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@ARTICLE{Manfredi:298965,
      author       = {L. Manfredi and B. Sodano and C. Raganato and F. Buscema
                      and L. Milani and A. Catalano and H. Freisling and P.
                      Ferrari and A. Abraha and R. Kaaks$^*$ and V. Katzke$^*$ and
                      S. Panico and C. S. Antoniussen and C. C. Dahm and S. T. Tin
                      and R. Vermeulen and I. Vaartjes and A. Tjønneland and A.
                      Olsen and S. Colorado-Yohar and S. Grioni and M. J. Gunter
                      and M. B. Schulze and R. Cordova and M.-J. Sánchez and C.
                      B. Bonet and R. Tumino and O. Mokoroa and G. Masala and M.
                      G. Eslava and M. Verschuren and C. Sacerdote and F. Ricceri},
      title        = {{A} longitudinal {A}nalysis of the {A}ssociation between
                      {S}ocioeconomic {P}osition and {M}ultimorbidity in the
                      {E}uropean {P}rospective {I}nvestigation into {C}ancer and
                      {N}utrition {S}tudy.},
      journal      = {Aging and disease},
      volume       = {nn},
      issn         = {2152-5250},
      address      = {[Erscheinungsort nicht ermittelbar]},
      publisher    = {JKL International},
      reportid     = {DKFZ-2025-00394},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {The association between socioeconomic position (SEP) and
                      non-communicable diseases (NCDs) is well established, but
                      its role in driving multimorbidity remains unclear.
                      Multimorbidity, defined as the co-occurrence of more than
                      one chronic condition, is linked to higher mortality and
                      reduced quality of life. This study investigates the
                      association between SEP and multimorbidity using data from
                      the European Prospective Investigation into Cancer and
                      Nutrition (EPIC). Incident cases of cancer, type 2 diabetes
                      (T2D), and cardiovascular diseases (CVDs) were analysed
                      alongside lifestyle factors such as smoking status, alcohol
                      intake, body mass index (BMI), physical activity and diet.
                      Multimorbidity was defined as the presence of at least two
                      of the studied NCDs. SEP was assessed using the Relative
                      Index of Inequality (RII) and categorized into high, medium,
                      and low SEP. The cohort included 277 302 participants
                      $(60.7\%$ women) from seven countries, enrolled between
                      1992-2000 and followed until the first diagnosis, end of
                      follow-up (31/12/2007), or death. For transitions to
                      multimorbidity, follow-up extended from the first diagnosis
                      to the second diagnosis, end of follow-up, or death.
                      Multistate models were used to examine the nine possible
                      transitions to first diagnoses and multimorbidity
                      combinations. Lifestyle factors were risk factors for all
                      the transitions, except alcohol intake. In the main model,
                      not stratified by sex, low SEP was associated with higher
                      risks of progressing from cancer to CVD (Hazard Ratio (HR):
                      1.23, CI: 1.02-1.50), CVD to T2D (HR: 1.35, CI: 1.07-1.71),
                      and cancer to T2D (HR: 1.37, CI: 1.10-1.69). These findings
                      highlight the persistent influence of social inequalities on
                      the risk of multimorbidity, even in individuals with an
                      existing chronic condition.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39965252},
      doi          = {10.14336/AD.2024.1166},
      url          = {https://inrepo02.dkfz.de/record/298965},
}