{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:13:58Z","timestamp":1783620838906,"version":"3.55.0"},"reference-count":80,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/W014416\/1"],"award-info":[{"award-number":["MR\/W014416\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["222849\/Z\/21\/Z"],"award-info":[{"award-number":["222849\/Z\/21\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015846","name":"Llywodraeth Cymru","doi-asserted-by":"publisher","award":["HS 22 04"],"award-info":[{"award-number":["HS 22 04"]}],"id":[{"id":"10.13039\/100015846","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>UK South Asian populations are at high risk of physical and mental health multimorbidity, which means they live with multiple long-term conditions. The life course emergence of multimorbidity, its underlying aetiology, and consequences for future health and mortality have yet to be studied in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We studied Internalising (depression, anxiety, somatoform disorders) and Cardiometabolic (hypertension, obesity, type 2 diabetes, chronic kidney disease, dyslipidaemia) MultiMorbidity (ICM-MM): the lifetime occurrence of \u22651 internalising mental health condition AND \u22651 cardiometabolic condition in a longitudinal cohort of Genes and Health study participants with linked genetic and health data from 1st April 1997\u201324th November 2024. We used multi-state models to investigate trajectories in ICM-MM and risk of major cardiovascular or renal events (CVR) or non-CVR death. We used flexible parametric models to estimate baseline hazards for health state transitions, adjusting for sociodemographic factors, a polygenic risk score (PRS) for ICM-MM (ICM-MM\n                      <jats:sub>PRS<\/jats:sub>\n                      ), and describe 10-year simulated health state probabilities. Over 10.2 years median follow-up of 23,554 British Bangladeshi and Pakistani participants (median baseline age 31.1 years, 12,934 [54.9%] women), 3,159 (13.4%) developed ICM-MM; 1,522 (6.5%) CVR; and there were 103 (0.4%) non-CVR deaths. Women were less likely to remain healthy, with higher probability of developing internalising conditions and subsequent ICM-MM, but lower risk of CVR than men. Younger age was associated with higher risk of developing internalising conditions. Bangladeshi ethnicity, higher deprivation, and smoking were all associated with higher probability of ICM-MM. 10-year CVR risk was highest for people who developed ICM-MM via the trajectory cardiometabolic-to-internalising (versus internalising-to-cardiometabolic) in mid-life (age 40). Higher ICM-MM\n                      <jats:sub>PRS<\/jats:sub>\n                      was associated with higher probability of ICM-MM via cardiometabolic conditions rather than internalising conditions. Our findings are based on routinely collected electronic health records from East London, which incompletely capture individual-level and time-varying risk factors, remission or recovery, and may not reflect British Bangladeshi and British Pakistani communities across the UK. The PRS was derived largely from GWAS of European ancestry populations, which may limit its transferability to this cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The burden of multimorbidity is high in British Bangladeshi and British Pakistani populations. Young Bangladeshi women are at high risk of ICM-MM, while men are at higher risk of CVR. Detection and intervention strategies for physical and mental health multimorbidity should be targeted early in the lifecourse, for those at highest risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004844","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:26:34Z","timestamp":1783617994000},"page":"e1004844","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Genetic and sociodemographic factors associated with trajectories of physical and mental health multimorbidity in a South Asian cohort in the UK: A multistate modelling analysis"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9534-4521","authenticated-orcid":true,"given":"Daniel","family":"Stow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-526X","authenticated-orcid":true,"given":"Ruby S. M.","family":"Tsang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2653-1614","authenticated-orcid":true,"given":"Ioanna K.","family":"Katzourou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinqin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1258-435X","authenticated-orcid":true,"given":"Miriam","family":"Samuel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1882-2355","authenticated-orcid":true,"given":"Megan L.","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1731-6039","authenticated-orcid":true,"given":"Jack F. G.","family":"Underwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Genes and Health Research Team, The LIfespaN multimorbidity research Collaborative (LINC)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5842-4645","authenticated-orcid":true,"given":"Rupert A.","family":"Payne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T. R.","family":"Walters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7141-9189","authenticated-orcid":true,"given":"Nicholas J.","family":"Timpson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5800-4520","authenticated-orcid":true,"given":"In\u00eas","family":"Barroso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary C.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0870-9412","authenticated-orcid":true,"given":"Peter A.","family":"Holmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne B. M.","family":"van den Bree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3817-8790","authenticated-orcid":true,"given":"Rohini","family":"Mathur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2684-4653","authenticated-orcid":true,"given":"Sarah","family":"Finer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"pmed.1004844.ref001","doi-asserted-by":"crossref","first-page":"101860","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":"SR Chowdhury","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"1","key":"pmed.1004844.ref002","article-title":"Measuring multimorbidity in research: Delphi consensus study","volume":"1","author":"ISS Ho","year":"2022","journal-title":"BMJ Med"},{"issue":"7","key":"pmed.1004844.ref003","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1038\/s41591-023-02420-6","article-title":"Biological and functional multimorbidity-from mechanisms to management","volume":"29","author":"C Langenberg","year":"2023","journal-title":"Nat Med"},{"key":"pmed.1004844.ref004","volume-title":"Multimorbidity: a priority for global health research","author":"The Academy of Medical Sciences","year":"2018"},{"issue":"4","key":"pmed.1004844.ref005","doi-asserted-by":"crossref","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":"A Head","year":"2024","journal-title":"Lancet Public Health"},{"issue":"3","key":"pmed.1004844.ref006","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/ageing\/afx201","article-title":"Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model","volume":"47","author":"MODEM project","year":"2018","journal-title":"Age Ageing"},{"issue":"1","key":"pmed.1004844.ref007","article-title":"Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study","volume":"5","author":"V Kuan","year":"2023","journal-title":"Lancet Digit Health"},{"issue":"716","key":"pmed.1004844.ref008","doi-asserted-by":"crossref","DOI":"10.3399\/BJGP.2021.0325","article-title":"Identifying multimorbidity clusters with the highest primary care use: 15 years of evidence from a multi-ethnic metropolitan population","volume":"72","author":"M Soley-Bori","year":"2022","journal-title":"Br J Gen Pract"},{"issue":"1","key":"pmed.1004844.ref009","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12916-020-01543-8","article-title":"Characteristics, service use and mortality of clusters of multimorbid patients in England: a population-based study","volume":"18","author":"Y Zhu","year":"2020","journal-title":"BMC Med"},{"issue":"7","key":"pmed.1004844.ref010","article-title":"Effect on life expectancy of temporal sequence in a multimorbidity cluster of psychosis, diabetes, and congestive heart failure among 1\u00b77 million individuals in Wales with 20-year follow-up: a retrospective cohort study using linked data","volume":"8","author":"RK Owen","year":"2023","journal-title":"Lancet Public Health"},{"issue":"100687","key":"pmed.1004844.ref011","doi-asserted-by":"crossref","first-page":"100687","DOI":"10.1016\/j.lanepe.2023.100687","article-title":"Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005-2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals","volume":"32","author":"J Lyons","year":"2023","journal-title":"Lancet Reg Health Eur"},{"issue":"11","key":"pmed.1004844.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004310","article-title":"Sociodemographic characteristics and longitudinal progression of multimorbidity: a multistate modelling analysis of a large primary care records dataset in England","volume":"20","author":"S Chen","year":"2023","journal-title":"PLoS Med"},{"issue":"10","key":"pmed.1004844.ref013","article-title":"Ethnic differences in early onset multimorbidity and associations with health service use, long-term prescribing, years of life lost, and mortality: A cross-sectional study using clustering in the UK Clinical Practice Research Datalink","volume":"20","author":"F Eto","year":"2023","journal-title":"PLoS Med"},{"key":"pmed.1004844.ref014","unstructured":"Raleigh V. The health of people from ethnic minority groups in England. 2023."},{"issue":"3","key":"pmed.1004844.ref015","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(20)30287-5","article-title":"Ethnic inequalities in health-related quality of life among older adults in England: secondary analysis of a national cross-sectional survey","volume":"6","author":"RE Watkinson","year":"2021","journal-title":"Lancet Public Health"},{"issue":"1","key":"pmed.1004844.ref016","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1038\/s41591-024-03317-8","article-title":"Genetic basis of early onset and progression of type 2 diabetes in South Asians","volume":"31","author":"S Hodgson","year":"2025","journal-title":"Nat Med"},{"key":"pmed.1004844.ref017","doi-asserted-by":"crossref","first-page":"101166","DOI":"10.1016\/j.lanepe.2024.101166","article-title":"Immuno-metabolic depression: from concept to implementation","volume":"48","author":"BWJH Penninx","year":"2024","journal-title":"Lancet Reg Health Eur"},{"issue":"1","key":"pmed.1004844.ref018","doi-asserted-by":"crossref","first-page":"7190","DOI":"10.1038\/s41467-024-51467-7","article-title":"Unique genetic and risk-factor profiles in clusters of major depressive disorder-related multimorbidity trajectories","volume":"15","author":"A Gezsi","year":"2024","journal-title":"Nat Commun"},{"key":"pmed.1004844.ref019","volume-title":"Genome UK: 2022 to 2025 implementation plan for England","author":"Department of Health and Social Care","year":"2022"},{"issue":"6","key":"pmed.1004844.ref020","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1093\/eurjpc\/zwae004","article-title":"A polygenic risk score added to a QRISK\u00ae2 cardiovascular disease risk calculator demonstrated robust clinical acceptance and clinical utility in the primary care setting","volume":"31","author":"A Fuat","year":"2024","journal-title":"Eur J Prev Cardiol"},{"issue":"2","key":"pmed.1004844.ref021","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1038\/s41591-021-01672-4","article-title":"A roadmap to increase diversity in genomic studies","volume":"28","author":"S Fatumo","year":"2022","journal-title":"Nat Med"},{"issue":"3","key":"pmed.1004844.ref022","article-title":"Contributions of common and rare genetic variation to different measures of mood and anxiety disorder in the UK Biobank","volume":"11","author":"LINC Consortium","year":"2025","journal-title":"BJPsych Open"},{"issue":"9836","key":"pmed.1004844.ref023","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study","volume":"380","author":"K Barnett","year":"2012","journal-title":"Lancet"},{"issue":"1","key":"pmed.1004844.ref024","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1038\/s43856-025-00742-9","article-title":"Multiple long-term conditions as the next transition in the global diabetes epidemic","volume":"5","author":"EW Gregg","year":"2025","journal-title":"Commun Med (Lond)"},{"issue":"1","key":"pmed.1004844.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003514","article-title":"Multimorbidity combinations, costs of hospital care and potentially preventable emergency admissions in England: A cohort study","volume":"18","author":"J Stokes","year":"2021","journal-title":"PLoS Med"},{"issue":"1","key":"pmed.1004844.ref026","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1186\/s12913-023-09894-7","article-title":"Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review","volume":"23","author":"A Rohwer","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"10141","key":"pmed.1004844.ref027","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S0140-6736(18)31308-4","article-title":"Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach","volume":"392","author":"C Salisbury","year":"2018","journal-title":"Lancet"},{"issue":"1","key":"pmed.1004844.ref028","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1093\/ije\/dyz174","article-title":"Cohort Profile: East London Genes & Health (ELGH), a community-based population genomics and health study in British Bangladeshi and British Pakistani people","volume":"49","author":"S Finer","year":"2020","journal-title":"Int J Epidemiol"},{"key":"pmed.1004844.ref029","unstructured":"UCL Partners. Discovery East London - linking data to improve healthcare; 2019 [updated 2019\/11\/15]. Available from: https:\/\/uclpartners.com\/impact-story\/discovery-east-london-linking-data-to-improve-healthcare\/"},{"key":"pmed.1004844.ref030","unstructured":"Eto F, Samuel M, Finer S. MULTIPLY-Initiative: clinical codelists Version 1.1: Zenodo; 2023 [updated 2023\/2] v1.1:Available from: https:\/\/zenodo.org\/records\/7643566"},{"issue":"10","key":"pmed.1004844.ref031","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1038\/ng.3656","article-title":"Next-generation genotype imputation service and methods","volume":"48","author":"S Das","year":"2016","journal-title":"Nat Genet"},{"issue":"7845","key":"pmed.1004844.ref032","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1038\/s41586-021-03205-y","article-title":"Sequencing of 53,831 diverse genomes from the NHLBI TOPMed Program","volume":"590","author":"D Taliun","year":"2021","journal-title":"Nature"},{"issue":"4","key":"pmed.1004844.ref033","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1093\/ije\/dyx015","article-title":"Data Resource profile: hospital episode statistics admitted patient care (HES APC)","volume":"46","author":"A Herbert","year":"2017","journal-title":"Int J Epidemiol"},{"issue":"7","key":"pmed.1004844.ref034","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/pds.1115","article-title":"The relationship between time since registration and measured incidence rates in the General Practice Research Database","volume":"14","author":"JD Lewis","year":"2005","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"pmed.1004844.ref035","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/1471-2288-13-32","article-title":"Misclassification of incident conditions using claims data: impact of varying the period used to exclude pre-existing disease","volume":"13","author":"RI Griffiths","year":"2013","journal-title":"BMC Med Res Methodol"},{"issue":"3","key":"pmed.1004844.ref036","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1093\/aje\/kwx281","article-title":"When to Censor","volume":"187","author":"C Lesko","year":"2017","journal-title":"Am. J. Epidemiol"},{"key":"pmed.1004844.ref037","unstructured":"Lifespan Multimorbidity Research Collaborative (LINC); 2025. Available from: https:\/\/www.cardiff.ac.uk\/lifespan-multimorbidity-research-collaborative"},{"issue":"1","key":"pmed.1004844.ref038","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1186\/s12874-021-01440-5","article-title":"Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review","volume":"21","author":"E Bosco","year":"2021","journal-title":"BMC Med Res Methodol"},{"issue":"25","key":"pmed.1004844.ref039","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1016\/j.jacc.2022.11.005","article-title":"The global burden of cardiovascular diseases and risk: a compass for future health","volume":"80","author":"M Vaduganathan","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"pmed.1004844.ref040","volume-title":"User guide to mortality statistics","author":"Office of National Statistics","year":"2025"},{"key":"pmed.1004844.ref041","volume-title":"The English Indices of Deprivation 2019","author":"Office of National Statistics","year":"2019"},{"key":"pmed.1004844.ref042","unstructured":"Smoking - clear (SNOMED). 2020. Available from: https:\/\/www.opencodelists.org\/codelist\/opensafely\/smoking-clear-snomed\/2020-04-29\/#full-list"},{"issue":"9","key":"pmed.1004844.ref043","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1038\/s41596-020-0353-1","article-title":"Tutorial: a guide to performing polygenic risk score analyses","volume":"15","author":"SW Choi","year":"2020","journal-title":"Nat Protoc"},{"key":"pmed.1004844.ref044","article-title":"Combining polygenic risk scores to understand genetic liability to physical-mental health multimorbidity in UK Biobank","author":"D Stow","year":"2026","journal-title":"Human Molecular Genetics"},{"issue":"7726","key":"pmed.1004844.ref045","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/s41586-018-0579-z","article-title":"The UK Biobank resource with deep phenotyping and genomic data","volume":"562","author":"C Bycroft","year":"2018","journal-title":"Nature"},{"issue":"1","key":"pmed.1004844.ref046","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1038\/s41467-019-09718-5","article-title":"Polygenic prediction via Bayesian regression and continuous shrinkage priors","volume":"10","author":"T Ge","year":"2019","journal-title":"Nat Commun"},{"issue":"4","key":"pmed.1004844.ref047","doi-asserted-by":"crossref","first-page":"100523","DOI":"10.1016\/j.xgen.2024.100523","article-title":"Integrative polygenic risk score improves the prediction accuracy of complex traits and diseases","volume":"4","author":"B Truong","year":"2024","journal-title":"Cell Genom"},{"issue":"3","key":"pmed.1004844.ref048","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1086\/519795","article-title":"PLINK: a tool set for whole-genome association and population-based linkage analyses","volume":"81","author":"S Purcell","year":"2007","journal-title":"Am J Hum Genet"},{"issue":"11","key":"pmed.1004844.ref049","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1002\/sim.2712","article-title":"Tutorial in biostatistics: competing risks and multi-state models","volume":"26","author":"H Putter","year":"2007","journal-title":"Stat Med"},{"key":"pmed.1004844.ref050","doi-asserted-by":"crossref","DOI":"10.18637\/jss.v070.i08","article-title":"flexsurv: a platform for parametric survival modeling in R","volume":"70","author":"CH Jackson","year":"2016","journal-title":"J Stat Softw"},{"issue":"15","key":"pmed.1004844.ref051","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1002\/sim.1203","article-title":"Flexible parametric proportional-hazards and proportional-odds models for censored survival data, with application to prognostic modelling and estimation of treatment effects","volume":"21","author":"P Royston","year":"2002","journal-title":"Stat Med"},{"key":"pmed.1004844.ref052","unstructured":"National Health Service. NHS Health Check. 2025. Available from: https:\/\/www.nhs.uk\/tests-and-treatments\/nhs-health-check\/"},{"issue":"8","key":"pmed.1004844.ref053","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1023\/B:EJEP.0000036568.02655.f8","article-title":"Loss to follow-up in cohort studies: how much is too much?","volume":"19","author":"V Kristman","year":"2004","journal-title":"Eur J Epidemiol"},{"issue":"1","key":"pmed.1004844.ref054","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1038\/s41467-025-67372-6","article-title":"A systematic review and meta-analysis of disease clusters in multimorbidity","volume":"17","author":"JK Ferris","year":"2025","journal-title":"Nat Commun"},{"issue":"12","key":"pmed.1004844.ref055","doi-asserted-by":"crossref","first-page":"107710","DOI":"10.1016\/j.jdiacomp.2020.107710","article-title":"Depression and cardiovascular disease events among patients with type 2 diabetes: a systematic review and meta-analysis with bias analysis","volume":"34","author":"K Inoue","year":"2020","journal-title":"J Diabetes Complications"},{"issue":"3","key":"pmed.1004844.ref056","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jdiacomp.2018.12.001","article-title":"Depressive symptom dimensions and medication non-adherence in suboptimally controlled type 2 diabetes","volume":"33","author":"CJ Hoogendoorn","year":"2019","journal-title":"J Diabetes Complications"},{"key":"pmed.1004844.ref057","volume-title":"Clinical knowledge summaries: diabetes - type 2: scenario: management - adults","author":"National Institute for Clinical Excellence","year":"2025"},{"issue":"7","key":"pmed.1004844.ref058","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.2337\/dci20-0023","article-title":"Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association","volume":"43","author":"MA Powers","year":"2020","journal-title":"Diabetes Care"},{"issue":"1","key":"pmed.1004844.ref059","doi-asserted-by":"crossref","first-page":"00130","DOI":"10.1183\/23120541.00130-2016","article-title":"Is individual smoking behaviour influenced by area-level ethnic density? A cross-sectional electronic health database study of inner south-east London","volume":"3","author":"R Mathur","year":"2017","journal-title":"ERJ Open Res"},{"issue":"1","key":"pmed.1004844.ref060","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1186\/s12889-024-19457-y","article-title":"Association of cigarette smoking, smoking cessation with the risk of cardiometabolic multimorbidity in the UK Biobank","volume":"24","author":"S Zhang","year":"2024","journal-title":"BMC Public Health"},{"key":"pmed.1004844.ref061","doi-asserted-by":"crossref","first-page":"105530","DOI":"10.1016\/j.ebiom.2024.105530","article-title":"Shared genetic architecture and bidirectional clinical risks within the psycho-metabolic nexus","volume":"111","author":"X Guo","year":"2025","journal-title":"EBioMedicine"},{"key":"pmed.1004844.ref062","doi-asserted-by":"crossref","first-page":"105584","DOI":"10.1016\/j.ebiom.2025.105584","article-title":"A systematic analysis of the contribution of genetics to multimorbidity and comparisons with primary care data","volume":"113","author":"O Murrin","year":"2025","journal-title":"EBioMedicine"},{"issue":"1","key":"pmed.1004844.ref063","doi-asserted-by":"crossref","first-page":"2451","DOI":"10.1038\/s41467-024-46686-x","article-title":"Elevated blood remnant cholesterol and triglycerides are causally related to the risks of cardiometabolic multimorbidity","volume":"15","author":"Y Zhao","year":"2024","journal-title":"Nat Commun"},{"issue":"4","key":"pmed.1004844.ref064","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1017\/S0033291723002349","article-title":"Temporal patterns in the recorded annual incidence of common mental disorders over two decades in the United Kingdom: a primary care cohort study","volume":"54","author":"J Dykxhoorn","year":"2024","journal-title":"Psychol Med"},{"issue":"3","key":"pmed.1004844.ref065","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/13674676.2013.785710","article-title":"Cultural and age differences in beliefs about depression: British Bangladeshis vs. British Whites","volume":"17","author":"A McClelland","year":"2014","journal-title":"Ment Health Relig Cult"},{"issue":"716","key":"pmed.1004844.ref066","doi-asserted-by":"crossref","DOI":"10.3399\/bjgp.2021.0345","article-title":"Emotional distress, anxiety, and depression in South Asians with long-term conditions: a qualitative systematic review","volume":"72","author":"H Awan","year":"2022","journal-title":"Br J Gen Pract"},{"issue":"1","key":"pmed.1004844.ref067","doi-asserted-by":"crossref","first-page":"7280","DOI":"10.1038\/s41598-022-11310-9","article-title":"Multimorbidity is associated with the income, education, employment and health domains of area-level deprivation in adult residents in the UK","volume":"12","author":"G Knies","year":"2022","journal-title":"Sci Rep"},{"issue":"1","key":"pmed.1004844.ref068","doi-asserted-by":"crossref","first-page":"26987","DOI":"10.1038\/s41598-024-77886-6","article-title":"Joint association of air pollutants on cardiometabolic multimorbidity","volume":"14","author":"L Xia","year":"2024","journal-title":"Sci Rep"},{"issue":"6","key":"pmed.1004844.ref069","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s00125-017-4518-6","article-title":"Promises and pitfalls of electronic health record analysis","volume":"61","author":"R Farmer","year":"2018","journal-title":"Diabetologia"},{"issue":"4","key":"pmed.1004844.ref070","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-004958","article-title":"Smoker, ex-smoker or non-smoker? The validity of routinely recorded smoking status in UK primary care: a cross-sectional study","volume":"4","author":"L Marston","year":"2014","journal-title":"BMJ Open"},{"issue":"11","key":"pmed.1004844.ref071","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-031537","article-title":"Completeness and validity of alcohol recording in general practice within the UK: a cross-sectional study","volume":"9","author":"K Mansfield","year":"2019","journal-title":"BMJ Open"},{"issue":"2","key":"pmed.1004844.ref072","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034542","article-title":"The extent to which family physicians record their patients\u2019 exercise in medical records: a scoping review","volume":"10","author":"C Lindeman","year":"2020","journal-title":"BMJ Open"},{"issue":"2","key":"pmed.1004844.ref073","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1111\/1467-985X.00586","article-title":"Deprivation, ill-health and the ecological fallacy","volume":"165","author":"G Lancaster","year":"2002","journal-title":"J R Stat Soc Ser A Stat Soc"},{"issue":"3","key":"pmed.1004844.ref074","doi-asserted-by":"crossref","DOI":"10.1093\/ije\/dyae054","article-title":"Reweighting UK Biobank corrects for pervasive selection bias due to volunteering","volume":"53","author":"S van Alten","year":"2024","journal-title":"Int J Epidemiol"},{"issue":"9","key":"pmed.1004844.ref075","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.2337\/dc22-2373","article-title":"Bidirectional mendelian randomization and multiphenotype GWAS show causality and shared pathophysiology between depression and type 2 diabetes","volume":"46","author":"JG Maina","year":"2023","journal-title":"Diabetes Care"},{"issue":"5","key":"pmed.1004844.ref076","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003981","article-title":"Integrating polygenic risk scores in the prediction of type 2 diabetes risk and subtypes in British Pakistanis and Bangladeshis: a population-based cohort study","volume":"19","author":"S Hodgson","year":"2022","journal-title":"PLoS Med"},{"issue":"6","key":"pmed.1004844.ref077","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgen.1010508","article-title":"A multivariate genome-wide association study of psycho-cardiometabolic multimorbidity","volume":"19","author":"V Baltramonaityte","year":"2023","journal-title":"PLoS Genet"},{"issue":"8","key":"pmed.1004844.ref078","doi-asserted-by":"crossref","DOI":"10.1002\/alz.70546","article-title":"Multimorbidity in dementia: current perspectives and future challenges","volume":"21","author":"LE Stirland","year":"2025","journal-title":"Alzheimers Dement"},{"issue":"9","key":"pmed.1004844.ref079","first-page":"4346","article-title":"Multimorbidity in people living with and beyond cancer: a scoping review","volume":"13","author":"TA Ahmad","year":"2023","journal-title":"Am J Cancer Res"},{"issue":"3","key":"pmed.1004844.ref080","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1038\/s41591-024-03438-0","article-title":"Our Future Health: a unique global resource for discovery and translational research","volume":"31","author":"MB Cook","year":"2025","journal-title":"Nat Med"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004844","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T17:26:46Z","timestamp":1783618006000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004844"}},"subtitle":[],"editor":[{"given":"Stefan","family":"Stender","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":80,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004844","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}