Multidimensional social exposure clusters and incident multimorbidity in a population-based cohort

Area of Science:

• Social Epidemiology
• Public Health
• Health Disparities Research

Background:

• Multimorbidity exhibits a significant social gradient, but the combined impact of social determinants on risk is under-researched.
• Existing studies often analyze social determinants in isolation, potentially missing crucial socially patterned subgroups influencing multimorbidity risk.

Purpose of the Study:

• To investigate the association between multidimensional social exposure profiles and multimorbidity risk.
• To identify distinct subgroups based on combined individual and area-level social determinants.

Main Methods:

• Unsupervised clustering was used to derive social exposure profiles from Canadian Community Health Survey data (2001-2011) linked with Census measures.
• Multimorbidity status was determined via administrative health data linkage.
• Sex-stratified Weibull models estimated hazard ratios for multimorbidity onset.

Main Results:

• Six distinct social exposure profiles were identified.
• Multimorbidity onset varied significantly across these profiles, with elevated risk linked to multiple patterns of social disadvantage.
• Disadvantage profiles were associated with earlier multimorbidity onset in both females and males.

Conclusions:

• Multidimensional social exposure profiles effectively capture population-level social patterning linked to differential multimorbidity risk.
• Findings underscore the importance of considering combined social determinants for understanding and addressing multimorbidity inequities.
• Results have implications for upstream policy interventions designed to reduce health disparities.