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Sociodemographic and lifestyle predictors of incident hospital admissions with multimorbidity in a general population, 1999–2019: the EPIC-Norfolk cohort
  1. Robert Luben1,
  2. Shabina Hayat1,
  3. Nicholas Wareham2,
  4. Paul P Pharoah1,
  5. Kay-Tee Khaw2
  1. 1Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
  2. 2MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
  1. Correspondence to Dr Robert Luben; robert.luben{at}


Background The ageing population and prevalence of long-term disorders with multimorbidity are a major health challenge worldwide. The associations between comorbid conditions and mortality risk are well established; however, few prospective community-based studies have reported on prior risk factors for incident hospital admissions with multimorbidity. We aimed to explore the independent associations for a range of demographic, lifestyle and physiological determinants and the likelihood of subsequent hospital incident multimorbidity.

Methods We examined incident hospital admissions with multimorbidity in 25 014 men and women aged 40–79 in a British prospective population-based study recruited in 1993–1997 and followed up until 2019. The determinants of incident multimorbidity, defined as Charlson Comorbidity Index ≥3, were investigated using multivariable logistic regression models for the 10-year period 1999–2009 and repeated with independent measurements in a second 10-year period 2009–2019.

Results Between 1999 and 2009, 18 179 participants (73% of the population) had a hospital admission. Baseline 5-year and 10-year incident multimorbidities were observed in 6% and 12% of participants, respectively. Age per 10-year increase (OR 2.19, 95% CI 2.06 to 2.33) and male sex (OR 1.32, 95% CI 1.19 to 1.47) predicted incident multimorbidity over 10 years. In the subset free of the most serious diseases at baseline, current smoking (OR 1.86, 95% CI 1.60 to 2.15), body mass index >30 kg/m² (OR 1.48, 95% CI 1.30 to 1.70) and physical inactivity (OR 1.16, 95% CI 1.04 to 1.29) were positively associated and plasma vitamin C (a biomarker of plant food intake) per SD increase (OR 0.86, 95% CI 0.81 to 0.91) inversely associated with incident 10-year multimorbidity after multivariable adjustment for age, sex, social class, education, alcohol consumption, systolic blood pressure and cholesterol. Results were similar when re-examined for a further time period in 2009–2019.

Conclusion Age, male sex and potentially modifiable lifestyle behaviours including smoking, body mass index, physical inactivity and low fruit and vegetable intake were associated with increased risk of future incident hospital admissions with multimorbidity.

  • epidemiology
  • health policy
  • social medicine

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  • Contributors K-TK, NW, SH and RL were involved in the conception and design of the study. RL drafted the manuscript, with support from K-TK and PPP. SH contributed to data interpretation. RL was responsible for external data linkage. SH and RL contributed to data collection and acquisition. All authors read and critically revised the manuscript and approved the final manuscript. RL is the guarantor. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The design and conduct of the EPIC-Norfolk study and the collection and management of the data were supported by programme grants from the Medical Research Council UK (G9502233, G0401527) and Cancer Research UK (C864/A8257, C864/A2883).

  • Disclaimer The sponsors had no role in any of the following: study design, data collection, data analysis, interpretation of data, writing of the article and decision to submit it for publication. All authors are independent of funders and sponsors and had access to all the data.

  • Competing interests RL, SH, K-TK and NW report grants from MRC and CRUK during the conduct of the study.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The work was approved by the East Norfolk and Waveney NHS research governance committee (2005EC07L) and the Norfolk research ethics committee (05/Q0101/191). All participants gave informed signed consent for study participation including access to medical records.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The authors will make the data set available under a Data Transfer Agreement to any bona fide researcher who wishes to obtain the data set in order to undertake a replication analysis. Although the data set is anonymised, the breadth of the data included and the multiplicity of variables that are included in this analysis file as primary variables or confounding factors mean that provision of the data set to other researchers without a Data Transfer Agreement would constitute a risk. Requests for data sharing/access should be submitted to the EPIC Management Committee (