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. 2024 Nov 28;21(1):37.
doi: 10.1007/s10433-024-00833-x.

Lifestyle factors and incident multimorbidity related to chronic disease: a population-based cohort study

Yihui Du  1   2 , Geertruida H de Bock  2 , Judith M Vonk  2 , An Thanh Pham  2 , M Yldau van der Ende  3 , Harold Snieder  2 , Nynke Smidt  2 , Paul F M Krabbe  2 , Behrooz Z Alizadeh  2 , Gerton Lunter  2 , Eva Corpeleijn  4
Affiliations

Lifestyle factors and incident multimorbidity related to chronic disease: a population-based cohort study

Yihui Du et al. Eur J Ageing. .

Abstract

Background: Multimorbidity is linked to poor quality of life, and increased healthcare costs, and multimorbidity risk is potentially mitigated by a healthy lifestyle. This study evaluated the individual and joint contributions of an extensive set of lifestyle factors to the development of multimorbidity.

Methods: A prospective study of 133,719 adults (age 45.2 ± 12.9, range 18-93 years) from the Dutch Lifelines cohort assessed the influence of lifestyle factors on multimorbidity, defined as having at least two of four major chronic diseases, using Cox regression models and population attributable fractions (PAFs). Lifestyle-related factors included diet quality, physical activity, TV watching, substance use (alcohol, smoking), sleep (duration, medication), stress (acute, chronic) and social connectedness (social contacts, marital status).

Results: Over a median follow-up of 3.4 years, 3687 (12.5%) of the 29,545 participants with a chronic disease at baseline developed multimorbidity, compared to 434 (0.4%) of the 104,174 without a chronic disease. Key lifestyle factors linked to multimorbidity included smoking, prolonged TV watching, and stress, with hazard ratios indicating a higher risk in both groups. Additionally, high alcohol consumption and inadequate sleep duration were found to increase multimorbidity risk specifically in those with a chronic disease. Lifestyle factors jointly accounted for 34.4% (PAF, 95%CI 28.8%-73.5%) (with baseline morbidity) and 55.6% (95%CI 17.2%-48.5%) (without) of multimorbidity cases, with smoking as the primary contributor.

Conclusions: Lifestyle factors, particularly smoking, alcohol consumption, TV watching, stress, and sleep, significantly contribute to the development of multimorbidity. The study underscores the importance of targeted prevention in public health and healthcare settings to manage and prevent multimorbidity.

Keywords: Chronic disease; Chronic stress; Cohort; Lifestyle factors; Multimorbidity; TV watching.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Lifelines Cohort Study was approved by the medical ethics committee of the University Medical Center Groningen, the Netherlands. All participants signed the informed consent form. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participant selection
Fig. 2
Fig. 2
Associations between lifestyle factors and incidence of multimorbidity in those with and without a disease at baseline. Black circles represent multimorbidity incidence in those with no disease at baseline, gray circles indicate incidence of multimorbidity in those who already live with a disease. Models were adjusted for age, sex, educational level, BMI and mutually adjusted for all evaluated lifestyle factors. The exact estimates are presented in Table S5
Fig. 3
Fig. 3
Associations between lifestyle factors and incidence of acquiring one additional disease in those with and without a disease at baseline. Gray circles indicate incidence of multimorbidity in those who already live with a disease, and open circles represent incidence of 1 disease in those with no disease at baseline. Models were adjusted for age, sex, educational level, BMI and mutually adjusted for all evaluated lifestyle factors. The exact estimates are presented in Table S5
Fig. 4
Fig. 4
Population attributable fraction of the established lifestyle factors for multimorbidity. PAF Population attributable fraction
See this image and copyright information in PMC

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