{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T17:27:07Z","timestamp":1786814827838,"version":"build-2736575974"},"reference-count":73,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"CIHR Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award","award":["72064776"],"award-info":[{"award-number":["72064776"]}]},{"name":"Canada Research Chair in Population Health Analytics","award":["72074328"],"award-info":[{"award-number":["72074328"]}]},{"name":"the MLTC"},{"name":"the Ontario MOH"},{"DOI":"10.13039\/100012665","name":"ICES","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Multimorbidity follows a strong social gradient, yet how the co-occurrence of social determinants shapes risk remains poorly understood. Most research examines individual determinants in isolation, potentially obscuring socially patterned subgroups relevant to multimorbidity risk. This study examines the association between multidimensional social exposure profiles (derived from individual- and area-level determinants) and multimorbidity risk. Profiles were derived through unsupervised clustering applied to population-based cohort of Ontario respondents to the Canadian Community Health Survey (2001-2011) and linked area-level Census measures. Chronic disease and subsequent multimorbidity status were identified through linkage to administrative health data until 2022. Sex-stratified Weibull models were used to estimate hazard ratios for the association between multidimensional social exposure and incident multimorbidity. Unsupervised clustering identified six distinct social exposure profiles, with multimorbidity onset differing across profiles and elevated risk observed across multiple patterns of social disadvantage, rather than following a simple graded gradient. In sex-stratified analyses, disadvantage social exposure profiles were associated with an earlier multimorbidity onset among females (adjusted HR: 1.70, 95%CI, 1.18-2.53) and males (adjusted HR: 1.59, 95%CI, 1.20-2.05). These multidimensional social exposure profiles capture population-level social patterning associated with differential multimorbidity risk. These findings have implications for upstream policy aimed at reducing inequities in multimorbidity.<\/jats:p>","DOI":"10.1093\/aje\/kwag172","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:42:15Z","timestamp":1784288535000},"source":"Crossref","is-referenced-by-count":0,"title":["Multidimensional social exposure clusters and incident multimorbidity in a population-based cohort"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4304-8381","authenticated-orcid":false,"given":"Ingrid","family":"Giesinger","sequence":"first","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3194-7331","authenticated-orcid":false,"given":"Emmalin","family":"Buajitti","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2458-9011","authenticated-orcid":false,"given":"Arjumand","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 ,","place":["Canada"]},{"name":"Department of Paediatrics, Hospital for Sick Children , 170 Elizabeth St, Toronto, ON M5G 1E8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8286-4563","authenticated-orcid":false,"given":"Peter M","family":"Smith","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 ,","place":["Canada"]},{"name":"Institute for Work & Health , 400 University Avenue, Suite 1800, Toronto, ON M5G 1S5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul G","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Toronto , University of Toronto 40 St. George Street, Room 4283, Toronto, ON M5S 2E4 ,","place":["Canada"]},{"name":"Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto , 1 King's College Circle, Medical Sciences Building, Room 2109, Toronto, ON M5S 1A8 ,","place":["Canada"]},{"name":"Vector Institute for Artificial Intelligence , W1140-108 College Street, Schwartz Reisman Innovation Campus, Toronto, ON M5G 0C6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Postill","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-869X","authenticated-orcid":false,"given":"Laura C","family":"Rosella","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7 ,","place":["Canada"]},{"name":"Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto , 1 King's College Circle, Medical Sciences Building, Room 2109, Toronto, ON M5S 1A8 ,","place":["Canada"]},{"name":"ICES , 155 College Street, Suite 424, Toronto, ON M5T 3M6 ,","place":["Canada"]},{"name":"Institute for Better Health, Trillium Health Partners \u00a0 100 Queensway West \u2013 Clinical Administrative Building, 6th Floor, Mississauga, ON L5B 1B8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"2026081513011557100_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.101860","article-title":"Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis","volume":"57","author":"Chowdhury","year":"2023","journal-title":"EClinicalMedicine."},{"key":"2026081513011557100_ref2","first-page":"127","volume-title":"Replace with other macmahon Multimorbidity: a priority for global health research","author":"MacMahon","year":"2018"},{"issue":"4","key":"2026081513011557100_ref3","doi-asserted-by":"publisher","first-page":"737","DOI":"10.17269\/s41997-021-00474-y","article-title":"Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians","volume":"112","author":"Kone","year":"2021","journal-title":"Can J Public Health"},{"issue":"4","key":"2026081513011557100_ref4","doi-asserted-by":"publisher","first-page":"e231","DOI":"10.1016\/S2468-2667(24)00028-8","article-title":"Socioeconomic inequalities in accumulation of multimorbidity in England from 2019 to 2049: a microsimulation projection study","volume":"9","author":"Head","year":"2024","journal-title":"Lancet Public Health"},{"key":"2026081513011557100_ref5","volume-title":"Projected Patterns of Illness in Ontario","author":"Rosella","year":"2024"},{"issue":"1","key":"2026081513011557100_ref6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2026081513011557100_ref7","first-page":"127","volume-title":"Multimorbidity: a priority for global health research","author":"MacMahon","year":"2018"},{"issue":"10131","key":"2026081513011557100_ref8","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1016\/S0140-6736(18)30941-3","article-title":"Making more of multimorbidity: an emerging priority","volume":"391","author":"Boast","year":"2018","journal-title":"Lancet."},{"issue":"1","key":"2026081513011557100_ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15256\/joc.2016.6.71","article-title":"Facing the challenge of multimorbidity","volume":"6","author":"Aza\u00efs","year":"2016","journal-title":"J Comorb"},{"issue":"1","key":"2026081513011557100_ref10","doi-asserted-by":"publisher","first-page":"e42","DOI":"10.1016\/S2468-2667(19)30226-9","article-title":"Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study","volume":"5","author":"Dugravot","year":"2020","journal-title":"Lancet Public Health"},{"issue":"1","key":"2026081513011557100_ref11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.15256\/joc.2016.6.72","article-title":"Multimorbidity: what do we know? What should we do?","volume":"6","author":"Navickas","year":"2016","journal-title":"J Comorb"},{"key":"2026081513011557100_ref12","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1081518","article-title":"Social determinants of multimorbidity patterns: a systematic review","volume":"11","author":"\u00c1lvarez-G\u00e1lvez","year":"2023","journal-title":"Front Public Health"},{"key":"2026081513011557100_ref13","doi-asserted-by":"crossref","DOI":"10.37829\/HF-2024-RC01","volume-title":"Health inequalities in 2040: current and projected patterns of illness by deprivation in England","author":"Raymond","year":"2024"},{"issue":"1","key":"2026081513011557100_ref14","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/s12916-017-0913-6","article-title":"The contribution of risk factors to socioeconomic inequalities in multimorbidity across the lifecourse: a longitudinal analysis of the Twenty-07 cohort","volume":"15","author":"Katikireddi","year":"2017","journal-title":"BMC Med"},{"key":"2026081513011557100_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2022.101630","article-title":"Life course socioeconomic conditions and multimorbidity in old age\u2013a scoping review","volume":"78","author":"Wagner","year":"2022","journal-title":"Ageing Res Rev"},{"issue":"3","key":"2026081513011557100_ref16","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1377\/hlthaff.2017.1150","article-title":"Accumulation of chronic conditions at the time of death increased in Ontario from 1994 to 2013","volume":"37","author":"Rosella","year":"2018","journal-title":"Health Aff"},{"issue":"8","key":"2026081513011557100_ref17","doi-asserted-by":"publisher","first-page":"e489","DOI":"10.1016\/S2666-7568(21)00146-X","article-title":"Inequalities in incident and prevalent multimorbidity in England, 2004\u201319: a population-based, descriptive study","volume":"2","author":"Head","year":"2021","journal-title":"Lancet Healthy Longev"},{"issue":"9","key":"2026081513011557100_ref18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003775","article-title":"Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: a longitudinal analysis of the MRC 1946 national survey of health and development in the UK","volume":"18","author":"Khanolkar","year":"2021","journal-title":"PLoS Med"},{"key":"2026081513011557100_ref19","doi-asserted-by":"crossref","first-page":"223","DOI":"10.4324\/9781315675411-19","volume-title":"The Routledge Handbook of Philosophy of Public Health","author":"Bartley","year":"2022"},{"issue":"2","key":"2026081513011557100_ref20","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s40471-014-0010-8","article-title":"Socioeconomic determinants of cardiovascular disease: recent findings and future directions","volume":"1","author":"Glymour","year":"2014","journal-title":"Curr Epidemiol Rep"},{"issue":"9","key":"2026081513011557100_ref21","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1136\/jech.2005.041319","article-title":"Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice","volume":"60","author":"Geyer","year":"2006","journal-title":"J Epidemiol Commun Health"},{"issue":"Extra Issue","key":"2026081513011557100_ref22","doi-asserted-by":"publisher","first-page":"80","DOI":"10.2307\/2626958","article-title":"Social conditions as fundamental causes of disease","volume":"35","author":"Link","year":"1995","journal-title":"J Health Soc Behav"},{"issue":"4","key":"2026081513011557100_ref23","doi-asserted-by":"publisher","first-page":"e261","DOI":"10.1016\/S2468-2667(24)00018-5","article-title":"Life course epidemiology and public health","volume":"9","author":"Wagner","year":"2024","journal-title":"Lancet Public Health"},{"key":"2026081513011557100_ref24","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780197510728.001.0001","volume-title":"Ecosocial theory, embodied truths, and the people's health","author":"Krieger","year":"2021"},{"issue":"5","key":"2026081513011557100_ref25","doi-asserted-by":"publisher","first-page":"100527","DOI":"10.1016\/j.jnha.2025.100527","article-title":"Association of polysocial risk score, cardiovascular health status, and the risk of premature mortality: findings from the UK biobank","volume":"29","author":"Shen","year":"2025","journal-title":"J Nutr Health Aging"},{"issue":"3","key":"2026081513011557100_ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/gerona\/glad262","article-title":"Polysocial and polygenic risk scores and all-cause dementia, Alzheimer\u2019s disease, and vascular dementia","volume":"79","author":"Li","year":"2024","journal-title":"J Gerontol A"},{"issue":"16","key":"2026081513011557100_ref27","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.1001\/jama.2020.2436","article-title":"Addressing social determinants of health: time for a polysocial risk score","volume":"323","author":"Figueroa","year":"2020","journal-title":"JAMA."},{"issue":"9","key":"2026081513011557100_ref28","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1093\/aje\/kwae074","article-title":"A critique and examination of the polysocial risk score approach: predicting cognition in the health and retirement study","volume":"193","author":"Jawadekar","year":"2024","journal-title":"Am J Epidemiol"},{"key":"2026081513011557100_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2026.110062","article-title":"Population-based clustering of co-occurring social determinants: an application of unsupervised machine learning","volume":"117","author":"Giesinger","year":"2026","journal-title":"Ann Epidemiol"},{"issue":"3","key":"2026081513011557100_ref30","first-page":"9","article-title":"Canadian Community Health Survey\u2014methodological overview","volume":"13","author":"B\u00e9land","year":"2002","journal-title":"Health Rep"},{"issue":"2","key":"2026081513011557100_ref31","doi-asserted-by":"publisher","DOI":"10.23889\/ijpds.v4i2.1135","article-title":"ICES: data, discovery, better health","volume":"4","author":"Schull","year":"2020","journal-title":"Int J Popul Data Sci"},{"key":"2026081513011557100_ref32","volume-title":"Ontario cancer screening performance report 2016","author":"Cancer Care Ontario","year":"2016"},{"key":"2026081513011557100_ref33","first-page":"1","volume-title":"Data and Measures in Health Services Research","author":"Prodhan","year":"2016"},{"issue":"10100","key":"2026081513011557100_ref34","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/S0140-6736(17)32154-2","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990\u20132016: a systematic analysis for the global burden of disease study 2016","volume":"390","author":"Vos","year":"2017","journal-title":"Lancet"},{"issue":"10100","key":"2026081513011557100_ref35","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specifc mortality for 264 causes of death, 1980-2016: a systematic analysis for the global burden of disease study 2016","volume":"390","author":"Naghavi","year":"2017","journal-title":"Lancet."},{"issue":"10","key":"2026081513011557100_ref36","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017264","article-title":"Effect of socio-demographic factors on the association between multimorbidity and healthcare costs: a population-based, retrospective cohort study","volume":"7","author":"Thavorn","year":"2017","journal-title":"BMJ Open"},{"issue":"9775","key":"2026081513011557100_ref37","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1016\/S0140-6736(11)60393-0","article-title":"Priority actions for the non-communicable disease crisis","volume":"377","author":"Beaglehole","year":"2011","journal-title":"Lancet"},{"key":"2026081513011557100_ref38","volume-title":"Report from the Canadian Chronic Disease Surveillance System: Heart Disease in Canada, 2018","author":"Public Health Agency of Canada","year":"2018"},{"key":"2026081513011557100_ref39","doi-asserted-by":"publisher","first-page":"l257","DOI":"10.1136\/bmj.l257","article-title":"Life course approach to prevention and control of non-communicable diseases","volume":"364","author":"Mikkelsen","year":"2019","journal-title":"Bmj."},{"issue":"5","key":"2026081513011557100_ref40","doi-asserted-by":"publisher","first-page":"845","DOI":"10.17269\/s41997-018-0103-0","article-title":"Beyond the grey tsunami: a cross-sectional population-based study of multimorbidity in Ontario","volume":"109","author":"Ryan","year":"2018","journal-title":"Can J Public Health"},{"key":"2026081513011557100_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2024.101743","article-title":"The association between total social exposure and incident multimorbidity: a population-based cohort study","volume":"29","author":"Giesinger","year":"2025","journal-title":"SSM Popul Health"},{"issue":"3","key":"2026081513011557100_ref42","doi-asserted-by":"publisher","first-page":"8","DOI":"10.12927\/hcq.2018.25709","article-title":"Putting a population health lens to multimorbidity in Ontario","volume":"21","author":"Rosella","year":"2018","journal-title":"Healthc Q"},{"issue":"6","key":"2026081513011557100_ref43","doi-asserted-by":"publisher","first-page":"e204669","DOI":"10.1001\/jamanetworkopen.2020.4669","article-title":"Development and validation of the chronic disease population risk tool (CDPoRT) to predict incidence of adult chronic disease","volume":"3","author":"Ng","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"3","key":"2026081513011557100_ref44","doi-asserted-by":"publisher","first-page":"287","DOI":"10.6000\/1929-6029.2015.04.03.7","article-title":"Multiple imputation by fully conditional specification for dealing with missing data in a large epidemiologic study","volume":"4","author":"Liu","year":"2015","journal-title":"Int J Stat Med Res"},{"issue":"2","key":"2026081513011557100_ref45","doi-asserted-by":"publisher","first-page":"e0247203","DOI":"10.1371\/journal.pone.0247203","article-title":"A machine learning approach to identify distinct subgroups of veterans at risk for hospitalization or death using administrative and electronic health record data","volume":"16","author":"Parikh","year":"2021","journal-title":"PloS One"},{"issue":"20","key":"2026081513011557100_ref46","doi-asserted-by":"publisher","first-page":"2003","DOI":"10.1001\/jama.2019.5791","article-title":"Derivation, validation, and potential treatment implications of novel clinical phenotypes for sepsis","volume":"321","author":"Seymour","year":"2019","journal-title":"JAMA."},{"key":"2026081513011557100_ref47","article-title":"GitHub","volume-title":"kmodes","author":"Vos"},{"key":"2026081513011557100_ref48","article-title":"Evaluation metrics for unsupervised learning algorithms","author":"Palacio-Ni\u00f1o","year":":1905.05667","journal-title":"ArXiv."},{"issue":"1","key":"2026081513011557100_ref49","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1093\/oxfordjournals.aje.a009034","article-title":"Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale","volume":"145","author":"Korn","year":"1997","journal-title":"Am J Epidemiol"},{"issue":"1","key":"2026081513011557100_ref50","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1093\/ije\/dyz078","article-title":"Smoking, drinking, diet and physical activity\u2014modifiable lifestyle risk factors and their associations with age to first chronic disease","volume":"49","author":"Ng","year":"2019","journal-title":"Int J Epidemiol"},{"issue":"6","key":"2026081513011557100_ref51","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","article-title":"Introduction to the analysis of survival data in the presence of competing risks","volume":"133","author":"Austin","year":"2016","journal-title":"Circulation."},{"key":"2026081513011557100_ref52","volume-title":"Survival analysis","author":"Kleinbaum","year":"2010"},{"issue":"1","key":"2026081513011557100_ref53","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1136\/jech-2025-224476","article-title":"Does lifestyle explain the relationship between socioeconomic position and multimorbidity of cancer and cardiometabolic diseases? A mediation analysis applied to the European prospective investigation into cancer and nutrition","volume":"80","author":"Manfredi","year":"2025","journal-title":"J Epidemiol Community Health"},{"issue":"9","key":"2026081513011557100_ref54","doi-asserted-by":"publisher","first-page":"e2335377","DOI":"10.1001\/jamanetworkopen.2023.35377","article-title":"APPRAISE-AI tool for quantitative evaluation of AI studies for clinical decision support","volume":"6","author":"Kwong","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"2026081513011557100_ref55","doi-asserted-by":"publisher","first-page":"4260","DOI":"10.1186\/s12889-025-25525-8","article-title":"Mapping the evidence on the intersection of gender and social determinants of health in health inequality: a scoping review","volume":"25","author":"Hossain","year":"2025","journal-title":"BMC Public Health"},{"issue":"10077","key":"2026081513011557100_ref56","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(17)30569-X","article-title":"Structural racism and health inequities in the USA: evidence and interventions","volume":"389","author":"Bailey","year":"2017","journal-title":"Lancet."},{"key":"2026081513011557100_ref57","volume-title":"Health inequality: an introduction to concepts, theories and methods","author":"Bartley","year":"2016"},{"issue":"3","key":"2026081513011557100_ref58","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1136\/jech-2020-214691","article-title":"Household and area-level social determinants of multimorbidity: a systematic review","volume":"75","author":"Ingram","year":"2021","journal-title":"J Epidemiol Community Health"},{"issue":"1","key":"2026081513011557100_ref59","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.eurger.2016.11.010","article-title":"Disparities in multimorbidity across Europe\u00a0\u2013\u00a0findings from the SHARE survey","volume":"8","author":"Nielsen","year":"2017","journal-title":"Eur Geriatric Med"},{"key":"2026081513011557100_ref60","doi-asserted-by":"publisher","first-page":"E75","DOI":"10.5888\/pcd21.240060","article-title":"Social deprivation and multimorbidity among community-based health center patients in the United States","volume":"21","author":"Valenzuela","year":"2024","journal-title":"Prev Chronic Dis"},{"issue":"2","key":"2026081513011557100_ref61","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-055264","article-title":"Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review","volume":"12","author":"Alfonzo","year":"2022","journal-title":"BMJ Open"},{"issue":"5","key":"2026081513011557100_ref62","doi-asserted-by":"publisher","first-page":"936","DOI":"10.2105\/AJPH.2011.300544","article-title":"Methods for the scientific study of discrimination and health: an ecosocial approach","volume":"102","author":"Krieger","year":"2012","journal-title":"Am J Public Health"},{"key":"2026081513011557100_ref63","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.ypmed.2018.05.003","article-title":"The contribution of health behaviors to socioeconomic inequalities in health: a systematic review","volume":"113","author":"Petrovic","year":"2018","journal-title":"Prev Med"},{"issue":"6","key":"2026081513011557100_ref64","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1016\/j.jamda.2023.01.009","article-title":"Socioeconomic and ethnic inequalities in the Progress of multimorbidity and the role of health behaviors","volume":"24","author":"Mira","year":"2023","journal-title":"J Am Med Dir Assoc"},{"key":"2026081513011557100_ref65","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1057\/s41599-022-01073-z","article-title":"The radically unequal distribution of COVID-19 vaccinations: a predictable yet avoidable symptom of the fundamental causes of inequality","volume":"9","author":"Rydland","year":"2022","journal-title":"Humanit Soc Sci Commun"},{"issue":"3","key":"2026081513011557100_ref66","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1136\/jech-2013-203159","article-title":"Association of socioeconomic position with smoking and mortality: the contribution of early life circumstances in the 1946 birth cohort","volume":"68","author":"Giesinger","year":"2014","journal-title":"J Epidemiol Community Health"},{"issue":"6","key":"2026081513011557100_ref67","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1042\/cs20220304","article-title":"By what molecular mechanisms do social determinants impact cardiometabolic risk?","volume":"137","author":"Baumer","year":"2023","journal-title":"Clin Sci"},{"issue":"4","key":"2026081513011557100_ref68","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3390\/geriatrics10040084","article-title":"The longitudinal relationship between Allostatic load and multimorbidity among older Americans","volume":"10","author":"Mira","year":"2025","journal-title":"Geriatrics."},{"issue":"3","key":"2026081513011557100_ref69","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1177\/10998004221147300","article-title":"Epigenomic links between social determinants of health and symptoms: a scoping review","volume":"25","author":"Ray","year":"2023","journal-title":"Biol Res Nurs"},{"issue":"1","key":"2026081513011557100_ref70","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1146\/annurev-publhealth-052020-105613","article-title":"Understanding health inequalities through the lens of social epigenetics","volume":"43","author":"Martin","year":"2022","journal-title":"Annu Rev Public Health"},{"issue":"1_suppl2","key":"2026081513011557100_ref71","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/00333549141291S206","article-title":"The social determinants of health: it's time to consider the causes of the causes","volume":"129","author":"Braveman","year":"2014","journal-title":"Public Health Rep"},{"issue":"12","key":"2026081513011557100_ref72","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1001\/jama.2010.297","article-title":"Association of socioeconomic position with health behaviors and mortality","volume":"303","author":"Stringhini","year":"2010","journal-title":"Jama."},{"key":"2026081513011557100_ref73","volume-title":"Canadian Community Health Survey\u2013Annual component (CCHS)","author":"Statistics Canada"}],"container-title":["American Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwag172\/69253136\/kwag172.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwag172\/69253136\/kwag172.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T17:01:26Z","timestamp":1786813286000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/aje\/advance-article\/doi\/10.1093\/aje\/kwag172\/8736991"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,18]]},"references-count":73,"URL":"https:\/\/doi.org\/10.1093\/aje\/kwag172","relation":{},"ISSN":["0002-9262","1476-6256"],"issn-type":[{"value":"0002-9262","type":"print"},{"value":"1476-6256","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,18]]},"article-number":"kwag172"}}