Lifestyle factors and multimorbidity: a cross sectional study

Abstract

Background: Lifestyle factors have been associated mostly with individual chronic diseases. We investigated the relationship between lifestyle factors (individual and combined) and the co-occurrence of multiple chronic diseases.

Methods: Cross-sectional analysis of results from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Subjects aged 45 years and older. A randomly-selected cohort in the general population recruited by telephone. Multimorbidity (3 or more chronic diseases) was measured by a simple count of self-reported chronic diseases from a list of 14. Five lifestyle factors (LFs) were evaluated: 1) smoking habit, 2) alcohol consumption, 3) fruit and vegetable consumption, 4) physical activity, and 5) body mass index (BMI). Each LF was given a score of 1 (unhealthy) if recommended behavioural targets were not achieved and 0 otherwise. The combined effect of unhealthy LFs (ULFs) was evaluated using the total sum of scores.

Results: A total of 1,196 subjects were analyzed. Mean number of ULFs was 2.6 ± 1.1 SD. When ULFs were considered separately, there was an increased likelihood of multimorbidity with low or high BMI [Odd ratio (95% Confidence Interval): men, 1.96 (1.11-3.46); women, 2.57 (1.65-4.00)], and present or past smoker [men, 3.16 (1.74-5.73)]. When combined, in men, 4-5 ULFs increased the likelihood of multimorbidity [5.23 (1.70-16.1)]; in women, starting from a threshold of 2 ULFs [1.95 (1.05-3.62)], accumulating more ULFs progressively increased the likelihood of multimorbidity.

Conclusions: The present study provides support to the association of lifestyle factors and multimorbidity.

Figure 1

Forest plot showing the bivariate effect of each unhealthy lifestyle factor on the likelihood of multimorbidity (3 or more chronic conditions). Bars represent 95% confidence intervals (95% CI).

Figure 2

Prevalence of multimorbidity and number of unhealthy lifestyle factors (ULF) in men. Bars represent 95% confidence intervals (95% CI). Relative risks (RR) and 95% CI for each group, compared with the 0–1 LF group, are also shown.

Figure 3

Prevalence of multimorbidity and number of unhealthy lifestyle factors (ULF) in women. Bars represent 95% confidence intervals (95% CI). Relative risks (RR) and 95% CI for each group, compared with the 0–1 LF group, are also shown.