Physical multimorbidity, depressive symptoms, and social participation in adults over 50 years of age: findings from the English Longitudinal Study of Ageing

Figures & data

Table 1. Sample characteristics at Wave 1.

	Overall (N = 11,391)	Relatively healthy (N = 7748, 68.0%)	Hypertension /diabetes (N = 1758, 15.4%)	Respiratory (N = 1201, 10.5%)	Complex/multisystem (N = 684, 6.0%)
	Mean ± SD or N(%)	Mean ± SD or N(%)	Mean ± SD or N(%)	Mean ± SD or N(%)	Mean ± SD or N(%)	p value
Age (median (IQR))	64 (56–73)	61 (55–69)	71 (63–78)	70 (62–78)	72 (64–79)	<0.0001
Female	6205 (54.5)	4174 (53.9)	876 (49.8)	802 (66.8)	353 (51.6)	<0.001
Ethnic minority group	320 (2.8)	188 (2.4)	83 (4.7)	28 (2.3)	21 (3.1)	<0.001
Total net wealth						<0.001
Quintile 1 (poorest)	2303 (20.2)	1436 (18.5)	365 (20.8)	290 (24.1)	212 (31.0)
Quintile 2	2261 (19.8)	1429 (18.5)	396 (22.5)	277 (23.1)	159 (23.2)
Quintile 3	2298 (20.2)	1537 (19.8)	367 (20.9)	243 (20.2)	151 (22.1)
Quintile 4	2251 (19.8)	1630 (21.0)	319 (18.1)	210 (17.5)	92 (13.5)
Quintile 5 (richest)	2278 (20.0)	1716 (22.2)	311 (17.7)	181 (15.1)	70 (10.2)
Educational attainment						<0.001
Degree/equivalent	1257 (11.0)	985 (12.7)	152 (8.7)	80 (6.7)	40 (5.8)
A-level/equivalent	5250 (46.1)	3798 (49.0)	727 (41.3)	474 (39.5)	251 (36.7)
No qual/O Level	4884 (42.9)	2965 (38.2)	879 (50.0)	647 (53.8)	393 (57.5)
Employment status
Employed	4070 (35.7)	3539 (45.7)	308 (17.5)	166 (13.8)	57 (8.3)
Retired/unemployed	7321 (64.3)	4209 (54.3)	1450 (82.5)	1035 (86.2)	627 (91.7)
Relationship status						<0.001
Married/Cohabiting	7830 (68.7)	5643 (72.8)	1106 (62.9)	670 (55.8)	411 (60.1)
Not cohabiting	3561 (31.3)	2105 (27.2)	652 (37.1)	531 (44.2)	273 (39.9)
Smoking status						<0.001
Current smoker	1999 (17.6)	1443 (18.6)	220 (12.5)	232 (19.3)	104 (15.2)
Past smoker	5389 (47.3)	3419 (44.1)	977 (55.6)	591 (49.2)	402 (58.6)
Never smoked	4003 (35.1)	2886 (37.3)	561 (31.9)	378 (31.5)	178 (26.0)
Mobility*	3.43 ± 0.99	3.68 ± 0.75	3.08 ± 1.13	2.85 ± 1.19	2.38 ± 1.22	<0.0001
Cognitive function**	−.03 ± 0.59	0.07 ± 0.58	−0.23 ± 0.59	−0.17 ± 0.58	−0.30 ± 0.55	<0.0001
Social network size	5.79 ± 4.45	5.92 ± 4.36	5.63 ± 4.73	5.47 ± 4.46	5.32 ± 4.62	<0.0001
Depressive symptoms (CES-D)	1.73 ± 2.08	1.45 ± 1.93	2.04 ± 2.16	2.50 ± 2.27	2.84 ± 2.32
Physical disease count	1.54 ± 1.39	0.79 ± 0.73	2.74 ± 0.87	2.93 ± 0.89	4.40 ± 1.21	<0.0001
Physical multimorbidity						<0.001
None or 1 LTC	6447 (56.6)	6366 (82.2)	81 (4.6)	–	–
2 LTCs	2469 (21.7)	1355 (17.5)	660 (37.5)	429 (35.7)	25 (3.7)
3 LTCs	1370 (12.0)	27 (0.3)	711 (40.5)	510 (42.5)	122 (17.8)
≥4 LTCs	1105 (9.7)	–	306 (17.4)	262 (21.8)	537 (78.5)

Notes. *Mobility scores ranged from 1 (unable to walk ¼ mile unaided) to 4 (no difficulty walking ¼ mile unaided). Higher scores indicate better mobility.

**Cognitive function scores were calculated using Z transformed scores on five tasks which were then averaged to generate an index of cognitive function. Higher scores indicate better cognitive function.

CES-D = Center for Epidemiological Studies Depression Scale; IQR = Interquartile range; LTC = Long-term condition; SD = Standard deviation.

Figure 1. Four-class model of physical multimorbidity patterns at Wave 1..

Table 2. Means and standard deviations for cultural engagement, civic participation, and leisure activities for the maximal sample available at each wave.

	Wave 1(n = 11,391)	Wave 2(n = 8780)	Wave 3(n = 8811)	Wave 4(n = 9896)	Wave 5(n = 9090)	Wave 6(n = 9169)	Wave 7(n = 8249)	Wave 8(n = 7223)
Cultural engagement (3–18)
Overall sample	6.41 ± 3.18	6.42 ± 3.07	6.63 ± 2.97	6.75 ± 3.04	6.69 ± 3.08	6.74 ± 3.12	6.93 ± 3.10	7.03 ± 3.15
Relatively healthy	6.81 ± 3.21	6.84 ± 3.07	6.97 ± 2.95	7.02 ± 3.02	6.96 ± 3.07	6.97 ± 3.09	7.12 ± 3.08	7.20 ± 3.13
Hypertension/diabetes	5.75 ± 2.95	5.66 ± 2.82	5.82 ± 2.80	5.64 ± 2.72	5.59 ± 2.79	5.69 ± 2.95	5.80 ± 2.93	5.92 ± 3.05
Respiratory	5.64 ± 2.98	5.42 ± 2.90	5.57 ± 2.83	5.60 ± 2.93	5.55 ± 3.02	5.53 ± 3.04	5.80 ± 3.02	5.89 ± 3.03
Complex/multisystem	4.97 ± 2.72	4.95 ± 2.61	5.02 ± 2.59	5.01 ± 2.58	4.95 ± 2.73	4.87 ± 2.71	5.06 ± 2.48	5.00 ± 2.45
Civic participation (0–4)
Overall sample	0.69 ± 0.90	0.73 ± 0.89	0.67 ± 0.84	0.65 ± 0.82	0.65 ± 0.83	0.64 ± 0.83	0.62 ± 0.82	0.64 ± 0.82
Relatively healthy	0.69 ± 0.90	0.75 ± 0.91	0.67 ± 0.84	0.65 ± 0.83	0.66 ± 0.84	0.64 ± 0.84	0.62 ± 0.83	0.63 ± 0.82
Hypertension/diabetes	0.71 ± 0.91	0.71 ± 0.85	0.68 ± 0.84	0.64 ± 0.82	0.64 ± 0.81	0.64 ± 0.78	0.64 ± 0.75	0.62 ± 0.76
Respiratory	0.67 ± 0.93	0.70 ± 0.86	0.67 ± 0.85	0.64 ± 0.82	0.67 ± 0.83	0.64 ± 0.84	0.70 ± 0.89	0.76 ± 0.90
Complex/multisystem	0.60 ± 0.83	0.64 ± 0.82	0.64 ± 0.83	0.61 ± 0.76	0.59 ± 0.79	0.52 ± 0.69	0.61 ± 0.80	0.62 ± 0.73
Leisure activities (0–4)
Overall sample	0.73 ± 0.84	0.76 ± 0.82	0.71 ± 0.79	0.71 ± 0.79	0.73 ± 0.82	0.75 ± 0.82	0.76 ± 0.83	0.78 ± 0.84
Relatively healthy	0.78 ± 0.86	0.81 ± 0.84	0.75 ± 0.80	0.74 ± 0.80	0.76 ± 0.83	0.77 ± 0.82	0.77 ± 0.83	0.80 ± 0.84
Hypertension/diabetes	0.64 ± 0.79	0.68 ± 0.78	0.60 ± 0.74	0.57 ± 0.69	0.61 ± 0.73	0.59 ± 0.72	0.66 ± 0.78	0.63 ± 0.76
Respiratory	0.62 ± 0.83	0.66 ± 0.82	0.58 ± 0.77	0.59 ± 0.77	0.57 ± 0.80	0.61 ± 0.82	0.68 ± 0.86	0.65 ± 0.88
Complex/multisystem	0.49 ± 0.72	0.53 ± 0.70	0.45 ± 0.60	0.49 ± 0.63	0.48 ± 0.65	0.51 ± 0.72	0.65 ± 0.84	0.53 ± 0.75

Table 3. Associations between multimorbidity patterns at Wave 1 and cultural engagement, civic participation, and leisure activities over all waves.

Cultural engagement (linear mixed models)
	Model 1 (unadjusted) BIC: 333980.7		Model 2 (age and sex) BIC: 330752.9		Model 3 (fully adjusted) BIC: 306550.2		Model 4 (fully adjusted + depressive symptoms) BIC: 295223.7
Multimorbidity pattern	β (95% CI)	p value	β (95% CI)	p value	β (95% CI)	p value	β (95% CI)	p value
Relatively healthy	Ref		Ref		Ref		Ref
Hypertension/diabetes	−1.22 (−1.31 to −1.15)	<0.001	−0.60 (−0.68 to −0.52)	<0.001	−0.08 (−0.14 to −0.01)	0.023	−0.06 (−0.13 to 0.01)	0.076
Respiratory	−1.36 (−1.45 to −1.27)	<0.001	−0.81 (−0.90 to −0.71)	<0.001	−0.13 (−0.21 to −0.05)	0.001	−0.09 (−0.17 to −0.01)	0.025
Complex/multisystem	−1.94 (−2.07 to −1.81)	<0.001	−1.27 (−1.40 to −1.14)	<0.001	−0.26 (−0.38 to −0.15)	<0.001	−0.23 (−0.34 to −0.12)	<0.001
Civic participation (mixed effects ordered logistic regression)
	Model 1 (unadjusted) BIC: 145145.5		Model 2 (age and sex) BIC: 144897.9		Model 3 (fully adjusted) BIC: 136427.2		Model 4 (fully adjusted + depressive symptoms) BIC: 136407.0
Hypertension/diabetes	1.03 (0.98 to 1.08)	0.280	0.94 (0.89 to 0.99)	0.013	1.14 (1.08 to 1.20)	<0.001	1.14 (1.09 to 1.21)	<0.001
Respiratory	1.01 (0.95 to 1.07)	0.698	0.90 (0.85 to 0.96)	0.001	1.17 (1.10 to 1.24)	<0.001	1.18 (1.11 to 1.25)	<0.001
Complex/multisystem	0.91 (0.83 to 0.98)	0.020	0.82 (0.75 to 0.89)	<0.001	1.13 (1.04 to 1.24)	0.005	1.14 (1.04 to 1.25)	0.003
Leisure activities (mixed effects ordered logistic regression)
	Model 1 (unadjusted) BIC: 148223.4		Model 2 (age and sex) BIC: 148153.2		Model 3 (fully adjusted) BIC: 138825.1		Model 4 (fully adjusted + depressive symptoms) BIC: 138571.9
Hypertension/diabetes	0.70 (0.67 to 0.74)	<0.001	0.73 (0.70 to 0.77)	<0.001	0.93 (0.88 to 0.98)	0.005	0.94 (0.89 to 0.99)	0.013
Respiratory	0.64 (0.60 to 0.68)	<0.001	0.68 (0.64 to 0.72)	<0.001	0.93 (0.88 to 0.99)	0.034	0.95 (0.90 to 1.02)	0.152
Complex/multisystem	0.52 (0.48 to 0.56)	<0.001	0.54 (0.50 to 0.59)	<0.001	0.84 (0.77 to 0.92)	<0.001	0.86 (0.78 to 0.94)	0.001

Notes. Model 1: Unadjusted.

Model 2: Age and sex adjusted.

Model 3: Model 2 + ethnicity, couple status, wealth, education level, employment, smoking, social network size, mobility, cognitive function.

Model 4: Model 3 + depressive symptoms (continuous CES-D score).