Date of Award
Spring 2025
Embargo Period
5-9-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Epidemiology and Biostatistics
Program
Epidemiology
First Advisor
Dr. Melissa Tracy
Committee Members
Dr. Melissa Tracy, Dr. Allison Appleton, Dr. Lindsay Cogan
Keywords
Multimorbidity, Adolescent, Latent class, childhood socioeconomic status, adult, health, longitudinal, disparities, FFCWS, logistic regression
Abstract
Abstract
Background:
Multimorbidity, defined as the co-occurrence of two or more health conditions (physical, mental, or both), has been thought of as a disease of the elderly, with most studies of multimorbidity focusing on adults and the elderly population. However, co-occurring (multimorbid) health conditions are common in adolescence, and it is important to understand the profiles and patterns of multimorbidity during adolescence, a critical developmental period with long-term implications. Social determinants of health, especially lower socioeconomic status (SES), are linked to higher risk of multimorbidity and poor outcomes in adulthood. However, most of the past studies that have looked at the influence of family SES on multimorbidity were cross-sectional, consisted of small samples in a primary care setting, had limited generalizability, and were largely not conducted in the US. Furthermore, growing evidence suggests that adolescent multimorbidity can negatively impact adult health outcomes. Unaddressed health problems in adolescence can have lasting consequences on physical and mental wellbeing in later life. Hence, it is crucial to investigate the profiles of multimorbidity in adolescence, the long-term influence of childhood family SES on multimorbidity and the extent to which adolescent multimorbidity can predict risk of adverse adult health outcomes. Understanding these relationships and the factors that moderate them will also help to identify effective points of prevention and intervention to reduce the burden of multimorbidity in this vulnerable population and its long-term consequences.
Methods:
This analysis was conducted using data from the Future of Families and Child Wellbeing Study (FFCWS). The FFCWS is a longitudinal birth cohort study that has collected information on focal children from birth (Wave 1) through adolescence (Wave 6; age 15) and young adulthood (Wave 7; age 22), along with interviews with mothers, fathers, and primary caregivers. In my Aim #1 analysis, I conducted latent class analysis (LCA) to identify adolescent multimorbidity profiles at age 15 based on the thirteen health conditions reported by the youth participant or their primary caregiver (PCG). Racial/ethnic disparities in the multimorbidity profiles were assessed. For aim #2, semi-parametric group-based trajectory modeling was conducted to identify childhood family socioeconomic status (SES) trajectories from birth through age 9 years. Multinomial logistic regression was used to assess the associations between childhood SES trajectories and multimorbidity latent class membership in adolescence. Effect modification by physical activity was also assessed. Finally, for aim #3, logistic regression models were used to estimate if multimorbidity latent class membership (at Wave 6) was associated with young adult health outcomes (at Wave 7) and if the associations were moderated by adolescent household income.
Results:
In Aim #1, the latent class analysis revealed three distinct multimorbidity profiles in the adolescent population. Class 1 (4.7%), the mental health conditions class, exhibited high probabilities for depression and anxiety; Class 2 (88.2%), the normative class, showed low probability of any health conditions, and Class 3 (7.1%), the physical and developmental conditions class, was characterized by asthma, ADHD, obesity/overweight and learning disability. Female adolescents had 1.57 times (95% CI = 1.01–2.45) the odds of Class 1 membership and 0.40 times (95% CI = 0.26–0.59) the odds of Class 3 membership. For adolescents with a low birth weight, the odds of being in class 3 were 1.66 times (95% CI = 1.14–2.41) those without low birth weight. Race/ethnicity was not associated with class membership.
In Aim #2, three income trajectories, including low (74.9%), medium (19.0%) and high (6.1%), were identified across early-to-middle childhood (birth through age 9). After adjusting for key sociodemographic characteristics, children in the low-income trajectory had increased odds (OR = 1.84, 95% CI: 1.15–2.97) of belonging to the Class 3 multimorbidity profile characterized by physical and developmental conditions. Females had lower odds of being in Class 3 compared to males (OR = 0.36, 95% CI: 0.24–0.54). Children with low birth weight had 1.63 times higher odds (95% CI: 1.11–2.38) of being in Class 3. Children who engaged in high physical activity (5-7 days in a typical week) had lower odds (OR = 0.62, 95% CI: 0.41–0.93) of being in Class 3 compared to children who engaged in low physical activity; however, there was no evidence of effect modification of the relation between family income trajectories and adolescent multimorbidity by physical activity.
In Aim #3, when adjusted for sociodemographic characteristics, Class 1 membership at Wave 6 was associated with increased risk for depression (OR: 2.18; 95% CI: 1.04 -4.57) and anxiety (OR: 2.21; 95% CI: 1.03-4.77) at Wave 7 in young adulthood. The association did not differ significantly by income level.
Conclusion:
The findings highlight the need for early and tailored interventions to address adolescent multimorbidity and its long-term implications. The accumulation of multimorbidity during adolescence could be prevented or mitigated by mental health screening for girls before adolescence and early developmental assessments for boys and low birth weight children. Public health policies that lessen the long-term exposure of children to adverse SES may lower the risk of adolescents developing physical and developmental multimorbidity. Furthermore, early identification and treatment of mental health issues during adolescence may promote improved health outcomes in young adulthood.
License
This work is licensed under the University at Albany Standard Author Agreement.
Recommended Citation
Sambandamoorthy, Savitha, "Multimorbidity in Adolescents: The Longitudinal Impact of Childhood Socioeconomic Trajectories and Health Risk in Adulthood" (2025). Electronic Theses & Dissertations (2024 - present). 226.
https://scholarsarchive.library.albany.edu/etd/226
