The association between stress and multiple long-term conditions: a cohort study
The association between stress and multiple long-term conditions: a cohort study
Background: stress is an important predictor of long-term conditions. We examine whether hair cortisol (a biomarker of stress) is associated with incidence and accumulation of multiple long-term conditions (MLTC).
Methods: we included data from 4295 individuals aged ≥50 years within the English Longitudinal Study of Ageing dataset with data on hair cortisol, sociodemographic and health behaviour variables. Cox proportional hazards models were used to quantify the association between hair cortisol at baseline and accumulation of MLTC between 2012/2013 and 2018/2019, both for individuals with and without MLTC at baseline.
Results: our cohort included 1458 (34.0%) individuals who accumulated MLTC between 2012/2013 and 2018/2019. The proportion of individuals with zero, 1, and ≥ 2 conditions at baseline who accumulated MLTC were 12.0% (n = 127), 40.4% (n = 520), and 41.7% (n = 811), respectively. Higher cortisol levels were associated with higher risk of accumulation of MLTC in both unadjusted [HR:1.15(1.05–1.25)] and models adjusted for sociodemographic and health behaviours [HR:1.12(1.02–1.22)]. For individuals without MLTC at baseline, higher cortisol levels were significantly associated with higher risk of developing MLTC in unadjusted [HR: 1.20(1.05–1.36)] and adjusted models [HR: 1.16(1.02–1.32)].
Conclusion: the study provides the first evidence of the role of stress in the development and accumulation of MLTC. This modifiable risk factor could be targeted to reduce the risk of MLTC. However, further work is needed to better understand the mechanisms and pathways that link stress and accumulation of MLTC.
Epidemiology, Multimorbidity, Older people, Personalised medicine, Stress, Hydrocortisone/metabolism, Humans, Aging, Longitudinal Studies, Hair/metabolism, Cohort Studies
111566
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Simpson, Glenn
802b50d9-aa00-4cca-9eaf-238385f8481c
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Farmer, Andrew
cfd4b749-4fe8-4bcc-879b-a4d9aa7f9b2e
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
January 2024
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Simpson, Glenn
802b50d9-aa00-4cca-9eaf-238385f8481c
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Farmer, Andrew
cfd4b749-4fe8-4bcc-879b-a4d9aa7f9b2e
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Hounkpatin, Hilda, Simpson, Glenn, Santer, Miriam, Farmer, Andrew and Dambha-Miller, Hajira
(2024)
The association between stress and multiple long-term conditions: a cohort study.
Journal of Psychosomatic Research, 176, , [111566].
(doi:10.1016/j.jpsychores.2023.111566).
Abstract
Background: stress is an important predictor of long-term conditions. We examine whether hair cortisol (a biomarker of stress) is associated with incidence and accumulation of multiple long-term conditions (MLTC).
Methods: we included data from 4295 individuals aged ≥50 years within the English Longitudinal Study of Ageing dataset with data on hair cortisol, sociodemographic and health behaviour variables. Cox proportional hazards models were used to quantify the association between hair cortisol at baseline and accumulation of MLTC between 2012/2013 and 2018/2019, both for individuals with and without MLTC at baseline.
Results: our cohort included 1458 (34.0%) individuals who accumulated MLTC between 2012/2013 and 2018/2019. The proportion of individuals with zero, 1, and ≥ 2 conditions at baseline who accumulated MLTC were 12.0% (n = 127), 40.4% (n = 520), and 41.7% (n = 811), respectively. Higher cortisol levels were associated with higher risk of accumulation of MLTC in both unadjusted [HR:1.15(1.05–1.25)] and models adjusted for sociodemographic and health behaviours [HR:1.12(1.02–1.22)]. For individuals without MLTC at baseline, higher cortisol levels were significantly associated with higher risk of developing MLTC in unadjusted [HR: 1.20(1.05–1.36)] and adjusted models [HR: 1.16(1.02–1.32)].
Conclusion: the study provides the first evidence of the role of stress in the development and accumulation of MLTC. This modifiable risk factor could be targeted to reduce the risk of MLTC. However, further work is needed to better understand the mechanisms and pathways that link stress and accumulation of MLTC.
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Accepted/In Press date: 8 December 2023
e-pub ahead of print date: 11 December 2023
Published date: January 2024
Additional Information:
Funding Information:
This report is independent research funded by the National Institute for Health and Care Research ( Artificial Intelligence for Multiple Long-Term Conditions (AIM), (NIHR202637). HH is supported by a National Institute for Health and Care Research School of Primary Care Research fellowship ( NIHR SPCR ) [Grant number: C011 ]. HDM is a National Institute for Health Research-funded Academic Clinical Lecturer and has received funding for this grant NIHR202637 . AF receives support from NIHR Oxford Biomedical Research Centre . The funders had no involvement in the study design, collection, analysis and interpretation of the data, writing of the report or decision to submit the article for publication. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care .
Copyright © 2023. Published by Elsevier Inc.
Keywords:
Epidemiology, Multimorbidity, Older people, Personalised medicine, Stress, Hydrocortisone/metabolism, Humans, Aging, Longitudinal Studies, Hair/metabolism, Cohort Studies
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Local EPrints ID: 486037
URI: http://eprints.soton.ac.uk/id/eprint/486037
ISSN: 0022-3999
PURE UUID: 41ff720e-691b-44ef-b27c-28aa44f68bd9
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Date deposited: 08 Jan 2024 17:31
Last modified: 18 Mar 2024 03:57
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Andrew Farmer
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