为了评估老年美国人多病进展中的社会经济和种族不平等，并确定行为因素是否可以解释这些不平等，我们使用了美国老年人健康和退休研究的纵向调查数据。我们合计了来自2006年至2018年（第8-14轮）的数据，共有38,061名参与者。我们使用了2006年至2018年的7轮调查。社会经济因素包括教育水平、总财富、贫困-收入比（收入）和种族/族裔。多病的指标为5种慢性病的自我报告诊断：糖尿病、心脏疾病、肺部疾病、癌症和中风。行为因素包括吸烟、过度饮酒、体育锻炼和身体质量指数（BMI）。我们建立了多层次混合效应广义线性模型，评估了社会经济和种族不平等在多病进展中的作用以及行为因素的作用。所有分析中的变量都是时间变化的，除了性别、种族/族裔和教育水平。 非裔美国人的多病率高于白人，但调整收入和教育水平后，相关性被颠倒。多病的进展与收入、财富和教育水平呈现明显的梯度关系。调整行为因素后，这些关系被弱化了。在考虑行为因素后，教育水平最低的参与者的多病发生率比例比在未调整和调整行为的模型中分别降低了9%（比例比率为1.21，95% CI 1.18-1.23和1.11，95% CI 1.17-1.14）。同样，最低财富四分位数人群的多病发生率比例经过调整行为因素后从1.47（95% CI 1.44-1.51）降至1.31（95% CI 1.26-1.36）。种族不平等在多病进展中的表现可以用财富、收入和教育来解释。行为因素在多病中部分弱化了社会经济不平等。这些结果对于确定应包含在旨在解决多病不平等的健康促进计划中的行为至关重要。 版权所有 © 2023 作者。由Elsevier Inc.出版。保留所有权利。

To assess socioeconomic and ethnic inequalities in the progress of multimorbidity and whether behavioral factors explain these inequalities among older Americans.Health and Retirement Study, a longitudinal survey of older American adults.Data pooled from 2006 to 2018 (waves 8-14), which include 38,061 participants.We used 7 waves of the survey from 2006 to 2018. Socioeconomic factors were indicated by education, total wealth, poverty-income ratio (income), and race/ethnicity. Multimorbidity was indicated by self-reported diagnoses of 5 chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioral factors were smoking, excessive alcohol consumption, physical activity, and body mass index (BMI). Multilevel mixed effects generalized linear models were constructed to assess socioeconomic and ethnic inequalities in the progress of multimorbidity and the role of behavior. All variables included in the analysis were time-varying except gender, race/ethnicity, and education.African American individuals had higher rates of multimorbidity than White individuals; however, after adjusting for income and education, the association was reversed. There were clear income, wealth, and education gradients in the progress of multimorbidity. After adjusting for behavioral factors, the relationships were attenuated. The rate ratio (RR) of multimorbidity attenuated by 9% among participants with the lowest level of education after accounting for behavior (RR 1.21; 95% CI 1.18-1.23 and 1.11; 95% CI 1.17-1.14) in the models unadjusted and adjusted for behaviors, respectively. Similarly, RR for multimorbidity among those in the lowest wealth quartile attenuated from 1.47 (95% CI 1.44-1.51) and 1.31 (95% CI 1.26-1.36) after accounting for behaviors.Ethnic inequalities in the progress of multimorbidity were explained by wealth, income, and education. Behavioral factors partially attenuated socioeconomic inequalities in multimorbidity. The findings are useful in identifying the behaviors that should be included in health promotion programs aiming at tackling inequalities in multimorbidity.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.