000170995 001__ 170995
000170995 005__ 20260430151736.0
000170995 0247_ $$2doi$$a10.1093/eurpub/ckag067
000170995 0248_ $$2sideral$$a149090
000170995 037__ $$aART-2026-149090
000170995 041__ $$aeng
000170995 100__ $$aIoakeim-Skoufa, Ignatios
000170995 245__ $$aEarly dynamics of multimorbidity in 17.4 million people in Spain: onset patterns and prognostic value
000170995 260__ $$c2026
000170995 5060_ $$aAccess copy available to the general public$$fUnrestricted
000170995 5203_ $$aAbstract
Multimorbidity, the coexistence of two or more chronic diseases, has become a defining challenge for ageing societies. Yet evidence on when and how chronic diseases begin to cluster, and on the prognostic importance of this timing, remains limited. We used nationwide primary care electronic health records covering 17.4 million people in Spain to reconstruct the onset and progression of chronic disease over the life course. The first recorded diagnosis was used to trace temporal trajectories of multimorbidity by age and sex. We examined how the first condition, age at diagnosis, and time since that diagnosis were associated with advanced (≥3 diseases), multisystem (≥2 organ systems), and complex multimorbidity (≥3 organ systems), as well as premature mortality (<50 and <65 years) and outcomes related to polypharmacy and high-risk prescribing, using multivariable regression and gradient boosting models. By 2021, more than one in three Spaniards lived with a chronic condition, and over half of adults aged 45 years or older had multimorbidity. Among them, nearly 60% had complex multimorbidity. The time elapsed since the first diagnosis showed the closest link to further accumulation, followed by age at first diagnosis and current age. Later onset, particularly after the mid-50s, was associated with faster decline once disease emerged. The timing of the first chronic condition is a powerful but often overlooked prognostic marker. Public health strategies delaying onset and integrating early management could substantially reduce the long-term burden of multimorbidity in European populations.
000170995 536__ $$9info:eu-repo/grantAgreement/ES/DGA-FEDER/B01-23R$$9info:eu-repo/grantAgreement/ES/ISCIII/RD21-0016-0019$$9info:eu-repo/grantAgreement/ES/ISCIII/RD24-0005-0013
000170995 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es
000170995 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000170995 700__ $$0(orcid)0000-0003-4629-6743$$aVicente-Romero, Jorge$$uUniversidad de Zaragoza
000170995 700__ $$0(orcid)0000-0003-2580-2002$$aGonzález-Rubio, Francisca
000170995 700__ $$aAza-Pascual-Salcedo, Mercedes
000170995 700__ $$aLaguna-Berna, Clara
000170995 700__ $$aSempere-Verdú, Ermengol
000170995 700__ $$aVicens-Caldentey, Caterina
000170995 700__ $$aPalop-Larrea, Vicente
000170995 700__ $$aArroyo-Aniés, María Pilar
000170995 700__ $$aEsteban-Jiménez, Óscar
000170995 700__ $$aOrueta-Sánchez, Ramón
000170995 700__ $$aBarrio-Díez, Isabel
000170995 700__ $$aMarín-Murillo, Pilar
000170995 700__ $$aPearson, Sallie-Anne
000170995 700__ $$aGómez-Vaquero, Carmen
000170995 700__ $$0(orcid)0000-0002-5440-1710$$aGimeno-Miguel, Antonio
000170995 700__ $$aHernández-Rodríguez, Miguel Ángel
000170995 7102_ $$11012$$2315$$aUniversidad de Zaragoza$$bDpto. Farmac.Fisiol.y Med.L.F.$$cÁrea Farmacología
000170995 773__ $$g36, 3 (2026), [8 pp.]$$pEur. j. public health$$tEuropean Journal of Public Health$$x1101-1262
000170995 8564_ $$s980536$$uhttps://zaguan.unizar.es/record/170995/files/texto_completo.pdf$$yVersión publicada
000170995 8564_ $$s3394319$$uhttps://zaguan.unizar.es/record/170995/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000170995 909CO $$ooai:zaguan.unizar.es:170995$$particulos$$pdriver
000170995 951__ $$a2026-04-30-13:58:40
000170995 980__ $$aARTICLE