Prevalence of multimorbidity in the Cypriot population and its relationship with Mediterranean Diet and quality of sleep; a crosssectional study (2018-2019)

Abstract

Introduction: Multimorbidity is defined as the co-existence of two or more chronic conditions. As life expectancy is increasing so does the prevalence of multimorbidity. Identifying the factors associated with the presence of multimorbidity is important. Furthermore, limited evidence exists on the association of Mediterranean Diet or of quality of sleep with the development of multimorbidity in an individual. The aim of this PhD dissertation work was: a) to estimate the prevalence of multimorbidity in Cyprus and identify the most prevalent diseases; b) to evaluate the level of adherence to the Mediterranean Diet in the adult general population of Cyprus and investigate its relationship with multimorbidity; and c) to assess the quality of sleep in Cyprus and examine its association with multimorbidity. Methods: This is a cross-sectional study and a stratified sampling procedure was implemented. A representative sample of individuals over 18 years old was surveyed during 2018-2019 in the five government-controlled municipalities of the Republic of Cyprus. Demographic data, dietary information, data on sleep quality, smoking, physical activity, stress, and quality of life, as well as the presence of chronic, clinical, and mental conditions were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision (ICD-10). Results: The mean age of the n=1140 participants was 41 ± 17 years old, 56% of them were women, 76% lived in an urban area, 54% were married, 64% had completed a higher education, and 50% had a yearly average income in the range €6,500 - €19,500. The age and sex standardized prevalence of multimorbidity was 28.6%. Multimorbidity was associated with age (p<0.01), with the highest rate observed among people aged 65 years old or older (68.9%). Multimorbidity was higher in women than men (28.2% vs. 22.5%, p<0.01) but similar in urban and rural regions (26.4% vs. 23.8%, p=0.40). The most prevalent chronic diseases among people with multimorbidity were hyperlipidemia (44.7%), followed by hypertension (37.5%), gastric reflux (23.9%), and thyroid diseases (22.2%), while the most common combinations of diseases were in the circulatory and endocrine systems. The profile of the multimorbid individual indicated this to be a person at an older age, with a higher BMI, being a current smoker, and having a higher salary. The average Mediterranean Diet score was 15.5 ± 4.0 with men and residents of rural regions being more adherent to the Mediterranean Diet, compared to women and residents of urban regions, respectively (p<0.05). Being in the higher tertile of adherence to the Mediterranean Diet was associated with lower odds of multimorbidity, compared to the lower tertile, and this result was statistically significant even after adjusting for age, sex, smoking habits, and physical activity (adjusted OR=0.68, 95% CI: 0.46, 0.99). The median Pittsburgh Sleep Quality score of the participants was 5 (q1=3, q3=7) with the maximum score being 17. Women, residents of Paphos, and married people had a poorer quality of sleep (p<0.05). Having a better quality of sleep was associated with lower odds of multimorbidity, even after adjusting for demographics, socioeconomic and lifestyle factors (adjusted OR=2.21, 95% CI: 1.55, 3.16). Conclusions: More than one quarter of the general population of Cyprus has multimorbidity, and this rate is almost 70% among the elderly, with multimorbidity being relatively common even in younger ages too. Adherence to the Mediterranean Diet and better quality of sleep were associated with lower risk of multimorbidity. The results of the study underline the need for prevention strategies and health awareness programs for the entire population, including in relation to dietary and sleeping habits. Prevention programs and public health guidelines in Cyprus and elsewhere should take these results into account and public health guidelines should be developed in regards to the importance of adherence to the Mediterranean Diet and good quality of sleep, highlighting their association with multimorbidity. Further research on multimorbidity should be carried out, including in specific subgroups of the population.