Multimorbidade, simultaneidade de fatores de risco à saúde e capital humano: relações a partir da adolescência até a vida adulta

Abstract

In the 1960s, studies on human capital (HC) begun, which is measured through several ways, such as executive function (EF), education, and intelligence quotient (IQ). Investments in these individual capabilities would lead to good achievement in social and monetary terms. About health, the higher burden of non-communicable diseases (NCD) in Brazil makes it important the monitoring the occurrence of multimorbidity (two or more diseases at the same time) and simultaneous health risk factors (SRF). This thesis was based on data from the 1993 Pelotas Birth Cohort at 11, 15, 18, and 22 years of follow-up visits. First, a descriptive study on the occurrence study SRF and multimorbidity was carried out (manuscript 1). Eight diseases and seven health risk factors were investigated. Allergy was the most prevalent disease at 11 and 15 years old. Excessive sedentary behaviour was the most prevalent risk factor at 11, 15, and 18 years old. The occurrence of multimorbidity increased from 26.3%, at 11 years, to 44.4% at 22 years. About 70% of the sample, regardless of age, had SRF. The presence of multimorbidity and SRF, at the same time, increased from 19.7% to 35.4% from 11 to 22 years. The second manuscript was designed to understand, how risk factors and morbidities are grouped in each assessed age. A network analysis was performed, in which the same 15 health conditions assessed in manuscript 1 were investigated. In early adolescence (11 years), a strong correlation pattern was observed between smoking, alcohol consumption, and illicit drug use triad. Additionally, smoking is the most important risk factor in the network in all ages and sexes. Finally, manuscript 3 addressed how the trajectories of health risk factors and diseases are associated with HC (EF, schooling, and IQ) in early adulthood (22 years). The analytical sample was restricted to cohort members with complete information for all five morbidities and six risk factors at four follow-ups (n=2441). Three trajectories were identified: "consistently lower" and "consistently intermediate" for both risk factors and morbidities; and “fast and consistent increase” (for risk factors) or "slightly and consistent increase" (only for morbidities). The incomplete education (at 22 years) was associated with the trajectory of health risk factors, even after the adjustments (OR=1.85, 95% CI 1.28; 2.67). The three studies indicate a high prevalence of SRF and multimorbidity in early adolescence and how they are impacting HC in early adult life. Policy makers should consider actions to reduce both in early phases of life.