ArticleBMC public health2008
The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort.
Article in BMC public health, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 3 of them syntheses that pooled it.
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Who cites it
67 citing papers in PubMed, 3 syntheses or guidelines pooled it, 141 citations in OpenAlex.
- Pooled it
- The association between educational level and multimorbidity among adults in Southeast Asia: A systematic review.PloS one · 2021Pooled it
- A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology.Annals of family medicinePooled it
- Prevalence and socioeconomic correlates of chronic morbidity among elderly people in Kosovo: a population-based survey.BMC geriatrics · 2013Trial
- Regional and educational disparities in inaccurately coded deaths in Sweden, 1997-2023: a systematic analysis.Population health metrics · 2026Article
- Boosting Immunity Through Nutrition and Gut Health: A Narrative Review on Managing Allergies and Multimorbidity.Nutrients · 2025Review
- Mediators of educational differences in dementia risk later in life: evidence from the HUNT study.BMC public health · 2025Article
- Socioeconomic disparities in multimorbidity of chronic diseases in the RaNCD cohort study.Scientific reports · 2025Article
- From curing to caring: exploring social care needs after the onset of chronic conditions among European older adults (50+).Innovation in aging · 2025Article
- Prevalence of multimorbidity and its relationship with socioeconomic status among Chinese older adults over time.PloS one · 2025Article
- Trajectory of Multiple Chronic Conditions and Associated Factors Among Noninstitutionalized Adults Aged 60 Years or Older in Southern Brazil.Preventing chronic disease · 2024Article
- Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India.BMJ open · 2023Article
- Association of smoking status and nicotine dependence with multi-morbidity in China: A nationally representative crosssectional study.Tobacco induced diseases · 2023Article
- Patterns and Predictors of Multimorbidity in the Azar Cohort.Archives of Iranian medicine · 2023Article
- Prevalence and factors associated with multimorbidity in adults in Brazil, according to sex: a population-based cross-sectional survey.Frontiers in public health · 2023Article
- Epidemiology and predictors of multimorbidity in Kharameh cohort study: A population-based cross-sectional study in southern Iran.Health science reports · 2023Article
- Decomposing urban-rural differences in multimorbidity among older adults in India: a study based on LASI data.BMC public health · 2022Article
- Gender differences in the association of obesity-related measures with multi-morbidity among older adults in India: evidence from LASI, Wave-1.BMC geriatrics · 2022Article
- Sociodemographic and behavioral influences on multimorbidity among adult residents of northeastern China.BMC public health · 2022Article
- Impact of childbirth policy changes on obstetric workload over a 13-year period in a regional referral center in China - implications on service provision planning.BMC pregnancy and childbirth · 2021Article
7 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn aging populations, the prevalence of multimorbidity is high, and the role of socioeconomic status and its correlates is not well described. Thus, we investigated the association between educational attainment and multimorbidity in a prospective cohort study, taking also into account intermediate factors that could explain such associations.
methodsWe included 13,781 participants of the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC), who were 50-75 years at the end of follow-up. Information on diet and lifestyle was collected at recruitment (1994-1998). During a median follow-up of 8.7 years, information on chronic conditions and death were collected.
resultsOverall, the prevalence of multimorbidity (>= 2 concurrent chronic diseases) was 67.3%. Compared to the highest educational category, the lowest was statistically significantly associated with increased odds of multimorbidity in men (OR = 1.43; 95% CI 1.28-1.61) and women (OR = 1.33; 95% CI 1.18-1.57). After adjustment, the positive associations were attenuated (men: OR = 1.28; 95% CI 1.12-1.46; women: OR = 1.16; 95% CI 0.99-1.36). Increasing BMI was more strongly than smoking status an intermediate factor in the association between education and multimorbidity.
conclusionIn this German population, the prevalence of multimorbidity is high and is significantly associated with educational level. Increasing BMI is the most important predictor of this association. However, even the fully adjusted model, i.e. considering also other known risk factors for chronic diseases, could not entirely explain socio-economic inequalities in multimorbidity. Educational level should be considered in the development and implementation of prevention strategies of multimorbidity.
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