Predicting the risk of multiple long-term conditions with role limitation at 46 years using early life data from the 1970 British cohort survey

Alipio, Joakim, Stannard, Seb, Ziauddeen, Nida, Fraser, Simon and Alwan, Nisreen A. (2025) Predicting the risk of multiple long-term conditions with role limitation at 46 years using early life data from the 1970 British cohort survey. (doi:10.1136/jech-2025-SSMabstracts.130).

Abstract

Background: an increasing number of people are living with multiple long-term conditions (MLTCs) that have a significant impact on everyday life. Whilst many studies explore the influence of adult factors on MLTCs, there is minimal research investigating whether MLTCs can be predicted using early life data. Identifying early life predictors that are potentially causal may also be important to inform the design of effective preventative interventions. We aimed to identify potential predictors at birth and age 5, and explore their association to later life MLTCs that impact everyday life.

Methods: the study analysed data from the 1970 British Cohort Study (BCS70), a longitudinal study following individuals born in 1970. The outcome was defined as two or more self-reported long-term health conditions with role-limitation (i.e. impacting everyday life functioning) due to a physical or mental health condition at age 46. The choice of domains of early life variables were informed by the research team with support from public contributors, and were reported at birth and age 5 in the BCS70 dataset. A backwards stepwise logistic regression model was used to test the associations between variables at those two time points and the outcome. Discrimination of the model was measured using the area under the curve (AUC).

Results: the initial analytical sample with available relevant data was 6,201 at age 46. 736, or 11.9%, of this sample had MLTCs with role limitation. The AUC for the model was 0.66. 12 predictors were retained. Retained age 5 predictors included: number of immunisations, sex, Rutter behaviour score, maternal malaise index (an indication of psychological distress), asthma diagnosis, if the child was seen by a doctor/nurse in school, whether the parent viewed their child as equals, and if the parent believed the child should have unequestioning obedience towards them. Pregnancy or birth predictors retained included maternal smoking, gestational age, parity, and if the mother ever had a teenage pregnancy.

Conclusion: using early life factors considered at birth and age 5 in a prediction model of MLTCs with role limitation at age 46 yielded moderate discrimination. Exploration of predictors during other time points in childhood and possibly adulthood is recommended to strengthen and inform risk stratification for the design of preventative interventions for MLTCs and role limitation.

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Contributors

Author: Seb Stannard

Author: Nida Ziauddeen

Author: Simon Fraser

Author: Nisreen A. Alwan

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