title: Multimorbidity: Epidemiology and Risk Factors in the Golestan Cohort Study, Iran: A Cross-Sectional Analysis.
abstract: Advances in medicine and health policy have resulted in growing of older population, with a concurrent rise in multimorbidity, particularly in Iran, as a country transitioning to a western lifestyle, and in which the percent of the population over the age of 60 years is increasing. This study aims to assess multimorbidity and the associated risk factors in Iran. We used data from 50,045 participants (age 40-75 y) in the Golestan Cohort Study, including data on demographics, lifestyle habits, socioeconomic status, and anthropometric indices. Multimorbidity was defined as the presence of 2 or more out of 8 self-reported chronic conditions, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, liver disease, gastroesophageal reflux disease, tuberculosis, and cancer. Multivariate logistic regression models were used to examine the associations between multiple different factors and the risk factors. Multimorbidity prevalence was 19.4%, with the most common chronic diseases being gastroesophageal reflux disease (76.7%), cardiovascular diseases (72.7%), diabetes (25.3%), and chronic obstructive pulmonary disease (21.9%). The odds of multimorbidity was 2.56-fold higher at the age of >60 years compared with that at <50 years (P < 0.001), and 2.11-fold higher in women than in men (P < 0.001). Other factors associated with higher risk of multimorbidity included non-Turkmen ethnicity, low education, unemployment, low socioeconomic status, physical inactivity, overweight, obesity, former smoking, opium and alcohol use, and poor oral health. Apart from advanced age and female sex, the most important potentially modifiable lifestyle factors, including excess body weight and opium use, and opium user, are associated with multimorbidity. Policies aiming at controlling multimorbidity will require a multidimensional approach to reduce modifiable risk factors in the younger population in developing countries alongside adopting efficient strategies to improve life quality in the older population.
authors.affiliation: From the Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (BA), Tehran, Iran; Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences (MA, AM, MB, FI, HP, AFS, AP, FK, AS, RM), Tehran, Iran; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences (MA, MB, HP, MHD, AFS, AP, AS, RM), Tehran, Iran; Department of Human Ecology, School of Public Health, Tehran University of Medical Sciences (MA), Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (MY), Tehran, Iran; Surveillance and Health Services Research, American Cancer Society (FI), Atlanta, GA; Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (PB), New York, NY; Division of Cardiovascular and Medical Sciences, Section of Gastroenterology, University of Glasgow (MHD), Glasgow, UK; Liver and Pancreatic-biliary Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences (AP), Tehran, Iran; Division of Cancer Epidemiology and Genetics, National Cancer Institute (CCA, SMD), Bethesda, MD; International Agency for Research on Cancer, Genetic Epidemiology Group (PB), Lyon, France; and Department of Public Health Analysis, School of Community Health and Policy, Morgan State University (FK), Baltimore, MD.
authors.forename: Batoul
authors.initials: B
authors.lastname: Ahmadi
authors.forename: Masoomeh
authors.initials: M
authors.lastname: Alimohammadian
authors.forename: Mehdi
authors.initials: M
authors.lastname: Yaseri
authors.forename: Azam
authors.initials: A
authors.lastname: Majidi
authors.forename: Majid
authors.initials: M
authors.lastname: Boreiri
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.forename: Hossein
authors.initials: H
authors.lastname: Poustchi
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Derakhshan
authors.forename: Akabar
authors.initials: A
authors.lastname: Feizesani
authors.forename: Akram
authors.initials: A
authors.lastname: Pourshams
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Alireza
authors.initials: A
authors.lastname: Sadjadi
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged