Effects of individual and parental educational levels on multimorbidity classes: a register-based longitudinal study in a Danish population

Abstract

ObjectivesTo assess the effects of individual educational level in adulthood and parental educational level during childhood, as well as combinations of individual and parental educational levels, on multimorbidity classes.Design and settingIn this longitudinal study, we used data from a random sample of the Danish population aged 32–56 years without multimorbidity in 2010 (n=102 818). The study population was followed until 2018. Information on individual and parental educational levels and chronic conditions was obtained from national registers. Multinomial logistic regression analyses were adjusted for sex, age and ethnicity.Outcome measureSeven multimorbidity classes were identified using latent class analysis based on 47 chronic conditions. Persons deceased during follow-up comprised a separate class.ResultsWe found an independent effect of individual educational level on five multimorbidity groups and death, most pronounced for the multimorbidity group ‘Many conditions’ (OR=1.89, 95% CI 1.58 to 2.26 for medium and OR=3.22, 95% CI 2.68 to 3.87 for short compared with long educational level) and of parental education on four groups and death, most pronounced for the multimorbidity group ‘Many conditions’ (OR=1.36, 95% CI 1.07 to 1.73 for medium and OR=1.48, 95% CI 1.15 to 1.89 for short compared with long educational level). Odds of belonging to four multimorbidity classes increased with lower combination of individual and parental educational levels, most pronounced for the multimorbidity group ‘Many conditions’.ConclusionAs both individual and parental educational levels contribute to the risk of multimorbidity, it is important to address inequality throughout the life course to mitigate multimorbidity. Future studies could adopt a life course approach to investigate the mediating role of behavioural, clinical, environmental and other social factors.

Subpopulations of children with multiple chronic health outcomes in relation to chemical exposures in the ECHO-PATHWAYS consortium

“…Our study is among the first to associate childhood multi-outcome clusters with environmental exposures. Two prior latent class analyses associated socioeconomic factors with clusters of multimorbid pediatric diagnoses, with both observing broad associations between either lower socioeconomic position levels or parental education and each derived multimorbid cluster ( Carrilero et al, 2020 ; Schramm et al, 2022 ). Our analysis differs in its focus on subclinical outcome assessments and its novel identification of an environmental exposure that is associated with multi-morbidity in Cluster 3.…”

A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity

“…Henchoz et al, 72 discussed the importance of many factors we have highlighted (including premature birth, food restriction, child labour, family economic environment, serious illness/accident, and stressful life events), but their research did not derive these factors into conceptual domains. Emergent research has also considered the role of individual domains we consider, such as education, 73 child adversity (child abuse and neglect, negative caregiver characteristics, and low socioeconomic status), 74 early life deprivation, 75 and socioeconomic conditions. 76 However, our model goes beyond these studies as we conceptualise the full picture of influence of early-life risk factors.…”

In Utero Exposure to Hormonal Contraception and Mortality in Offspring with and without Cancer: A Nationwide Cohort Study

“…Moreover, we assessed the effects of several potential confounders by change in estimate methods, but none of the potential confounders changed the risk estimate for death in the children. Moreover, parental education is found to be a good proxy for socioeconomic status in Denmark, and information on parental educational level in childhood has previously been used as a measure of childhood socioeconomic status [ 52 ]. As social inequality in multimorbidity has been reported, people of low socioeconomic status have a higher likelihood of having multimorbidity compared with individuals of higher socioeconomic status [ 52 ].…”