American Journal of Preventive Medicine · Jan 21, 2026

Cumulative Disadvantage in Education and Progression of Physical-Mental-Cognitive Multimorbidity: Evidence From 2 National Cohorts

By Cao J, Yang S, Zhou C

INTRODUCTION: Socioeconomic determinants such as education have been shown to be vital factors in multimorbidity progression among middle-aged and older adults. However, whether cumulative disadvantage in education is associated with multimorbidity progression remains unclear, particularly in cross-cultural contexts. This study aimed to investigate the progression of physical-mental-cognitive multimorbidity and to evaluate how cumulative disadvantage in education influenced its progression among Chinese and English populations. METHODS: Data were extracted from the China Health and Retirement Longitudinal Study (2011-2020) and the English Longitudinal Study of Ageing (2011-2019). Cumulative disadvantage in education was measured by classification of educational years among core family members (participants, their parents, and spouse). Multimorbidity involved chronic conditions in physical-mental-cognitive domains, and its quantitative changes were identified through group-based trajectory modeling. Logistic regressions and competing risk models were used to examine the associations between educational disadvantages and multimorbidity trajectories. RESULTS: A total of 13,278 participants aged ≥45 years were included. Four multimorbidity trajectories were identified: steady, slow growth, medium growth, and fast growth. Most individuals had severe educational disadvantage (45.46%) and physical-mental multimorbidity pattern (23.26%). Educational disadvantage was significantly associated with faster multimorbidity trajectories (p<0.001) and higher risks of complex multimorbidity patterns, particularly physical-mental-cognitive multimorbidity (p<0.001). Maternal education significantly influenced multimorbidity progressions in England (p<0.001) but not in China (p=0.100). CONCLUSIONS: It is important to monitor quantitative and pattern changes in multimorbidity among middle-aged and older adults holistically. Public health should prioritize individuals with educational disadvantages as well as their families to more effectively address multimorbidity management.

doi.org/10.1016/j.amepre.2026.108277 PubMed 41576997 Populations