Wagner Cornelia, Jackisch Josephine, Ortega Natalia, Chiolero Arnaud, Cullati Stéphane, Carmeli Cristian
Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
Swiss School of Public Health (SSPH+), University of Fribourg, Fribourg, Switzerland.
Eur J Public Health. 2024 Aug 1;34(4):704-709. doi: 10.1093/eurpub/ckae096.
Social inequalities in multimorbidity may occur due to familial and/or individual factors and may differ between men and women. Using population-based multi-generational data, this study aimed to (1) assess the roles of parental and individual education in the risk of multimorbidity and (2) examine the potential effect modification by sex.
Data were analysed from 62 060 adults aged 50+ who participated in the Survey of Health, Ageing and Retirement in Europe, comprising 14 European countries. Intergenerational educational trajectories (exposure) were High-High (reference), Low-High, High-Low and Low-Low, corresponding to parental-individual educational attainments. Multimorbidity (outcome) was ascertained between 2013 and 2020 as self-reported occurrence of ≥2 diagnosed chronic conditions. Inequalities were quantified as multimorbidity-free years lost (MFYL) between the ages of 50 and 90 and estimated via differences in the area under the standardized cumulative risk curves. Effect modification by sex was assessed via stratification.
Low individual education was associated with higher multimorbidity risk regardless of parental education. Compared to the High-High trajectory, Low-High was associated with -0.2 MFYL (95% confidence intervals: -0.5 to 0.1), High-Low with 3.0 (2.4-3.5), and Low-Low with 2.6 (2.3-2.9) MFYL. This pattern was observed for both sexes, with a greater magnitude for women. This effect modification was not observed when only diseases diagnosed independently of healthcare-seeking behaviours were examined.
Individual education was the main contributor to intergenerational inequalities in multimorbidity risk among older European adults. These findings support the importance of achieving a high education to mitigate multimorbidity risk.
多种疾病并存的社会不平等现象可能源于家庭和/或个人因素,且可能因性别而异。本研究利用基于人群的多代数据,旨在:(1)评估父母教育程度和个人教育程度在多种疾病并存风险中的作用;(2)研究性别对其潜在的效应修正作用。
对参加欧洲健康、老龄化与退休调查的62060名50岁及以上成年人的数据进行分析,该调查涵盖14个欧洲国家。代际教育轨迹(暴露因素)分为高高(参照组)、低高、高低和低低,分别对应父母和个人的教育程度。多种疾病并存(结局)通过2013年至2020年期间自我报告的≥2种已确诊慢性病的发生情况来确定。不平等程度通过50至90岁之间无多种疾病并存的年数损失(MFYL)来量化,并通过标准化累积风险曲线下面积的差异进行估计。通过分层分析评估性别对效应的修正作用。
无论父母教育程度如何,个人教育程度低都与多种疾病并存的风险较高相关。与高高轨迹相比,低高轨迹的MFYL为-0.2(95%置信区间:-0.5至0.1),高低轨迹为3.0(2.4 - 3.5),低低轨迹为2.6(2.3 - 2.9)。这种模式在男女中均有观察到,女性的幅度更大。在仅检查独立于就医行为诊断出的疾病时,未观察到这种效应修正作用。
个人教育程度是欧洲老年成年人多种疾病并存风险代际不平等的主要促成因素。这些发现支持了接受高等教育以降低多种疾病并存风险的重要性。