR 1.73 [95% CI 1.03-2.90]), smoking (RRR 1.91 [95% CI 1.16-3.14]) and being overweight (RRR 1.88 [95% CL 1.12-3.16]) were unique risk factors of developing initial LTCs, whereas low income (RRR 2.53 [95% CI 1.11-5.80]), working part-time (RRR 2.82 ([95% CL 1.12-7.10]), being unemployed (RRR 4.83 [95% CI 1.69-13.84]), and making an early work exit (RRR 16.86 [95% CI 3.99-71.30]) all increased the risk of progressing from one LTC to multimorbidity compared to being employed full-time. At follow-up, depression was the most prevalent LTC in the unemployed group whereas musculoskeletal conditions were the most prevalent in those working.
The journey to multimorbidity is complex, with both common and unique risk factors. Non-full-time employment was associated with an increased risk of progression to multimorbidity. Future research should explore the risk and benefit pathways between employment and progression of LTCs. Interventions to prevent progression of LTCs should include mitigation of modifiable risk factors such as social isolation.
长期疾病（LTCs）从零到一（起始）和从一到多（进展）的进展是影响个人生活质量的常见轨迹，包括他们的工作能力。本研究旨在探讨 LTC 起始和进展的人口统计学、社会经济学、心理社会和健康相关决定因素，重点是工作参与。
对完成了东南伦敦社区健康调查两轮（基线和随访）的 622 名在职成年人的数据进行了分析。卡方检验和多项逻辑回归用于描述自我报告的人口统计学、社会经济学、心理社会和健康相关变量与 LTC 进展之间的关联。
小社交网络、压力生活事件增多、自我评估健康状况差、功能障碍和躯体症状严重程度增加均与从无 LTC 到有 LTC 再到多病种（两种或多种 LTC）的进展相关。租用住房（RRR 1.73 [95%CI 1.03-2.90]）、吸烟（RRR 1.91 [95%CI 1.16-3.14]）和超重（RRR 1.88 [95%CL 1.12-3.16]）是发生初始 LTC 的独特危险因素，而低收入（RRR 2.53 [95%CI 1.11-5.80]）、兼职工作（RRR 2.82 [95%CL 1.12-7.10]）、失业（RRR 4.83 [95%CI 1.69-13.84]）和提前退休（RRR 16.86 [95%CI 3.99-71.30]）与全职工作相比，均增加了从一种 LTC 进展为多病种的风险。在随访时，失业组中最常见的 LTC 是抑郁症，而工作组中最常见的是肌肉骨骼疾病。
向多病种发展的过程是复杂的，存在共同和独特的危险因素。非全时就业与进展为多病种的风险增加相关。未来的研究应探讨就业与 LTC 进展之间的风险和获益途径。预防 LTC 进展的干预措施应包括减轻社会隔离等可改变的危险因素。
