Preterm birth and the risk of multimorbidity in adolescence: a multiregister-based cohort study.

Infant, Newborn Child Female Humans Adolescent Cohort Studies Multimorbidity Premature Birth / epidemiology Death European Union

Journal

The Lancet. Public health
ISSN: 2468-2667
Titre abrégé: Lancet Public Health
Pays: England
ID NLM: 101699003

Informations de publication

Date de publication:
09 2023
Historique:
received: 25 01 2023
revised: 19 06 2023
accepted: 05 07 2023
medline: 28 8 2023
pubmed: 27 8 2023
entrez: 26 8 2023
Statut: ppublish

Résumé

Multimorbidity affects people of all ages, but the risk factors of multimorbidity in adolescence are unclear. The aim of this study was to examine preterm birth (<37 weeks) as a shared risk factor for multiple health outcomes and the role of gestational age (degree of prematurity) in the development of increasingly complex multimorbidity (two, three, or four health outcomes) in adolescence (age 10-18 years). We used population-wide data from Finland (1 187 610 adolescents born 1987-2006) and Norway (555 431 adolescents born 1998-2007). Gestational age at birth was ascertained from medical birth registers and categorised as 23-27 weeks (extremely preterm), 28-31 weeks (very preterm), 32-33 weeks (moderately preterm), 34-36 weeks (late preterm), 37-38 weeks (early term), 39-41 weeks (term, reference category) and 42-44 weeks (post-term). Children who died or emigrated before their 10th birthday, and those with missing or implausible data on gestational age, birthweight, or covariates, were excluded. Health outcomes at age 10-18 years were ascertained from specialised health care and mortality registers. We calculated hazard ratios (HRs) and population attributable fractions (PAFs) with 95% CIs for multiple health outcomes during adolescence. Individuals were followed up from age 10 to 18 years (mean follow-up: 6 years, SD: 3 years). Preterm birth was associated with increased risks of 20 hospital-treated malignant, cardiovascular, endocrinological, neuropsychiatric, respiratory, genitourinary, and congenital health outcomes, after correcting for multiple testing and ignoring small effects (HR <1·2). Confounder-adjusted HRs comparing preterm with term-born adolescents were 2·29 (95% CI 2·19-2·39) for two health outcomes (PAF 9·0%; 8·3-9·6), and 4·22 (3·66-4·87) for four health outcomes (PAF 22·7%; 19·4-25·8) in the Finnish data. Results in the Norwegian data showed a similar pattern. We observed a consistent dose-response relationship between an earlier gestational age and elevated risks of increasingly complex multimorbidity in both datasets. Preterm birth is associated with increased risks of diverse multimorbidity patterns at age 10-18 years. Adolescents with a preterm-born background could benefit from diagnostic vigilance directed at multimorbidity and a multidisciplinary approach to health care. European Union Horizon 2020, Academy of Finland, Foundation for Pediatric Research, Sigrid Jusélius Foundation, Signe and Ane Gyllenberg Foundation.

Sections du résumé

BACKGROUND
Multimorbidity affects people of all ages, but the risk factors of multimorbidity in adolescence are unclear. The aim of this study was to examine preterm birth (<37 weeks) as a shared risk factor for multiple health outcomes and the role of gestational age (degree of prematurity) in the development of increasingly complex multimorbidity (two, three, or four health outcomes) in adolescence (age 10-18 years).
METHODS
We used population-wide data from Finland (1 187 610 adolescents born 1987-2006) and Norway (555 431 adolescents born 1998-2007). Gestational age at birth was ascertained from medical birth registers and categorised as 23-27 weeks (extremely preterm), 28-31 weeks (very preterm), 32-33 weeks (moderately preterm), 34-36 weeks (late preterm), 37-38 weeks (early term), 39-41 weeks (term, reference category) and 42-44 weeks (post-term). Children who died or emigrated before their 10th birthday, and those with missing or implausible data on gestational age, birthweight, or covariates, were excluded. Health outcomes at age 10-18 years were ascertained from specialised health care and mortality registers. We calculated hazard ratios (HRs) and population attributable fractions (PAFs) with 95% CIs for multiple health outcomes during adolescence.
FINDINGS
Individuals were followed up from age 10 to 18 years (mean follow-up: 6 years, SD: 3 years). Preterm birth was associated with increased risks of 20 hospital-treated malignant, cardiovascular, endocrinological, neuropsychiatric, respiratory, genitourinary, and congenital health outcomes, after correcting for multiple testing and ignoring small effects (HR <1·2). Confounder-adjusted HRs comparing preterm with term-born adolescents were 2·29 (95% CI 2·19-2·39) for two health outcomes (PAF 9·0%; 8·3-9·6), and 4·22 (3·66-4·87) for four health outcomes (PAF 22·7%; 19·4-25·8) in the Finnish data. Results in the Norwegian data showed a similar pattern. We observed a consistent dose-response relationship between an earlier gestational age and elevated risks of increasingly complex multimorbidity in both datasets.
INTERPRETATION
Preterm birth is associated with increased risks of diverse multimorbidity patterns at age 10-18 years. Adolescents with a preterm-born background could benefit from diagnostic vigilance directed at multimorbidity and a multidisciplinary approach to health care.
FUNDING
European Union Horizon 2020, Academy of Finland, Foundation for Pediatric Research, Sigrid Jusélius Foundation, Signe and Ane Gyllenberg Foundation.

Identifiants

DOI: 10.1016/S2468-2667(23)00145-7 PMID: 37633677
pubmed: 37633677
pii: S2468-2667(23)00145-7
doi: 10.1016/S2468-2667(23)00145-7
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

e680-e690

Subventions

Organisme : Medical Research Council
ID : MR/S011676/1
Pays : United Kingdom
Organisme : NIA NIH HHS
ID : R01 AG056477
Pays : United States
Organisme : NIA NIH HHS
ID : RF1 AG062553
Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests We declare no competing interests.

Auteurs

Katriina Heikkilä (K)

Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland. Electronic address: katriina.heikkila@thl.fi.

Johanna Metsälä (J)

Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.

Anna Pulakka (A)

Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Research Unit of Population Health, University of Oulu, Oulu, Finland.

Sara Marie Nilsen (SM)

Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Centre for Health Care Improvement, St. Olavs Hospital, Trondheim, Norway.

Mika Kivimäki (M)

Department of Mental Health for Older People, Faculty of Brain Sciences, University College London, London, UK; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Kari Risnes (K)

Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Centre for Health Care Improvement, St. Olavs Hospital, Trondheim, Norway; Children's Clinic, St. Olavs Hospital, Trondheim, Norway.

Eero Kajantie (E)

Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Clinical Medicine Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Comorbidité › Multimorbidité › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › Maladies urogénitales › Maladies de l'appareil urogénital féminin et complications de la grossesse › Complications de la grossesse › Complications du travail obstétrical › Travail obstétrical prématuré › Naissance prématurée › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Mort › Preterm birth and the risk of multimorbidity...
questionsmedicales.fr › Sciences sociales › Internationalité › Coopération internationale › Union européenne › Preterm birth and the risk of multimorbidity...