title: Short and long term determinants of incident multimorbidity in a cohort of 1988 earthquake survivors in Armenia.
abstract: BACKGROUND
  Multimorbidity, presence of two or more health conditions, is a widespread phenomenon affecting populations' health all over the world. It becomes a serious public health concern due to its negative consequences on quality of life, mortality, and cost of healthcare services utilization. Studies exploring determinants of multimorbidity are limited, particularly those looking at vulnerable populations prospectively over time. This study aimed at identifying short and long term socioeconomic, psychosocial, and health behavioral determinants of incident multimorbidity among a cohort of the 1988 Armenian earthquake survivors.
  
  
  METHODS
  The study included a representative subsample of 725 from a larger initial cohort of the earthquake survivors. Data on this subsample were collected via four phases of this cohort study during the period 1990-2012. The final logistic regression analysis eliminated all those cases with baseline multimorbidity to investigate short and long term determinants of incident multimorbidity; this subsample included 600 participants.
  
  
  RESULTS
  More than 75% of the studied sample had multimorbidity. Perceived low affordability of healthcare services, poor living standards during the post-earthquake decade, and lower education were independent predictors of incident multimorbidity developed during the period 1990-2012. Stressful life events and poor social support were among psychosocial determinants of incident multimorbidity. Participants' baseline BMI reported in 1990 was independently associated with incident multimorbidity.
  
  
  CONCLUSIONS
  Most of the identified determinants of incident multimorbidity in our study population were markers of social inequities, indicating that inequities pose a serious threat to both individual and public health-related outcomes. Strategies targeting to decrease such inequities along with promotion of healthy lifestyle and strengthening of social networks may considerably reduce multimorbidity among population groups with similar socioeconomic and cultural profiles.
authors: School of Public Health, American University of Armenia, 40 Marshal Baghramian Avenue, Yerevan 0019, Armenia. ademirch@aua.am
authors: Anahit
authors: A
authors: Demirchyan
authors: Vahe
authors: V
authors: Khachadourian
authors: Haroutune K
authors: HK
authors: Armenian
authors: Varduhi
authors: V
authors: Petrosyan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001136:Armenia / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D055866:Earthquakes; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011584:Psychology; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D013997:Time Factors
references: Lancet. 2012 Jul 7;380(9836):37-43
references: 22579043
references: BMC Public Health. 2008 Nov 11;8:384
references: 19014444
references: Curr Opin Psychiatry. 2006 Mar;19(2):184-9
references: 16612201
references: BMC Public Health. 2012 Mar 19;12:201
references: 22429338
references: Lancet. 2013 Feb 16;381(9866):585-97
references: 23410608
references: Chronic Illn. 2007 Sep;3(3):202-18
references: 18083677
references: J Clin Epidemiol. 2012 Jan;65(1):100-6
references: 21835591
references: Health Qual Life Outcomes. 2004 Sep 20;2:51
references: 15380021
references: J Clin Epidemiol. 1996 Jul;49(7):743-7
references: 8691223
references: Am J Public Health. 2008 Jul;98(7):1198-200
references: 18511722
references: Int J Epidemiol. 1997 Aug;26(4):806-13
references: 9279613
references: Med Care. 1996 Nov;34(11):1093-101
references: 8911426
references: Scand J Public Health. 2012 Nov;40(8 Suppl):12-105
references: 23147863
references: Arch Intern Med. 2002 Nov 11;162(20):2269-76
references: 12418941
references: Gend Med. 2012 Oct;9(5):309-18
references: 22940276
references: J Clin Epidemiol. 2008 Nov;61(11):1104-12
references: 18538993
references: Qual Life Res. 2006 Feb;15(1):83-91
references: 16411033
references: J Nutr. 2003 Nov;133(11):3485-91
references: 14608062
references: BMC Public Health. 2010 Nov 22;10:718
references: 21092218
references: Eur J Gen Pract. 2008;14 Suppl 1:28-32
references: 18949641
references: J Clin Epidemiol. 2001 Jul;54(7):661-74
references: 11438406
references: J Gerontol A Biol Sci Med Sci. 2011 Mar;66(3):301-11
references: 21112963
references: Br J Gen Pract. 2011 Jan;61(582):e12-21
references: 21401985
references: J Clin Epidemiol. 1998 May;51(5):367-75
references: 9619963
references: Ann Fam Med. 2012 Mar-Apr;10(2):142-51
references: 22412006
references: J Clin Epidemiol. 2001 Jul;54(7):675-9
references: 11438407
references: Ageing Res Rev. 2011 Sep;10(4):430-9
references: 21402176
references: Ann Fam Med. 2005 May-Jun;3(3):223-8
references: 15928225
references: Epidemiol Rev. 2013;35:75-83
references: 23372025
references: BMC Med Res Methodol. 2012 Feb 15;12:14
references: 22335836
references: J Psychosom Res. 2001 Feb;50(2):95-102
references: 11274666
references: BMC Health Serv Res. 2012 Apr 03;12:89
references: 22471952
references: Gerontologist. 2003 Oct;43(5):649-60
references: 14570961
references: Psychosom Med. 1993 May-Jun;55(3):248-59
references: 8346333
references: Soc Sci Med. 2000 Jun;50(11):1679-93
references: 10795973
references: Int J Equity Health. 2011 Apr 20;10:15
references: 21507245
references: Int J Equity Health. 2012 Nov 14;11:67
references: 23151068
references: Annu Rev Psychol. 1997;48:191-214
references: 9046559
references: J Urban Health. 2002 Sep;79(3):373-82
references: 12200506
references: Acta Psychiatr Scand. 2000 Jul;102(1):58-64
references: 10892611