慢性身体疾病（例如心脏病、糖尿病）随着人口老龄化而增加，导致心理和认知多重疾病。然而，人们对这一过程中的社会经济不平等知之甚少。我们研究了社会经济地位 (SES) 与身体状况发生后发展为心理和认知多重病之间的关联。我们使用了来自美国、欧洲和亚洲 24 个国家的五项前瞻性队列研究的统一个人水平数据，这些研究具有重复发病率2002 年至 2021 年间的测量结果。对至少患有一种新发身体疾病（高血压、糖尿病、心脏病、中风、慢性肺病、癌症或关节炎）的参与者进行随访，以了解其进展为身体-心理多重病、身体-认知多重病的情况，以及身体-心理-认知多重病态。社会经济地位是根据教育水平和身体状况出现时的家庭总财富确定的。通过 SES 分层分析来估计进展性心理和认知多重疾病的发生时间和发生率。使用细灰色次分布风险模型和多状态模型来估计 SES 与心理和认知多种疾病进展之间的关联。 在 20,250 名年龄≥45 岁的参与者中（身体状况发生的平均年龄 65.38 岁，标准差 8.37），分析中至少有一种新发的身体状况，在中位随访 8.0 年（168,575 人年）期间，7928 人（39.2%）进展为心理和认知多重疾病。低 SES 个体的无身体-心理-认知多重病态的平均生存时间为 11.96 年（95% 置信区间 11.57-12.34），而高 SES 个体的平均生存时间为 15.52 年（15.40-15.63），相应的发病率为 18.44每1000人年分别为（16.32-20.82）和3.15（2.48-4.01）。教育、家庭财富和社会经济地位与多种疾病的关联遵循剂量依赖关系，每个降低的社会经济地位类别的次分布风险比对于身体-心理多种疾病为1.24（1.19-1.29），对于身体-认知多种疾病为1.47（1.40-1.54） ，以及 1.84 (1.72-1.97) 的身体-心理-认知多重病态。在患有关节炎、高血压或糖尿病的参与者中观察到最强的 SES 与多种疾病的关联。在多状态模型中，SES 与从身体状况到身体-心理多重病态、身体-认知多重病态和身体-心理-认知多重病态的所有五种转变有关。社会经济不平等与慢性身体状况的进展有关，SES 较低。不同群体的心理和认知多重疾病发生时间较早，发生率较高。这些发现强调需要更有效的公平导向政策和医疗保健实践，以解决社会经济地位低和身体状况不佳的个体心理健康和认知维持能力下降的问题。浙江大学百人计划研究启动基金、中央高校基本科研业务费专项资金、Wellcome Trust、医学研究委员会、国家老龄化研究所、芬兰科学院。© 2024 作者。

Chronic physical conditions (e.g., heart diseases, diabetes) increase with population ageing, contributing to psychological and cognitive multimorbidities. Yet, little is known about socioeconomic inequalities in this process. We examined the associations between socioeconomic status (SES) and progression to psychological and cognitive multimorbidities after onset of a physical condition.We used harmonized individual-level data from five prospective cohort studies across 24 countries in the US, Europe and Asia, with repeated morbidity measurements between 2002 and 2021. Participants with at least one new-onset physical conditions (hypertension, diabetes, heart diseases, stroke, chronic lung diseases, cancer, or arthritis) were followed up for progression to physical-psychological multimorbidity, physical-cognitive multimorbidity, and physical-psychological-cognitive multimorbidity. SES was determined based on educational level and total household wealth at the onset of a physical condition. Time to and incidence rates of progressing psychological and cognitive multimorbidities were estimated in analyses stratified by SES. Fine-Gray subdistribution hazard models and multi-state models were used to estimate the associations between SES and progression to psychological and cognitive multimorbidities.Among 20,250 participants aged ≥45 years (mean age at a physical condition onset 65.38 years, standard deviation 8.37) with at least one new-onset physical conditions in the analysis, 7928 (39.2%) progressed to psychological and cognitive multimorbidities during a median follow-up of 8.0 years (168,575 person-years). The mean survival time free from physical-psychological-cognitive multimorbidity was 11.96 years (95% confidence interval 11.57-12.34) in low SES individuals, compared to 15.52 years (15.40-15.63) in high SES individuals, with the corresponding incidence rate of 18.44 (16.32-20.82) and 3.15 (2.48-4.01) per 1000 person-years, respectively. The associations of education, household wealth and SES with multimorbidities followed a dose-dependent relation, with subdistribution hazard ratios per decreasing SES category being 1.24 (1.19-1.29) for physical-psychological multimorbidity, 1.47 (1.40-1.54) for physical-cognitive multimorbidity, and 1.84 (1.72-1.97) for physical-psychological-cognitive multimorbidity. The strongest SES-multimorbidities associations were observed in participants with arthritis, hypertension or diabetes. In multi-state models SES was linked to all five transitions from physical condition to physical-psychological multimorbidity, physical-cognitive multimorbidity and physical-psychological-cognitive multimorbidity.Socioeconomic inequalities are associated with the progression of a chronic physical condition, with the lower SES groups had both an earlier time to and a higher incidence of psychological and cognitive multimorbidities. These findings underscore the need for more effective equity-oriented policies and healthcare practices to address reduced psychological wellness and cognitive maintenance among individuals with low SES and physical conditions.Zhejiang University Hundred Talents Program Research Initiation Fund, Fundamental Research Funds for the Central Universities in China, Wellcome Trust, Medical Research Council, National Institute on Aging, Academy of Finland.© 2024 The Author(s).