Abstract
Objective
To examine the association of multibehavior on multimorbidity.
Patients and Methods
Data from the 2005-2006 National Health and Nutrition Examination Survey were used.
The study duration was from October 20, 2013, through December 16, 2014. A multimorbidity
index variable was created that indicated the number of 14 morbidities that each patient
had. A multibehavior index variable was created that indicated the number of 4 health-enhancing
behaviors each participant had; physical activity was assessed via accelerometry,
dietary behavior was assessed via an interview, smoking was determined via cotinine
levels, and sleep duration was self-reported.
Results
For the entire sample of 2048 participants, those with 1, 2, 3, and 4 health behaviors,
compared with 0 health behaviors, had a 35% (odds ratio [OR], 0.65; 95% CI, 0.47-0.90;
P=.01), 44% (OR, 0.56; 95% CI, 0.38-0.82; P=.006), 63% (OR, 0.37; 95% CI, 0.26-0.51; P<.001), and 69% (OR, 0.31; 95% CI, 0.19-0.52; P<.001) reduced odds of being multimorbid, respectively. Only physical activity (β=−.46)
and sleep (β=−.23) were independently associated with multimorbidity, and only 2 health
behavior combinations were associated with multimorbidity: physical activity and sleep
(β=−.17) and physical activity and nonsmoking (β=−.16).
Conclusions
Americans engaging in more health behaviors were less likely to be multimorbid. Physical
activity was independently, as well is in combination with other health behaviors,
associated with multimorbidity. Implications for developing a multibehavior-multimorbidity
framework to treat the patients’ holistic needs is discussed.
Abbreviations and Acronyms:
HDL (high-density lipoprotein cholesterol), NHANES (National Health and Nutrition Examination Survey), PIR (poverty-to-income ratio)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Physical activity and dietary behavior in US adults and their combined influence on health.Mayo Clin Proc. 2014; 89: 190-198
- Association between flavonoid-rich fruit and vegetable consumption and total serum bilirubin.Angiology. 2015; 66: 286-290
- Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association.Circulation. 1997; 96: 3243-3247
- Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies.Sleep. 2010; 33: 585-592
- Concurrent occurrence of multiple positive lifestyle behaviors and depression among adults in the United States.J Affect Disord. 2014; 165: 126-130
- Multiple health behaviors and serum hepatic enzymes among US adults with obesity.Prev Med. 2011; 53: 278-283
- Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study.Am J Public Health. 2011; 101: 1922-1929
- Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.Lancet. 2012; 380: 37-43
- A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology.Ann Fam Med. 2012; 10: 142-151
- Lifestyle factors and multimorbidity: a cross sectional study.BMC Public Health. 2014; 14: 686
- Causes and consequences of comorbidity: a review.J Clin Epidemiol. 2001; 54: 661-674
- Clinical multimorbidity and physical function in older adults: a record and health status linkage study in general practice.Fam Pract. 2007; 24: 412-419
- Relationship between multimorbidity and health-related quality of life of patients in primary care.Qual Life Res. 2006; 15: 83-91
- Multimorbidity and quality of life in primary care: a systematic review.Health Qual Life Outcomes. 2004; 2: 51
- Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study.Br J Gen Pract. 2011; 61: e12-e21
- Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.Arch Intern Med. 2002; 162: 2269-2276
- Vision impairment predicts 5 year mortality.Br J Ophthalmol. 2001; 85: 322-326
- Validity of actigraphs uniaxial and triaxial accelerometers for assessment of physical activity in adults in laboratory conditions.BMC Med Phys. 2013; 13: 5
- Actigraph accelerometer interinstrument reliability during free-living in adults.Med Sci Sports Exerc. 2007; 39: 1509-1514
- Physical activity in the United States measured by accelerometer.Med Sci Sports Exerc. 2008; 40: 181-188
- Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women.Int J Behav Nutr Phys Act. 2010; 7: 60
National Cancer Institute: Healthy Eating Index - 2005 Tools for Researchers. Sample SAS code to create HEI-2005 scores. http://riskfactor.cancer.gov/tools/hei/tools.html. Accessed December 12, 2014.
- Healthy lifestyle behaviors and all-cause mortality among adults in the United States.Prev Med. 2012; 55: 23-27
- Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004.Am J Epidemiol. 2009; 169: 236-248
- Misclassification rates for current smokers misclassified as nonsmokers.Am J Public Health. 1998; 88: 1503-1509
- Misclassification of smoking status in the CARDIA study: a comparison of self-report with serum cotinine levels.Am J Public Health. 1992; 82: 33-36
US Department of Health and Human Services, National Heart, Lung, and Blood Institute. Your Guide to Healthy Sleep. https://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf. Accessed December 12, 2014.
- Self-reported and measured sleep duration: how similar are they?.Epidemiology. 2008; 19: 838-845
- Sports Nutrition: An Introduction to Energy Production and Performance.2nd ed. Human Kinetics, Champaign, IL2009
- Cholesterol treatment guidelines update.Am Fam Physician. 2002; 65: 871-880
US Census Bureau. Current population survey—definitions and explanations. Vol 2010. http://www.census.gov/population/www/cps/cpsdef.html. Accessed December 12, 2014.
- Effects of socioeconomic status and acculturation on accelerometer-measured moderate-to-vigorous physical activity among Mexican American adolescents: findings from NHANES 2003-2004.J Phys Act Health. 2012; 9: 1155-1162
- A review of multiple health behavior change interventions for primary prevention.Am J Lifestyle Med. 2011; 5
- Prevalence of multimorbidity in a geographically defined American population: patterns by age, sex, and race/ethnicity.Mayo Clin Proc. 2014; 89: 1336-1349
- Multiple Chronic Conditions—A Strategic Framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions.US Dept of Health and Human Services, Washington, DCDecember 2010
- Optimizing health for persons with multiple chronic conditions.JAMA. 2014; 312: 1199-1200
- The strategic framework on multiple chronic conditions.Med Care. 2014; 52: S1-S2
- Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life.Public Health Rep. 2011; 126: 460-471
- Defining and measuring chronic conditions: imperatives for research, policy, program, and practice.Prev Chronic Dis. 2013; 10: E66
- Multiple chronic conditions among US adults who visited physician offices: data from the National Ambulatory Medical Care Survey, 2009.Prev Chronic Dis. 2013; 10: E64
- Health care expenditures for adults with multiple treated chronic conditions: estimates from the Medical Expenditure Panel Survey, 2009.Prev Chronic Dis. 2013; 10: E63
- Hospital utilization, costs, and mortality for adults with multiple chronic conditions, Nationwide Inpatient Sample, 2009.Prev Chronic Dis. 2013; 10: E62
- The dimensions of multiple chronic conditions: where do we go from here? A commentary on the Special Issue of Preventing Chronic Disease.Prev Chronic Dis. 2013; 10: E59
- Multimorbidity at the local level: implications and research directions.Mayo Clin Proc. 2014; 89: 1321-1323
- Exercise therapy: the public health message.Scand J Med Sci Sports. 2012; 22: e24-e28
Loprinzi PD. Physical activity is the best buy in medicine, but perhaps for less obvious reasons. Prev Med. In press.
- Fitness effects on the cognitive function of older adults: a meta-analytic study.Psychol Sci. 2003; 14: 125-130
- Physical activity and the brain: a review of this dynamic, bi-directional relationship.Brain Res. 2013; 1539: 95-104
- Executive attention: conflict, target detection, and cognitive control.in: Parasuraman R. The Attentive Brain. MIT Press, Cambridge, MA1998: 401-423
- Effects of alcoholism severity and smoking on executive neurocognitive function.Addiction. 2009; 104: 38-48
- The neurocognitive connection between physical activity and eating behaviour.Obes Rev. 2011; 12: 800-812
Article Info
Publication History
Published online: April 08, 2015
Identification
Copyright
© 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
