Lifestyle factors related to prevalent chronic disease multimorbidity: A population-based cross-sectional study

Abstract

Background: Multimorbidity is associated with poor quality of life, polypharmacy, health care costs and mortality, with those affected potentially benefitting from a healthy lifestyle. We assessed a comprehensive set of lifestyle factors in relation to multimorbidity with major chronic diseases.

Methods: This cross-sectional study utilised baseline data for adults from the prospective Lifelines Cohort in the north of the Netherlands (N = 79,345). We defined multimorbidity as the co-existence of two or more chronic diseases (i.e. cardiovascular disease, cancer, respiratory disease, type 2 diabetes) and evaluated factors in six lifestyle domains (nutrition, physical (in)activity, substance abuse, sleep, stress, relationships) among groups by the number of chronic diseases (≥2, 1, 0). Multinomial logistic regression models were created, adjusted for appropriate confounders, and odds ratios (OR) with 95% confidence intervals (95%CI) were reported.

Results: 3,712 participants had multimorbidity (4.7%, age 53.5 ± 12.5 years), and this group tended to have less healthy lifestyles. Compared to those without chronic diseases, those with multimorbidity reported physical inactivity more often (OR, 1.15; 95%CI, 1.06-1.25; not significant for one condition), chronic stress (OR, 2.14; 95%CI, 1.92-2.38) and inadequate sleep (OR, 1.70; 95%CI, 1.41-2.06); as expected, they more often watched television (OR, 1.70; 95%CI, 1.42-2.04) and currently smoked (OR, 1.91; 95%CI, 1.73-2.11), but they also had lower alcohol intakes (OR, 0.66; 95%CI, 0.59-0.74).

Conclusions: Chronic stress and poor sleep, in addition to physical inactivity and smoking, are lifestyle factors of great concern in patients with multimorbidity.

Fig 1. Overlap in the prevalence of The Big Four chronic diseases.

The Big Four chronic diseases are respiratory disease, cardiovascular disease, type 2 diabetes and cancer. Data are presented as number (%) from a total of 26,195 participants with at least one chronic disease. The full sample comprised 79,345 participants, of which 53,150 had no major chronic disease. Abbreviations: CVD, cardiovascular disease; RD, Respiratory disease; T2D, Type 2 Diabetes.

Fig 2. Comparison of lifestyle patterns by number of major chronic diseases.

We adjusted multinomial logistic regression models for age, sex, education, household equivalent income and weight status, and mutually adjusted for the lifestyle factors. Data points show the odds ratios with their 95% confidence intervals. The actual numbers are presented in S3 Table in S1 File.