Childhood Health and Educational Inequalities as Determinants of Adult Multimorbidity in the Global South: A Need for Life-Course Approach
1
Public Health, ICMR-Regional Medical Researh Centre, Bhubaneswar, India
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Multimorbidity is an escalating public health challenge in low- and middle-income countries (LMICs), threatening the equity and sustainability of already constrained health systems.¹ Life-course epidemiology suggests that health and social disadvantages experienced in childhood may become biologically embedded, shaping health trajectories across borders and generations.² However, evidence from the Global South on how early-life disadvantage influences adult multimorbidity remains limited.³ This study examined the association between childhood health and social disadvantages and adult multimorbidity in two LMICs, India and Brazil.
METHODS:
We conducted a secondary analysis of nationally representative data on adults aged ≥50 years from the Longitudinal Ageing Study in India (2017–2018; n=51,481) and the Brazilian Longitudinal Study of Ageing (2015–2016; n=8,730). Weighted prevalence estimates with 95% confidence intervals were calculated. Associations between childhood disadvantages and adult multimorbidity were assessed using generalized linear models with a log link, reporting adjusted prevalence ratios (APR).
RESULTS:
The prevalence of multimorbidity was 25.5% in India and 55.2% in Brazil. Across both countries, individuals reporting poor self-rated childhood health or prolonged school absence due to illness experienced substantially higher levels of multimorbidity in later life. After adjusting for age and gender, poor childhood health was significantly associated with adult multimorbidity in India (APR: 1.38; 95% CI: 1.16–1.65) and Brazil (APR: 1.19; 95% CI: 1.09–1.30). Missing school for one month or longer due to illness was also strongly associated with multimorbidity in India (APR: 1.73; 95% CI: 1.49–2.01) and Brazil (APR: 1.16; 95% CI: 1.08–1.25).
CONCLUSIONS:
Childhood health, educational, and social disadvantages are strongly associated with adult multimorbidity in diverse Global South contexts, highlighting persistent life-course health inequities. Addressing early-life disadvantage is essential for inclusive, equitable, and sustainable strategies to prevent multimorbidity and reduce long-term strain on health systems in LMICs.
Multimorbidity is an escalating public health challenge in low- and middle-income countries (LMICs), threatening the equity and sustainability of already constrained health systems.¹ Life-course epidemiology suggests that health and social disadvantages experienced in childhood may become biologically embedded, shaping health trajectories across borders and generations.² However, evidence from the Global South on how early-life disadvantage influences adult multimorbidity remains limited.³ This study examined the association between childhood health and social disadvantages and adult multimorbidity in two LMICs, India and Brazil.
METHODS:
We conducted a secondary analysis of nationally representative data on adults aged ≥50 years from the Longitudinal Ageing Study in India (2017–2018; n=51,481) and the Brazilian Longitudinal Study of Ageing (2015–2016; n=8,730). Weighted prevalence estimates with 95% confidence intervals were calculated. Associations between childhood disadvantages and adult multimorbidity were assessed using generalized linear models with a log link, reporting adjusted prevalence ratios (APR).
RESULTS:
The prevalence of multimorbidity was 25.5% in India and 55.2% in Brazil. Across both countries, individuals reporting poor self-rated childhood health or prolonged school absence due to illness experienced substantially higher levels of multimorbidity in later life. After adjusting for age and gender, poor childhood health was significantly associated with adult multimorbidity in India (APR: 1.38; 95% CI: 1.16–1.65) and Brazil (APR: 1.19; 95% CI: 1.09–1.30). Missing school for one month or longer due to illness was also strongly associated with multimorbidity in India (APR: 1.73; 95% CI: 1.49–2.01) and Brazil (APR: 1.16; 95% CI: 1.08–1.25).
CONCLUSIONS:
Childhood health, educational, and social disadvantages are strongly associated with adult multimorbidity in diverse Global South contexts, highlighting persistent life-course health inequities. Addressing early-life disadvantage is essential for inclusive, equitable, and sustainable strategies to prevent multimorbidity and reduce long-term strain on health systems in LMICs.
| eISSN: | 2654-1459 |
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