The Relationship Between Sleep duration, Physical Activity and Incidence of Multimorbidity: A Prospective Study of UK Biobank

The Relationship Between Sleep duration, Physical Activity and Incidence of Multimorbidity: A Prospective Study of UK Biobank | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship Between Sleep duration, Physical Activity and Incidence of Multimorbidity: A Prospective Study of UK Biobank Ya Peng, Tingting Jin, Changping Li, Jiayu Wang, Lianqin Chen, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6621017/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: The prevention of multimorbidity epidemics has emerged as a significant challenge in both clinical and public health domains worldwide. This study aimed to comprehensively investigate the complex relationships between sleep duration, physical activity (PA), and the incidence of multimorbidity, with the objective of providing evidence-based behavioral recommendations for clinical practice. Patients and methods: A total of 178,933 participants from the UK Biobank, who were free from 17 diseases at the baseline, were enrolled. Sleep duration and PA levels were self-reported. Multimorbidity was defined as the presence of two or more diseases. Both the Cox risk regression model and the isochronous substitution model were employed for analysis. Results: Over a mean follow-up period of 14.578 years, 7,318 individuals developed multimorbidity. The findings revealed that short sleep (<7 hours) and low levels of PA were significantly linked to an elevated risk of multimorbidity. Notably, the combinations of “short sleep-low PA” and “short sleep-high PA” carried a higher risk compared to “good sleep-moderate PA”. Subgroup analysis and sensitivity analysis confirmed the initial findings.No significant results were observed in the isochronous substitution model. Conclusion: Ensuring a sleep duration of 7 to 8 hours is optimal for minimizing the risk of multimorbidity. Individuals with poor sleep patterns are advised to adjust their sleep duration to 7-8 hours to decrease the likelihood of multimorbidity and enhance their long-term quality of life. Sleep duration Physical activity Multimorbidity UK Biobank Figures Figure 1 Figure 2 Figure 3 Introduction Multimorbidity is defined as the coexistence of two or more chronic diseases within an individual 1 . In comparison to a single chronic disease, multimorbidity is associated with a greater number of outpatient visits, longer hospital stays, higher medical costs, an increased likelihood of mental disorders, a reduced quality of life, and an elevated risk of death 2 – 8 . Consequently, preventing the epidemic of multimorbidity has emerged as a major clinical and public health challenge on a global scale. As of now, numerous studies worldwide have examined the relationship between physical activity(PA) and multimorbidity. The vast majority of these studies have found that good PA reduces the incidence of multimorbidity 9 – 17 and can prolong life 18 . However, the results are not consistent. For example, in two studies conducted on the UK population.A longitudinal study found that compared with the inactive group, the moderate PA group had a 39% lower likelihood of having multimorbidity 18 . In contrast, another study showed that inactivity was not identified as a significant risk factor for transitioning from one disease to multimorbidity 19 . Multiple studies on the connection between sleep and diseases have demonstrated that obtaining good sleep is crucial for maintaining overall health and preventing the development of many chronic diseases. Studies conducted in Portugal 20 , China 21 – 24 , Germany 25 , Brazil 26 , Canada 27 , Luxembourg 28 , and the United Kingdom 29 have observed an association between insufficient sleep duration and an increased risk of multimorbidity. However, the majority of these studies are cross-sectional in nature 20 , 22 – 28 , while the other two are cohort studies 21 , 29 . However, as of now, only a limited number of studies have delved into the relationship between "sleep duration-PA" and multimorbidity. We have discovered that a study from NHANSE found that healthy sleep duration (7–8 hours) in combination with PA (≥ 150 minutes per week of moderate-to-vigorous PA [MVPA]) was associated with a 17% lower risk of multimorbidity 30 . Another study from China found that in women, PA can modify the connection between poor sleep and multimorbidity 21 . However, in this study, long sleep (> 9 hours) and short sleep (< 7 hours) were not examined separately. Therefore, to strengthen the evidence, we will continue to explore the relationship between sleep and PA and multimorbidity through the UK Biobank database. Considering the possible behavioral differences based on gender 31 , age, and BMI 32 , this study will conduct subgroup analyses by gender, age, and BMI. Material and methods This study utilized the resources of the UK Biobank. The UK Biobank is a prospective study designed to enhance the prevention, diagnosis, and treatment of chronic diseases in individuals aged 38 to 73 years. It recruited participants from 22 sites across the United Kingdom. The study encompassed 502,400 participants who had their baseline measurements collected between 2006 and 2010 33 . The data was linked to hospital and mortality records. Prior to data collection, participants provided written informed consent and the study received ethical approval from the Northwest Research Ethics Committee 34 . Participants without self-reported sleep duration and PA (PA) data from the baseline assessment (n = 100,870) and those without covariate information (n = 188,634) were excluded. Additionally, at baseline, participants with any of the 17 diseases were also excluded (n = 33,963). In total, 178,933 participants remained for analysis(Fig. 1 ). 2.1 Ethics Approval The UK Biobank is approved by the North West Multi-Centre Research Ethics Committee (ref. 11/NW/0382). The research programme is available online. The work was carried out under UK Biobank Application number 7155. Meanwhile, in compliance with the relevant national policies of the People's Republic of China, this research has been exempted from full review by our local ethics committee. 2.2 Multimorbidity Definition For the purposes of this study, multimorbidity was defined as the presence of two or more chronic diseases. The 17 chronic diseases included in the Charlson Comorbidity Index (CCI) are all defined according to the International Classification of Diseases, 10th Revision (ICD-10). These 17 chronic diseases are used in this study, and individuals who develop two or more of these chronic diseases will be identified as having multimorbidity. The 17 chronic diseases are all diagnosed in the hospital by self-report and include: myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, connective tissue disease, peptic ulcer disease, diabetes, chronic obstructive pulmonary disease, hemiplegia, chronic kidney disease, solid tumors, leukemia, lymphoma, moderate to severe liver disease, malignant tumors, and AIDS. In the CCI scoring system: 1 point is assigned to myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, connective tissue disease, peptic ulcer disease, diabetes without any complications, and chronic obstructive pulmonary disease. 2 points are given to hemiplegia, diabetes with complications of end-organ damage such as hands and feet, chronic kidney disease, solid tumor, leukemia, and lymphoma. 3 points are for moderate and severe liver disease. 6 points are for malignant tumor and AIDS. According to the score of each disease, the participants' CCI score was calculated. Relevant studies have shown that the higher the CCI score, the worse the prognosis of patients and the higher the mortality 35 . We grouped the participants into three categories based on their CCI scores as secondary outcomes: low risk, medium risk, and high risk. Specifically, a CCI score of 1–2 points is classified as low risk; a CCI score of 3–4 points is considered medium risk; and a CCI score of 5 points or more is defined as high risk 41 . 2.3 Sleep duration Participants were requested to report their average nightly actual sleep duration during the past month. In this study, sleep duration excluded naps. The response choices ranged from 0 to 24 hours. We defined individuals who slept for 7 to 8 hours as having "healthy sleep", those who slept less than 7 hours as having "short sleep", and those who slept more than 8 hours as having "long sleep". 2.4 Physical Activity PA levels were measured by using the revised International PA Questionnaire (IPAQ). The questionnaire has been validated in 12 countries 36 , as determined by the frequency and duration of different intensities of PA. Participants were asked to answer seven questions and recall how they engaged in vigorous, moderate, and light physical activities for at least 10 minutes at a time during a typical week. If they participated in any vigorous, moderate, and light physical activities, each lasting at least 10 minutes, they were further asked to report the frequency and duration. For example, "On how many days in a typical week do you engage in at least 10 minutes of vigorous exercise?" The response time ranges from 1 to 7 days. Also, for the question "On those days, how much time do you usually spend on vigorous physical exercise?" The response options are < 30 minutes, 30 minutes to 2 hours, 2 hours to 4 hours, and ≥ 4 hours. In addition, participants were asked to recall the time they spent walking in a typical week. This includes walking at work and at home, walking from place to place, and any other walks they may take for fun, sport, exercise, or leisure, as well as any other activities. According to the IPAQ protocol, participants were then divided into low, moderate, and high groups based on the metabolic equivalent (MET) minutes per week of moderate to vigorous PA. "High level" is defined as at least 30 minutes of vigorous activity per day for at least 3 days. "Moderate" meets one of the following criteria: (1) at least 20 minutes of vigorous exercise per day for three or more days; (2) at least 30 minutes of moderate-intensity exercise and/or walking per day for 5 days or more; (3) 5 or more days of walking, with any combination of moderate-intensity or vigorous-intensity exercise, achieving at least 600 MET-minutes/week of total PA. Those not meeting the above criteria are considered to have low level PA 37 . 2.5 Covariates Sociodemographic Characteristics: Age was determined through the date of birth. Ethnicity was self-reported as white, black, or other ethnic backgrounds. Employment status was self-reported as unemployment, employed without pay, or employed with pay. Income level was rated as less than £180,000, between £180,000 and £1 million, or more than £1 million based on self-reported annual salary. Education degree was self-reported based on the highest level of qualifications and divided into secondary, high school, university, and above levels. Lifestyle Behaviors: Smoking status was self-reported and classified into never-smokers, former smokers, and current smokers. Drinking status was self-reported among never-drinkers, former drinkers, and current drinkers. Dietary intakes of fruits and vegetables, red meat, processed meat, and oily fish were based on a self-completed food frequency questionnaire at baseline. A healthy diet score of 1 point was given for each of the following characteristics on a scale of 0–5: (1) at least 4 tablespoons of vegetables per day (median); (2) consume at least three pieces of fruit per day (median); (3) eat fish at least twice a week (median); have no more than two servings of unprocessed red meat per week (median); and have an intake of processed meat no more than twice a week (median) 38 , 39 . Health-Related Factors: Height and weight were measured by a trained nurse at baseline assessment. Body mass index (BMI) is calculated by dividing weight in kilograms by the square of height in meters. Participants were classified as underweight (BMI < 18.5 kg/m²), normal (18.5 to 24.9 kg/m²), overweight (25.0 to 29.9 kg/m²), or obese (≥ 30.0 kg/m²) according to WHO criteria. High blood pressure is determined by a physician self-reporting the diagnosis, using blood pressure medications, or measuring systolic blood pressure ≥ 140 mmHg. Fasting blood glucose, glycated hemoglobin, triglycerides, cholesterol, high-density lipoprotein, low-density lipoprotein, and uric acid levels were all measured from blood samples taken when the participants were enrolled. 2.6 Statistical Analysis Continuous variables are presented as mean with standard deviation, while categorical variables are presented as frequencies with percentages. The exposure factors we studied are divided into the following three types: (1) Sleep duration. According to the self-reported average sleep duration per night, participants are classified into short sleep (less than 7 hours), good sleep (7–8 hours), and long sleep (more than 8 hours). (2) Based on the length and intensity of weekly PA assessed by the International PA Questionnaire (IPAQ), PA level is divided into low, moderate, and high levels. (3) Nine combination patterns are formed by combining sleep duration and PA level: good sleep + moderate PA level, good sleep + low PA level, good sleep + high PA level, short sleep + low PA level, short sleep + moderate PA level, short sleep + high PA level, long sleep + low PA level, long sleep + moderate PA level, and long sleep + high PA level. The relationship between sleep duration, PA, and the incidence of multimorbidity is analyzed in different models using the Cox proportional hazards method. The proportional hazards assumption is verified by Schoenfeld residuals. The analysis is first unadjusted (with age as the time scale; Model 1), then adjusted for sociodemographic measures (Model 2), and finally lifestyle behaviors and health-related factors are added (Model 3). In addition, we conduct subgroup analyses for age, sex, and body mass index (BMI) to determine if there is consistency across population segments and to identify whether PA and sleep timing are more effective in reducing the risk of multimorbidity in certain populations. We also perform a sensitivity analysis, a 2-year landmark analysis, to exclude participants who developed 17 chronic diseases at the 2-year follow-up after baseline to reduce the risk of reverse causality to outcomes at baseline, whether subclinical or preclinical. All analyses are performed using survival packages in Stata 17 and R version 4.0.2. P value less than 0.05 is considered statistically significant. Result 3.1 Baseline characteristics of included participants Table 1 presents the baseline characteristics stratified by sleep duration and total participants. The baseline refers to the participants enrolled from 2006 to 2010. The mean age of these participants is 54.683 (±8.027), and the proportion of female participants (51.2%) is slightly higher than that of male respondents. Most of them have a paid job (68.8%), a college degree or above (81.4%), a white ethnic background (92.7%), and an annual income between £180,000 and £1 million (78.6%). In terms of lifestyle habits, most of them are never-smokers (57.8%), drink alcohol (94.6%), have an ideal dietary pattern (score of 4 or 5) [39] (score of 4: 35.5%), are overweight in BMI (43.3%), have a moderate level of PA (41.7%), and have good sleep (71.7%). Most participants do not have high blood pressure (78.9%). After a median follow-up of 14.578 years, a total of 7,318 individuals developed multimorbidity events, with an incidence of 4.09%. 3.2 The independent association between sleep duration and PA and multimorbidity Table 2 shows the association between sleep duration and PA (PA) independently and the occurrence of multimorbidity. In unadjusted Model 1, the Schoenfeld residual test hypothesis was not passed. In fully adjusted Model 3, taking good sleep duration (7-8 hours) as the reference, those with short sleep duration (8 hours) is 1.199 (95% CI: 1.102-1.304). In fully adjusted Model 3, taking moderate PA as the reference, low PA is associated with the higher risk of multimorbidity(HR = 1.065(1.000-1.134)), and the HR for high PA is 1.059 (1.005-1.115). 3.3 The association between 9 behavioral patterns composed of sleep duration combined with PA and multimorbidity Table 3 shows the association between 9 behavioral patterns composed of sleep duration combined with PA and the incidence of multimorbidity. In unadjusted Model 1, the Schoenfeld residual test hypothesis was not passed. In fully adjusted Model 3, taking the behavioral pattern of good sleep + moderate PA as the reference group, short sleep + low PA is associated with the highest risk of multimorbidity (HR = 1.355 (1.221-1.504)). This is followed by short sleep + high PA (HR = 1.340 (1.233-1.456)), long sleep + medium PA (HR = 1.267 (1.114-1.442)), long sleep + low PA (HR = 1.228 (1.035-1.545)), short sleep + medium PA (HR = 1.211 (1.112-1.318)), and long sleep + high PA (HR = 1.205 (1.048-1.386)). 3.4 The Subgroup and Sensitivity Analyses The subgroup analyses for age, sex, and BMI are conducted in fully adjusted Model 3. The results of the subgroup analysis suggest a consistent relationship (Figure 2). The results of the sensitivity analyses are basically consistent with the main results (Table 4). 3.5 Secondary Outcome Analyses In the independent risk analysis, low PA increased the occurrence of low-risk events (HR = 1.069 (1.024-1.116)), medium-risk events (HR = 1.083 (1.018-1.153)), and high-risk events (HR = 1.096 (1.024-1.172)). Long sleep duration was associated with low-risk events (HR = 1.143 (1.077-1.212)) and medium-risk events (HR = 1.110 (1.018-1.210)), and short sleep duration was associated with low-risk events (HR = 1.129 (1.088-1.172)). In the nine combinations of sleep duration and PA, compared with good sleep + moderate PA, the probability of low-risk events (HR = 1.272 (0.131-1.431))(Figure 3a), medium-risk events (HR = 1.393 (1.181-1.644))(Figure 3b), and high-risk events (HR = 1.353 (1.126-1.626)) (Figure 3c) was the highest in long sleep + low PA . 3.6 Isochronous Substitution Model We utilized the isochronous substitution model to examine whether altering the duration of PA has an impact on the risk of multimorbidity in both short sleep and long sleep groups. In the short sleep group, increasing the time of PA by one hour instead of engaging in other activities except sleep had no statistically significant effect on the occurrence of multimorbidity. There was also no statistical significance in the long sleep duration group (Table 5). For the secondary outcome analysis, although some results were statistically significant, the value was extremely small and equivalent to being negligible in real life, thus having no significant practical significance. For instance, in the long sleep group, an increase of one hour of moderate PA (MPA) would increase the high-risk events of the CCI score by only 0.05% (1.0001, 1.0009), which had no significant impact. Therefore, we think in the analysis of the isochronous substitution model, we can’t conclude that changing the time of PA during poor sleep duration can affect the risk of multimorbidity. Discussion Utilizing data from the UK Biobank, we carried out a prospective cohort study to probe into the relationship between sleep duration, PA (PA), and the development of multiple disorders. The results indicated that both poor sleep duration (less than 7 hours and more than 8 hours) and non-moderate levels of PA were independently associated with the risk of multiple co-morbidities. When analyzing the relationship between the nine "sleep duration + PA" combination patterns and multiple disease co-occurrence, it was discovered that compared with the "good sleep duration - medium level PA" combination, the "short sleep duration - low level PA" combination had the highest risk of multiple disease co-occurrence (HR = 1.355 (1.221–1.504)). This was followed by combinations such as "short sleep duration - high PA" (HR = 1.340 (1.233–1.456)). This implies that insufficient sleep duration has a more significant impact on the co-occurrence risk of multimorbidity, and the change of PA level under different sleep durations has a varying impact on the risk. First, the findings of this study reinforce the evidence that compared to 7–8 hours of sleep, short and long sleep durations were independently and significantly related to an increased risk of multimorbidity. A prospective UK study based on Whitehall II data found that patients with short sleep (less than 7 hours) had a higher risk of developing multiple conditions 29 . This study extends these observations to a larger sample of UK adults and confirms that sleep duration is crucial for the prevention of multimorbidity. This discovery is in line with the findings of Portugal 20 , China 21 – 24 , Germany 25 , Brazil 26 , Canada 27 , and Luxembourg 28 . These results suggest that sleeping less than the recommended 7h per day is detrimental to health. At the same time, our study also found that a long sleep duration (more than 8 hours) is associated with an increased risk of multiple medical conditions, complementing previous research. Secondly, our results demonstrated that both low and high PA increased the risk of multimorbidity compared with moderate PA. In the Finnish population 15 , 44 , the UK cohort study 12 , 18 , 42 , the Chinese cohort study 21 , and the Australian Longitudinal Study of Women's Health 10 , 14 , an increased incidence of multimorbidity was observed in the low PA group. A cohort study of 357,554 participants in the United Kingdom showed that moderate-to-vigorous PA (MVPA) can reduce the risk of first cardio-renal metabolic disease 43 . Our study also found an association between low PA and multimorbidity consistent with the above studies. Our study found that high PA increases the risk of multiple conditions. However, a longitudinal study in Finland found that high PA can reduce the prevalence of diabetes, hypertension, high cholesterol, and osteoporosis 44 . Nevertheless, the Finnish study did not show an observed relationship between high PA and multiple disorders, and more studies are needed to confirm this. In the combined analysis of sleep duration and PA, we are consistent with the conclusions of the NHANES study, which found that poor sleep and low levels of PA increase the risk of multimorbidity. Nevertheless, the NHANES study has several limitations. Firstly, only 2048 participants were included, which makes the sample size rather small. Secondly, it was a cross-sectional study and lacked follow-up. In this study, these limitations are made up, which makes the result more convincing. However, we have not concluded that PA can change the relationship between sleep duration and the incidence of multimorbidity in prospective studies in China 21 . We postulate that there exist two potential reasons accounting for the discrepancy in results. Firstly, it might be associated with factors such as behavioral disparities and racial variations among individuals from different countries. Secondly, in the Chinese study, the sleep time was categorized into healthy and poor sleep time, without separately discussing short sleep ( 9h). Therefore, further research needs to be confirmed by multi-center, multi-country, and multi-ethnic comparative studies. In addition, our study also found through the isochronous substitution model that in short sleep and long sleep groups, by reducing the time of other activities by one hour and increasing the time of PA by one hour, the occurrence of multimorbidity could not be significantly reduced. This has not been studied before and needs to be further confirmed by more studies in the future. This study has some limitations. First, sleep duration, PA, and illness were all based on participants' self-reports. Therefore, if the participant has not yet been in contact with the health care system to obtain a diagnosis, or the participant may not have reported a chronic illness, the incidence of the disease may be underestimated. Regarding the use of self-reported PA 45 , it was found that the International PA Questionnaire (IPAQ) measures generally overestimated PA compared to objective measures. Therefore, the effect of PA on chronic disease may have been underestimated in this analysis. With regard to the use of self-reported sleep duration, there is the possibility of recall bias and subjective judgment differences. Second, the study samples were mainly from the UK Biobank, and the participants were mostly middle- and high-income people and white people. There was a lack of studies on other races and people from low- and middle-income countries, which may limit the universality and representativeness of the research results. In addition, this study only discussed sleep duration and did not deeply study the influence of other sleep-related factors such as sleep quality and sleep rhythm on the co-occurrence of multimorbidity. Future studies can further expand on this content. This study further confirmed the important role of sleep duration and PA in the incidence of multimorbidity and provided a basis for the prevention of incidence of multimorbidity. It is recommended that people ensure 7–8 hours of sleep. When the sleep time is insufficient or too long, it should be adjusted according to one's own situation. At the same time, when sleep is insufficient, one should try to maintain a moderate level of PA and avoid excessive PA. When sleeping too long, a higher level of PA should be ensured to reduce the risk of incidence of multimorbidity and improve the quality of life and health level. Future research could address the limitations of this study to gain a deeper understanding of the complex relationship between sleep, PA, and the incidence of multimorbidity. Conclusion Getting 7–8 hours of sleep is the first choice to reduce the risk of multiple conditions. If the sleep duration is insufficient and the sleep duration is too long, the sleep duration should be adjusted according to the own situation to ensure 7–8 hours, reduce the incidence of multimorbidity, improve the long-term quality and level of life, and improve the prognosis. If sleep duration cannot be guaranteed, sleep duration is insufficient, it is recommended to ensure that the PA is mainly at a moderate level, while avoiding excessive PA; When sleeping for too long, it is recommended to ensure that PA is mainly at a high level. Declarations Acknowledgments The authors thank the staff and participants of the study for their indispensable contributions. Funding This study was funded by First Level Leading Talent Project of "123 Climbing Plan" for Clinical Talents of Tianjin Medical University; "Tianjin Medical Talents" project, the second batch of high-level talents selection project in health industry in Tianjin [no.TJSJMYXYC-D2-014]; Key Project of Natural Science Foundation of Tianjin [no.22JCZDJC00590]; Tianjin Key Medical Discipline (Specialty) Construct Project [No.TJYXZDXK-032A]; Tianjin Science and Technology Major Special Project and Engineering Public Health Science and Technology Major Special Project [No.21ZXGWSY00100]; China International Medical Foundation[No.Z-2017-26-1902-5]. Consent for publication All authors of this paper have read and approved the final version submitted. Author contributions Ya Peng: Conceptualization, Data curation, Formal analysis, Methodology, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. Tingting Jin: Writing - review & editing, Methodology, Investigation. Lianqin Chen: Formal analysis, Data curation. Yanyan Ma: Methodology, Formal analysis. Jiayu Wang: Writing - review & editing. Siyi Zhang: Writing - review & editing. Liuxu Chen: Writing - review & editing. Yue Qi: Writing - review & editing. Weiran Zhao: Writing - review & editing. Yao Lin: Methodology. Changping Li: Methodology. Zhuang Cui: Methodology, Conceptualization. Hongyan Liu: Supervision, Validation, Conceptualization. Pei Yu: Supervision, Re sources, Project administration, Funding acquisition, Conceptualization. Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Data availability The raw data are not available. The data are from the UK Biobank, but there are restrictions on their availability. 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Tables Table 1 Baseline Characteristics Stratified by Sleep Duration and Total short sleep duration(8h) Total participants P Value N=40,028 N=128,350 N=10,555 N=178,933 Age 54.502(7.744) 54.5907(8.069) 56.4881(8.341) 54.683(8.027) <0.001 Sex <0.001 Male 20,588(51.4%) 62,184(48.4%) 4,614(43.7%) 873,86(48.8%) Female 19,440(48.6%) 66,166(51.6%) 5,941(56.3%) 91,547(51.2%) Ethnic <0.001 White 36,467(91.1%) 119,525(93.1%) 9,794(92.8%) 165,786(92.7%) Black 3,136(7.8%) 8,395(6.5%) 720(6.8%) 12,251(6.8%) Others 425(1.1%) 430(0.3%) 41(0.4%) 896(0.5%) Employment <0.001 Unemployment 8,919(22.3%) 32,753(25.5%) 4,885(46.3%) 46,557(26.0%) Employed but no paid 1,697(4.2%) 6,715(5.2%) 849(8.0%) 9,261(5.2%) Employed and paid 29,412(73.5%) 88,882(69.2%) 4,821(45.7%) 123,115(68.8%) Education <0.001 Secondary school 5,350(13.4%) 15,391(12.0%) 1,585(15.0%) 22,326(12.5%) High school 2,437(6.1%) 7,799(6.1%) 652(6.2%) 10,888(6.1%) University and above levels 32,241(80.5%) 105,160(81.9%) 8,318(78.8%) 145,719(81.4%) Income <0.001 Low（100000） 2,754(6.9%) 9,698(7.6%) 410(3.9%) 12,862(7.2%) Smoking <0.001 Never 22,352(55.8%) 75,281(58.7%) 5,847(55.4%) 103,480(57.8%) Current 4,603(11.5%) 11,573(9.0%) 1,126(10.7%) 17,302(9.7%) Previous 13,073(32.7%) 41,496(32.3%) 3,582(33.9%) 58,151(32.5%) Drinking <0.001 Never 1,409(3.5%) 3,479(2.7%) 421(4.0%) 5,309(3.0%) Current 37,398(93.4%) 122,067(95.1%) 9,744(92.3%) 169,209(94.6%) Previous 1,221(3.1%) 2,804(2.2%) 390(3.7%) 4,415(2.5%) Healthy diet score <0.001 0 296(0.7%) 648(0.5%) 64(0.6%) 1,008(0.6%) 1 1,962(4.9%) 5,092(4.0%) 408(3.9%) 7,462(4.2%) 2 4,946(12.4%) 14,256(11.1%) 1,210(11.5%) 20,412(11.4%) 3 8,784(21.9%) 28,741(22.4%) 2,330(22.1%) 39,855(22.3%) 4 13,936(34.8%) 45,955(35.8%) 3,719(35.2%) 63,610(35.5%) 5 10,104(25.2%) 33,658(26.2%) 2,824(26.8%) 46,586(26.0%) BMI <0.001 Underweight(BMI<18.5 kg/m2) 210(0.5%) 626(0.5%) 54(0.5%) 890(0.5%) Normal(18.5-24.9 kg/m2) 12,909(32.2%) 48,315(37.6%) 3,520(33.3%) 64,744(36.2%) Overweight(25.0-29.9 kg/m2) 17,161(42.9%) 55,827(43.5%) 4,571(43.3%) 77,559(43.3%) Obesity(≥30.0 kg/m2) 9,748(24.4%) 23,582(18.4%) 2,410(22.8%) 35,740(20.0%) Physical activity <0.001 Low 7,734(19.3%) 22,301(17.4%) 2,054(19.5%) 32,089(17.9%) Moderate 15,873(39.7%) 54,354 (42.3%) 4,399(41.7%) 74,626(41.7%) High 16,421(41.0%) 51,695(40.3%) 4,102(38.9%) 72,218(40.4%) High blood pressure <0.001 Yes 9,250(23.1%) 25,801(20.1%) 2,684(25.4%) 37,735(21.1%) No 30,778(76.9%) 102,549(79.9%) 7,871(74,6%) 141,198(78.9%) Triglyceride 1.726(1.030) 1.677(0.992) 1.815(1.067) 1.696(1.006) <0.001 Cholesterol 5.774(1.077) 5.766(1,067) 5.818(1.124) 5.771(1.073) <0.001 How-density lipoprotein 1.451(0.379) 1.471(0.376) 1.453(0.377) 1.466(0.377) <0.001 Low-density lipoprotein 3.628(0.826) 3.614(0.820) 3.651(0.860) 3.619(0.824) <0.001 Fasting blood glucose 4.967(0.803) 4.947(0.756) 4.999(0.774) 4.954(0.768) <0.001 Glycated hemoglobin 35.037(0.444) 34.622(0.431) 34.900(4.292) 34.731(4.339) <0.001 Uric acid 312.271(79.357) 305.659(78.961) 307.693(80.677) 307.258(79.198) <0.001 Table 2 Independently Association of Sleep duration , Physical Activity and Incidence of Multimorbidity Model 1:Unadjusted Model (age as timescale) Model 2:Adjusted for sociodemographic variables Model 3:Model 2+behavioral and health-related factor physical activity HR(95%CI) P-Value HR(95%CI) P-Value HR(95%CI) P-Value moderate Ref — Ref — Ref — low 1.131(1.063-1.204) P=0.000 1.226(1.152-1.305) P=0.000 1.065(1.000-1.134) P=0.049 high 1.059(0.975-1.080) P=0.325 1.009(0.958-1.062) P=0.742 1.059(1.005-1.115) P=0.030 sleep duration good(≥7 hours&≤8 hours) Ref — Ref — Ref — short(8 hours) 1.632(1.502-1.774) P=0.000 1.305(1.199-1.419) P=0.000 1.199(1.102-1.304) P=0.000 Table 3 Association between Sleep duration and Physical Activity and the Incidence of Multimorbidity Model 1:Unadjusted Model (age as timescale) Model 2:Adjusted for sociodemographic variables Model 3:Model 2+behavioral and health-related factor sleep duration +physical activity HR(95%CI) P-Value HR(95%CI) P-Value HR(95%CI) P-Value good+moederate Ref — Ref — Ref — good+low 1.091(1.008-1.180) P=0.030 1.182(1.092-1.278) P=0.000 1.057(0.977-1.144) P=0.169 good+high 1.022(0.959-1.088) P=0.510 0.996(0.935-1.062) P=0.911 1.055(0.990-1.124) P=0.099 short+low 1.537(1.386-1.704) P=0.000 1.663(1.500-1.845) P=0.000 1.355(1.221-1.504) P=0.000 short+moderate 1.302(1.196-1.417) P=0.000 1.288(1.182-1.402) P=0.000 1.211(1.112-1.318) P=0.000 short+high 1.377(1.268-1.496) P=0.000 1.361(1.253-1.479) P=0.000 1.340(1.233-1.456) P=0.000 long+low 1.871(1.579-2.217） P=0.010 1.586(1.338-1.880） P=0.019 1.228(1.035-1.545） P=0.019 long+moderate 1.694(1.489-1.926) P=0.000 1.326(1.165-1.509) P=0.000 1.267(1.114-1.442) P=0.000 long+high 1.544(1.344-1.774) P=0.000 1.228(1.068-1.412) P=0.004 1.205(1.048-1.386) P=0.006 Table 3 Sensitivity Analysis in Fully Adjusted Model 3 HR(95%CI) P-Value physical activity moderate Ref — low 1.045(0.973-1.121) P=0.226 high 1.081(1.020-1.145) P=0.008 sleep duration good Ref — short 1.239(1.168-1.315) P=0.000 long 1.202(1.094-1.322) P=0.000 sleep duration+physical activity good+moederate Ref — good+low 1.035(0.947-1.131) P=0.452 good+high 1.094(1.019-1.174) P=0.012 short+low 1.341(1.193-1.508) P=0.000 short+moderate 1.225(1.114-1.346) P=0.000 short+high 1.339(1.221-1.470) P=0.000 long+low 1.263(1.042-1.531) P=0.017 long+moderate 1.268(1.096-1.468) P=0.001 long+high 1.234(1.056-1.442) P=0.008 Additional Declarations No competing interests reported. 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08:48:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111562,"visible":true,"origin":"","legend":"\u003cp\u003eStudy population inclusion and exclusion criteria flow chart\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6621017/v1/054aebe58345288225e2e39c.jpg"},{"id":83030197,"identity":"386bdd0a-6101-4716-b603-3dae5a67e19e","added_by":"auto","created_at":"2025-05-19 08:56:47","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":149978,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analyses for sex(2a), age(2b), and BMI(2c) and sensitivity analysis in fully adjusted Model 3\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6621017/v1/16e0976c488dadfa98f578b6.jpg"},{"id":83028880,"identity":"a85dd387-4291-412f-9763-304540fc5cd5","added_by":"auto","created_at":"2025-05-19 08:48:47","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":102821,"visible":true,"origin":"","legend":"\u003cp\u003eSecondary outcome analyses\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e Figure 3a:CCI score was 1-2 scores;Figure 3b:CCI score was 3-4 scores;Figure 3c:CCI score was ≥5 scores.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6621017/v1/3139cbe3b03630a6d04498cb.jpg"},{"id":90492950,"identity":"cd9783a4-c4bb-4102-ad53-c49c52579fb2","added_by":"auto","created_at":"2025-09-03 10:02:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1410662,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6621017/v1/f135dc4e-6479-4b92-be2c-b61fda89ed0e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship Between Sleep duration, Physical Activity and Incidence of Multimorbidity: A Prospective Study of UK Biobank","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMultimorbidity is defined as the coexistence of two or more chronic diseases within an individual \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In comparison to a single chronic disease, multimorbidity is associated with a greater number of outpatient visits, longer hospital stays, higher medical costs, an increased likelihood of mental disorders, a reduced quality of life, and an elevated risk of death \u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Consequently, preventing the epidemic of multimorbidity has emerged as a major clinical and public health challenge on a global scale.\u003c/p\u003e \u003cp\u003eAs of now, numerous studies worldwide have examined the relationship between physical activity(PA) and multimorbidity. The vast majority of these studies have found that good PA reduces the incidence of multimorbidity \u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and can prolong life \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. However, the results are not consistent. For example, in two studies conducted on the UK population.A longitudinal study found that compared with the inactive group, the moderate PA group had a 39% lower likelihood of having multimorbidity \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In contrast, another study showed that inactivity was not identified as a significant risk factor for transitioning from one disease to multimorbidity \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMultiple studies on the connection between sleep and diseases have demonstrated that obtaining good sleep is crucial for maintaining overall health and preventing the development of many chronic diseases. Studies conducted in Portugal \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, China \u003csup\u003e\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, Germany \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, Brazil \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, Canada \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, Luxembourg \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, and the United Kingdom \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e have observed an association between insufficient sleep duration and an increased risk of multimorbidity. However, the majority of these studies are cross-sectional in nature \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26 CR27\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, while the other two are cohort studies \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, as of now, only a limited number of studies have delved into the relationship between \"sleep duration-PA\" and multimorbidity. We have discovered that a study from NHANSE found that healthy sleep duration (7\u0026ndash;8 hours) in combination with PA (\u0026ge;\u0026thinsp;150 minutes per week of moderate-to-vigorous PA [MVPA]) was associated with a 17% lower risk of multimorbidity \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Another study from China found that in women, PA can modify the connection between poor sleep and multimorbidity\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. However, in this study, long sleep (\u0026gt;\u0026thinsp;9 hours) and short sleep (\u0026lt;\u0026thinsp;7 hours) were not examined separately.\u003c/p\u003e \u003cp\u003eTherefore, to strengthen the evidence, we will continue to explore the relationship between sleep and PA and multimorbidity through the UK Biobank database. Considering the possible behavioral differences based on gender \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, age, and BMI \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, this study will conduct subgroup analyses by gender, age, and BMI.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThis study utilized the resources of the UK Biobank. The UK Biobank is a prospective study designed to enhance the prevention, diagnosis, and treatment of chronic diseases in individuals aged 38 to 73 years. It recruited participants from 22 sites across the United Kingdom. The study encompassed 502,400 participants who had their baseline measurements collected between 2006 and 2010 \u003csup\u003e33\u003c/sup\u003e. The data was linked to hospital and mortality records. Prior to data collection, participants provided written informed consent and the study received ethical approval from the Northwest Research Ethics Committee \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eParticipants without self-reported sleep duration and PA (PA) data from the baseline assessment (n\u0026thinsp;=\u0026thinsp;100,870) and those without covariate information (n\u0026thinsp;=\u0026thinsp;188,634) were excluded. Additionally, at baseline, participants with any of the 17 diseases were also excluded (n\u0026thinsp;=\u0026thinsp;33,963). In total, 178,933 participants remained for analysis(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Ethics Approval\u003c/h2\u003e \u003cp\u003e The UK Biobank is approved by the North West Multi-Centre Research Ethics Committee (ref. 11/NW/0382). The research programme is available online. The work was carried out under UK Biobank Application number 7155.\u003c/p\u003e \u003cp\u003eMeanwhile, in compliance with the relevant national policies of the People's Republic of China, this research has been exempted from full review by our local ethics committee.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Multimorbidity Definition\u003c/h2\u003e \u003cp\u003eFor the purposes of this study, multimorbidity was defined as the presence of two or more chronic diseases. The 17 chronic diseases included in the Charlson Comorbidity Index (CCI) are all defined according to the International Classification of Diseases, 10th Revision (ICD-10). These 17 chronic diseases are used in this study, and individuals who develop two or more of these chronic diseases will be identified as having multimorbidity. The 17 chronic diseases are all diagnosed in the hospital by self-report and include: myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, connective tissue disease, peptic ulcer disease, diabetes, chronic obstructive pulmonary disease, hemiplegia, chronic kidney disease, solid tumors, leukemia, lymphoma, moderate to severe liver disease, malignant tumors, and AIDS.\u003c/p\u003e \u003cp\u003eIn the CCI scoring system:\u003c/p\u003e \u003cp\u003e1 point is assigned to myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, connective tissue disease, peptic ulcer disease, diabetes without any complications, and chronic obstructive pulmonary disease.\u003c/p\u003e \u003cp\u003e2 points are given to hemiplegia, diabetes with complications of end-organ damage such as hands and feet, chronic kidney disease, solid tumor, leukemia, and lymphoma.\u003c/p\u003e \u003cp\u003e3 points are for moderate and severe liver disease.\u003c/p\u003e \u003cp\u003e6 points are for malignant tumor and AIDS.\u003c/p\u003e \u003cp\u003eAccording to the score of each disease, the participants' CCI score was calculated. Relevant studies have shown that the higher the CCI score, the worse the prognosis of patients and the higher the mortality \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe grouped the participants into three categories based on their CCI scores as secondary outcomes: low risk, medium risk, and high risk. Specifically, a CCI score of 1\u0026ndash;2 points is classified as low risk; a CCI score of 3\u0026ndash;4 points is considered medium risk; and a CCI score of 5 points or more is defined as high risk\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sleep duration\u003c/h2\u003e \u003cp\u003eParticipants were requested to report their average nightly actual sleep duration during the past month. In this study, sleep duration excluded naps. The response choices ranged from 0 to 24 hours. We defined individuals who slept for 7 to 8 hours as having \"healthy sleep\", those who slept less than 7 hours as having \"short sleep\", and those who slept more than 8 hours as having \"long sleep\".\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Physical Activity\u003c/h2\u003e \u003cp\u003ePA levels were measured by using the revised International PA Questionnaire (IPAQ). The questionnaire has been validated in 12 countries \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, as determined by the frequency and duration of different intensities of PA. Participants were asked to answer seven questions and recall how they engaged in vigorous, moderate, and light physical activities for at least 10 minutes at a time during a typical week. If they participated in any vigorous, moderate, and light physical activities, each lasting at least 10 minutes, they were further asked to report the frequency and duration. For example, \"On how many days in a typical week do you engage in at least 10 minutes of vigorous exercise?\" The response time ranges from 1 to 7 days. Also, for the question \"On those days, how much time do you usually spend on vigorous physical exercise?\" The response options are \u0026lt;\u0026thinsp;30 minutes, 30 minutes to 2 hours, 2 hours to 4 hours, and \u0026ge;\u0026thinsp;4 hours. In addition, participants were asked to recall the time they spent walking in a typical week. This includes walking at work and at home, walking from place to place, and any other walks they may take for fun, sport, exercise, or leisure, as well as any other activities.\u003c/p\u003e \u003cp\u003eAccording to the IPAQ protocol, participants were then divided into low, moderate, and high groups based on the metabolic equivalent (MET) minutes per week of moderate to vigorous PA. \"High level\" is defined as at least 30 minutes of vigorous activity per day for at least 3 days. \"Moderate\" meets one of the following criteria: (1) at least 20 minutes of vigorous exercise per day for three or more days; (2) at least 30 minutes of moderate-intensity exercise and/or walking per day for 5 days or more; (3) 5 or more days of walking, with any combination of moderate-intensity or vigorous-intensity exercise, achieving at least 600 MET-minutes/week of total PA. Those not meeting the above criteria are considered to have low level PA \u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Covariates\u003c/h2\u003e \u003cp\u003eSociodemographic Characteristics: Age was determined through the date of birth. Ethnicity was self-reported as white, black, or other ethnic backgrounds. Employment status was self-reported as unemployment, employed without pay, or employed with pay. Income level was rated as less than \u0026pound;180,000, between \u0026pound;180,000 and \u0026pound;1\u0026nbsp;million, or more than \u0026pound;1\u0026nbsp;million based on self-reported annual salary. Education degree was self-reported based on the highest level of qualifications and divided into secondary, high school, university, and above levels.\u003c/p\u003e \u003cp\u003eLifestyle Behaviors: Smoking status was self-reported and classified into never-smokers, former smokers, and current smokers. Drinking status was self-reported among never-drinkers, former drinkers, and current drinkers. Dietary intakes of fruits and vegetables, red meat, processed meat, and oily fish were based on a self-completed food frequency questionnaire at baseline. A healthy diet score of 1 point was given for each of the following characteristics on a scale of 0\u0026ndash;5: (1) at least 4 tablespoons of vegetables per day (median); (2) consume at least three pieces of fruit per day (median); (3) eat fish at least twice a week (median); have no more than two servings of unprocessed red meat per week (median); and have an intake of processed meat no more than twice a week (median) \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHealth-Related Factors: Height and weight were measured by a trained nurse at baseline assessment. Body mass index (BMI) is calculated by dividing weight in kilograms by the square of height in meters. Participants were classified as underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u0026sup2;), normal (18.5 to 24.9 kg/m\u0026sup2;), overweight (25.0 to 29.9 kg/m\u0026sup2;), or obese (\u0026ge;\u0026thinsp;30.0 kg/m\u0026sup2;) according to WHO criteria. High blood pressure is determined by a physician self-reporting the diagnosis, using blood pressure medications, or measuring systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg. Fasting blood glucose, glycated hemoglobin, triglycerides, cholesterol, high-density lipoprotein, low-density lipoprotein, and uric acid levels were all measured from blood samples taken when the participants were enrolled.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented as mean with standard deviation, while categorical variables are presented as frequencies with percentages.\u003c/p\u003e \u003cp\u003eThe exposure factors we studied are divided into the following three types: (1) Sleep duration. According to the self-reported average sleep duration per night, participants are classified into short sleep (less than 7 hours), good sleep (7\u0026ndash;8 hours), and long sleep (more than 8 hours). (2) Based on the length and intensity of weekly PA assessed by the International PA Questionnaire (IPAQ), PA level is divided into low, moderate, and high levels. (3) Nine combination patterns are formed by combining sleep duration and PA level: good sleep\u0026thinsp;+\u0026thinsp;moderate PA level, good sleep\u0026thinsp;+\u0026thinsp;low PA level, good sleep\u0026thinsp;+\u0026thinsp;high PA level, short sleep\u0026thinsp;+\u0026thinsp;low PA level, short sleep\u0026thinsp;+\u0026thinsp;moderate PA level, short sleep\u0026thinsp;+\u0026thinsp;high PA level, long sleep\u0026thinsp;+\u0026thinsp;low PA level, long sleep\u0026thinsp;+\u0026thinsp;moderate PA level, and long sleep\u0026thinsp;+\u0026thinsp;high PA level.\u003c/p\u003e \u003cp\u003eThe relationship between sleep duration, PA, and the incidence of multimorbidity is analyzed in different models using the Cox proportional hazards method. The proportional hazards assumption is verified by Schoenfeld residuals. The analysis is first unadjusted (with age as the time scale; Model 1), then adjusted for sociodemographic measures (Model 2), and finally lifestyle behaviors and health-related factors are added (Model 3).\u003c/p\u003e \u003cp\u003eIn addition, we conduct subgroup analyses for age, sex, and body mass index (BMI) to determine if there is consistency across population segments and to identify whether PA and sleep timing are more effective in reducing the risk of multimorbidity in certain populations.\u003c/p\u003e \u003cp\u003eWe also perform a sensitivity analysis, a 2-year landmark analysis, to exclude participants who developed 17 chronic diseases at the 2-year follow-up after baseline to reduce the risk of reverse causality to outcomes at baseline, whether subclinical or preclinical.\u003c/p\u003e \u003cp\u003eAll analyses are performed using survival packages in Stata 17 and R version 4.0.2. P value less than 0.05 is considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003ch3\u003e3.1 Baseline characteristics of included participants\u003c/h3\u003e\n\u003cp\u003eTable 1 presents the baseline characteristics stratified by sleep duration and total participants. The baseline refers to the participants enrolled from 2006 to 2010. The mean age of these participants is 54.683 (\u0026plusmn;8.027), and the proportion of female participants (51.2%) is slightly higher than that of male respondents. Most of them have a paid job (68.8%), a college degree or above (81.4%), a white ethnic background (92.7%), and an annual income between \u0026pound;180,000 and \u0026pound;1 million (78.6%). In terms of lifestyle habits, most of them are never-smokers (57.8%), drink alcohol (94.6%), have an ideal dietary pattern (score of 4 or 5) [39] (score of 4: 35.5%), are overweight in BMI (43.3%), have a moderate level of PA (41.7%), and have good sleep (71.7%). Most participants do not have high blood pressure (78.9%). After a median follow-up of 14.578 years, a total of 7,318 individuals developed multimorbidity events, with an incidence of 4.09%.\u003c/p\u003e\n\u003ch3\u003e3.2 The independent association between sleep duration and PA and multimorbidity\u003c/h3\u003e\n\u003cp\u003eTable 2 shows the association between sleep duration and PA (PA) independently and the occurrence of multimorbidity. In unadjusted Model 1, the Schoenfeld residual test hypothesis was not passed. In fully adjusted Model 3, taking good sleep duration (7-8 hours) as the reference, those with short sleep duration (\u0026lt;7 hours) face a higher risk of multimorbidity incidence, with a hazard ratio (HR) of 1.249 (95% confidence interval [CI]: 1.184-1.317). Meanwhile, the HR for long sleep duration (\u0026gt;8 hours) is 1.199 (95% CI: 1.102-1.304). In fully adjusted Model 3, taking moderate PA as the reference, low PA is associated with the higher risk of multimorbidity(HR = 1.065(1.000-1.134)), and the HR for high PA is 1.059 (1.005-1.115).\u003c/p\u003e\n\u003ch3\u003e3.3 The association between 9 behavioral patterns composed of sleep duration combined with PA and multimorbidity\u003c/h3\u003e\n\u003cp\u003eTable 3 shows the association between 9 behavioral patterns composed of sleep duration combined with PA and the incidence of multimorbidity. In unadjusted Model 1, the Schoenfeld residual test hypothesis was not passed. In fully adjusted Model 3, taking the behavioral pattern of good sleep + moderate PA as the reference group, short sleep + low PA is associated with the highest risk of multimorbidity (HR = 1.355 (1.221-1.504)). This is followed by short sleep + high PA (HR = 1.340 (1.233-1.456)), long sleep + medium PA (HR = 1.267 (1.114-1.442)), long sleep + low PA (HR = 1.228 (1.035-1.545)), short sleep + medium PA (HR = 1.211 (1.112-1.318)), and long sleep + high PA (HR = 1.205 (1.048-1.386)).\u003c/p\u003e\n\u003ch3\u003e3.4 The Subgroup and Sensitivity Analyses\u003c/h3\u003e\n\u003cp\u003eThe subgroup analyses for age, sex, and BMI are conducted in fully adjusted Model 3. The results of the subgroup analysis suggest a consistent relationship (Figure 2).\u003c/p\u003e\n\u003cp\u003eThe results of the sensitivity analyses are basically consistent with the main results (Table 4).\u003c/p\u003e\n\u003ch3\u003e3.5 Secondary Outcome Analyses\u003c/h3\u003e\n\u003cp\u003eIn the independent risk analysis, low PA increased the occurrence of low-risk events (HR = 1.069 (1.024-1.116)), medium-risk events (HR = 1.083 (1.018-1.153)), and high-risk events (HR = 1.096 (1.024-1.172)). Long sleep duration was associated with low-risk events (HR = 1.143 (1.077-1.212)) and medium-risk events (HR = 1.110 (1.018-1.210)), and short sleep duration was associated with low-risk events (HR = 1.129 (1.088-1.172)).\u003c/p\u003e\n\u003cp\u003eIn the nine combinations of sleep duration and PA, compared with good sleep + moderate PA, the probability of low-risk events (HR = 1.272 (0.131-1.431))(Figure 3a), medium-risk events (HR = 1.393 (1.181-1.644))(Figure 3b), and high-risk events (HR = 1.353 (1.126-1.626)) (Figure 3c) was the highest in long sleep + low PA .\u003c/p\u003e\n\u003ch3\u003e3.6 Isochronous Substitution Model\u003c/h3\u003e\n\u003cp\u003eWe utilized the isochronous substitution model to examine whether altering the duration of PA has an impact on the risk of multimorbidity in both short sleep and long sleep groups.\u003c/p\u003e\n\u003cp\u003eIn the short sleep group, increasing the time of PA by one hour instead of engaging in other activities except sleep had no statistically significant effect on the occurrence of multimorbidity. There was also no statistical significance in the long sleep duration group (Table 5). For the secondary outcome analysis, although some results were statistically significant, the value was extremely small and equivalent to being negligible in real life, thus having no significant practical significance. For instance, in the long sleep group, an increase of one hour of moderate PA (MPA) would increase the high-risk events of the CCI score by only 0.05% (1.0001, 1.0009), which had no significant impact.\u003c/p\u003e\n\u003cp\u003eTherefore, we think in the analysis of the isochronous substitution model, we can\u0026rsquo;t conclude that changing the time of PA during poor sleep duration can affect the risk of multimorbidity.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUtilizing data from the UK Biobank, we carried out a prospective cohort study to probe into the relationship between sleep duration, PA (PA), and the development of multiple disorders. The results indicated that both poor sleep duration (less than 7 hours and more than 8 hours) and non-moderate levels of PA were independently associated with the risk of multiple co-morbidities.\u003c/p\u003e \u003cp\u003eWhen analyzing the relationship between the nine \"sleep duration\u0026thinsp;+\u0026thinsp;PA\" combination patterns and multiple disease co-occurrence, it was discovered that compared with the \"good sleep duration - medium level PA\" combination, the \"short sleep duration - low level PA\" combination had the highest risk of multiple disease co-occurrence (HR\u0026thinsp;=\u0026thinsp;1.355 (1.221\u0026ndash;1.504)). This was followed by combinations such as \"short sleep duration - high PA\" (HR\u0026thinsp;=\u0026thinsp;1.340 (1.233\u0026ndash;1.456)). This implies that insufficient sleep duration has a more significant impact on the co-occurrence risk of multimorbidity, and the change of PA level under different sleep durations has a varying impact on the risk.\u003c/p\u003e \u003cp\u003eFirst, the findings of this study reinforce the evidence that compared to 7\u0026ndash;8 hours of sleep, short and long sleep durations were independently and significantly related to an increased risk of multimorbidity. A prospective UK study based on Whitehall II data found that patients with short sleep (less than 7 hours) had a higher risk of developing multiple conditions \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. This study extends these observations to a larger sample of UK adults and confirms that sleep duration is crucial for the prevention of multimorbidity. This discovery is in line with the findings of Portugal\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, China \u003csup\u003e\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, Germany \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, Brazil \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, Canada \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, and Luxembourg \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. These results suggest that sleeping less than the recommended 7h per day is detrimental to health. At the same time, our study also found that a long sleep duration (more than 8 hours) is associated with an increased risk of multiple medical conditions, complementing previous research.\u003c/p\u003e \u003cp\u003eSecondly, our results demonstrated that both low and high PA increased the risk of multimorbidity compared with moderate PA. In the Finnish population \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e, the UK cohort study \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e, the Chinese cohort study \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, and the Australian Longitudinal Study of Women's Health \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, an increased incidence of multimorbidity was observed in the low PA group. A cohort study of 357,554 participants in the United Kingdom showed that moderate-to-vigorous PA (MVPA) can reduce the risk of first cardio-renal metabolic disease \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Our study also found an association between low PA and multimorbidity consistent with the above studies. Our study found that high PA increases the risk of multiple conditions. However, a longitudinal study in Finland found that high PA can reduce the prevalence of diabetes, hypertension, high cholesterol, and osteoporosis \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Nevertheless, the Finnish study did not show an observed relationship between high PA and multiple disorders, and more studies are needed to confirm this.\u003c/p\u003e \u003cp\u003eIn the combined analysis of sleep duration and PA, we are consistent with the conclusions of the NHANES study, which found that poor sleep and low levels of PA increase the risk of multimorbidity. Nevertheless, the NHANES study has several limitations. Firstly, only 2048 participants were included, which makes the sample size rather small. Secondly, it was a cross-sectional study and lacked follow-up. In this study, these limitations are made up, which makes the result more convincing. However, we have not concluded that PA can change the relationship between sleep duration and the incidence of multimorbidity in prospective studies in China \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. We postulate that there exist two potential reasons accounting for the discrepancy in results. Firstly, it might be associated with factors such as behavioral disparities and racial variations among individuals from different countries. Secondly, in the Chinese study, the sleep time was categorized into healthy and poor sleep time, without separately discussing short sleep (\u0026lt;\u0026thinsp;7h) and long sleep (\u0026gt;\u0026thinsp;9h). Therefore, further research needs to be confirmed by multi-center, multi-country, and multi-ethnic comparative studies.\u003c/p\u003e \u003cp\u003eIn addition, our study also found through the isochronous substitution model that in short sleep and long sleep groups, by reducing the time of other activities by one hour and increasing the time of PA by one hour, the occurrence of multimorbidity could not be significantly reduced. This has not been studied before and needs to be further confirmed by more studies in the future.\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, sleep duration, PA, and illness were all based on participants' self-reports. Therefore, if the participant has not yet been in contact with the health care system to obtain a diagnosis, or the participant may not have reported a chronic illness, the incidence of the disease may be underestimated. Regarding the use of self-reported PA \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e,\u003c/sup\u003e it was found that the International PA Questionnaire (IPAQ) measures generally overestimated PA compared to objective measures. Therefore, the effect of PA on chronic disease may have been underestimated in this analysis. With regard to the use of self-reported sleep duration, there is the possibility of recall bias and subjective judgment differences. Second, the study samples were mainly from the UK Biobank, and the participants were mostly middle- and high-income people and white people. There was a lack of studies on other races and people from low- and middle-income countries, which may limit the universality and representativeness of the research results. In addition, this study only discussed sleep duration and did not deeply study the influence of other sleep-related factors such as sleep quality and sleep rhythm on the co-occurrence of multimorbidity. Future studies can further expand on this content.\u003c/p\u003e \u003cp\u003eThis study further confirmed the important role of sleep duration and PA in the incidence of multimorbidity and provided a basis for the prevention of incidence of multimorbidity. It is recommended that people ensure 7\u0026ndash;8 hours of sleep. When the sleep time is insufficient or too long, it should be adjusted according to one's own situation. At the same time, when sleep is insufficient, one should try to maintain a moderate level of PA and avoid excessive PA. When sleeping too long, a higher level of PA should be ensured to reduce the risk of incidence of multimorbidity and improve the quality of life and health level. Future research could address the limitations of this study to gain a deeper understanding of the complex relationship between sleep, PA, and the incidence of multimorbidity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGetting 7\u0026ndash;8 hours of sleep is the first choice to reduce the risk of multiple conditions. If the sleep duration is insufficient and the sleep duration is too long, the sleep duration should be adjusted according to the own situation to ensure 7\u0026ndash;8 hours, reduce the incidence of multimorbidity, improve the long-term quality and level of life, and improve the prognosis. If sleep duration cannot be guaranteed, sleep duration is insufficient, it is recommended to ensure that the PA is mainly at a moderate level, while avoiding excessive PA; When sleeping for too long, it is recommended to ensure that PA is mainly at a high level.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the staff and participants of the study for their indispensable contributions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by First Level Leading Talent Project of \u0026quot;123 Climbing Plan\u0026quot; for Clinical Talents of Tianjin Medical University; \u0026quot;Tianjin Medical Talents\u0026quot; project, the second batch of high-level talents selection project in health industry in Tianjin [no.TJSJMYXYC-D2-014]; Key Project of Natural Science Foundation of Tianjin [no.22JCZDJC00590]; Tianjin Key Medical Discipline (Specialty) Construct Project [No.TJYXZDXK-032A]; Tianjin Science and Technology Major Special Project and Engineering Public Health Science and Technology Major Special Project [No.21ZXGWSY00100]; China International Medical Foundation[No.Z-2017-26-1902-5].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors of this paper have read and approved the final version submitted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYa Peng: Conceptualization, Data curation, Formal analysis, Methodology, Software, Supervision, Validation, Visualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. Tingting Jin: Writing - review \u0026amp; editing, Methodology, Investigation. Lianqin Chen: Formal analysis, Data curation. Yanyan Ma: Methodology, Formal analysis. Jiayu Wang: Writing - review \u0026amp; editing. Siyi Zhang: Writing - review \u0026amp; editing. Liuxu Chen: Writing - review \u0026amp; editing. Yue Qi: Writing - review \u0026amp; editing. Weiran Zhao: Writing - review \u0026amp; editing. Yao Lin: Methodology. Changping Li: Methodology. Zhuang Cui: Methodology, Conceptualization. Hongyan Liu: Supervision, Validation, Conceptualization. Pei Yu: Supervision, Re sources, Project administration, Funding acquisition, Conceptualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data are not available. The data are from the UK Biobank, but there are restrictions on their availability. These data were used under a license for the current study and are not publicly accessible. Researchers who wish to access the UK Biobank database will need to apply for access through the following link: https://www.ukbiobank.ac.uk/enable-your-research/.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAcademy of Medical Sciences. Multimorbidity: A Priority for Global Health Research. 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://acmedsci.ac.uk/file-download/82222577\u003c/span\u003e\u003cspan address=\"https://acmedsci.ac.uk/file-download/82222577\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Y, Zhang P, Oldenburg B, Hall T, Lu S, Haregu TN, et al. The impact of mental and physical multimorbidity on healthcare utilization and health spending in China: a nationwide longitudinal population-based study. 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Int J Behav Nutr Phys Act. 2011;8(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u0026nbsp; Baseline Characteristics Stratified by Sleep Duration and Total\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"107%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eshort sleep duration(\u0026lt;7h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003egood sleep duration(\u0026ge;7h\u0026amp;\u0026le;8h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003elong sleep duration(\u0026gt;8h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eTotal participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eN=40,028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eN=128,350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eN=10,555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eN=178,933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e54.502(7.744)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e54.5907(8.069)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e56.4881(8.341)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e54.683(8.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e20,588(51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e62,184(48.4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4,614(43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e873,86(48.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e19,440(48.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e66,166(51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e5,941(56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e91,547(51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eEthnic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e36,467(91.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e119,525(93.1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e9,794(92.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e165,786(92.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e3,136(7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e8,395(6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e720(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e12,251(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e425(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e430(0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e41(0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e896(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eUnemployment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8,919(22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e32,753(25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4,885(46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e46,557(26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eEmployed but no paid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1,697(4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e6,715(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e849(8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e9,261(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eEmployed and paid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e29,412(73.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e88,882(69.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4,821(45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e123,115(68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5,350(13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e15,391(12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1,585(15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e22,326(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHigh\u0026nbsp;school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2,437(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e7,799(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e652(6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e10,888(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eUniversity and above levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e32,241(80.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e105,160(81.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e8,318(78.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e145,719(81.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eLow（\u0026lt;18000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6,278(15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e16,461(12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2,647(25.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e25,386(14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eModerate（\u0026ge;18000\u0026amp;\u0026le;100000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e30,996(77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e102,191(79.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e7,498(71.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e140,685(78.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHigh（\u0026gt;100000）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2,754(6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e9,698(7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e410(3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e12,862(7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e22,352(55.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e75,281(58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e5,847(55.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e103,480(57.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4,603(11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e11,573(9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1,126(10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e17,302(9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePrevious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e13,073(32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e41,496(32.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3,582(33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e58,151(32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eDrinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1,409(3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3,479(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e421(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e5,309(3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e37,398(93.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e122,067(95.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e9,744(92.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e169,209(94.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePrevious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1,221(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2,804(2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e390(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4,415(2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHealthy diet score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e296(0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e648(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e64(0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1,008(0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1,962(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5,092(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e408(3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e7,462(4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4,946(12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e14,256(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1,210(11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e20,412(11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8,784(21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e28,741(22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2,330(22.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e39,855(22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e13,936(34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e45,955(35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3,719(35.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e63,610(35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e10,104(25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e33,658(26.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2,824(26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e46,586(26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eUnderweight(BMI\u0026lt;18.5 kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e210(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e626(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e54(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e890(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNormal(18.5-24.9 kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e12,909(32.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e48,315(37.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3,520(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e64,744(36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eOverweight(25.0-29.9 kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e17,161(42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e55,827(43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4,571(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e77,559(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eObesity(\u0026ge;30.0 kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e9,748(24.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e23,582(18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2,410(22.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e35,740(20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7,734(19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e22,301(17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2,054(19.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e32,089(17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e15,873(39.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e54,354 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4,399(41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e74,626(41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e16,421(41.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e51,695(40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4,102(38.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e72,218(40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHigh blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e9,250(23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e25,801(20.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2,684(25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e37,735(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e30,778(76.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e102,549(79.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e7,871(74,6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e141,198(78.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eTriglyceride\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.726(1.030)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1.677(0.992)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.815(1.067)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.696(1.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5.774(1.077)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5.766(1,067)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e5.818(1.124)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e5.771(1.073)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHow-density lipoprotein\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1.451(0.379)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1.471(0.376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.453(0.377)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.466(0.377)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eLow-density lipoprotein\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e3.628(0.826)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3.614(0.820)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3.651(0.860)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3.619(0.824)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eFasting blood glucose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4.967(0.803)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e4.947(0.756)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4.999(0.774)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e4.954(0.768)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eGlycated hemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e35.037(0.444)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e34.622(0.431)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e34.900(4.292)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e34.731(4.339)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eUric acid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e312.271(79.357)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e305.659(78.961)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e307.693(80.677)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e307.258(79.198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u0026nbsp; Independently Association of Sleep duration , Physical Activity and Incidence of Multimorbidity\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"713\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eModel 1:Unadjusted Model (age as timescale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 208px;\"\u003e\n \u003cp\u003eModel 2:Adjusted for sociodemographic variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eModel 3:Model 2+behavioral and health-related factor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ephysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eHR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003elow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.131(1.063-1.204)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.226(1.152-1.305)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.065(1.000-1.134)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003ehigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.059(0.975-1.080)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.009(0.958-1.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.742\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.059(1.005-1.115)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esleep duration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003egood(\u0026ge;7 hours\u0026amp;\u0026le;8 hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eshort(\u0026lt;7 hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.347(1.277-1.419）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.348(1.279-1.422)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.249(1.184-1.317）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003elong(\u0026gt;8 hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.632(1.502-1.774)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.305(1.199-1.419)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.199(1.102-1.304)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u0026nbsp; Association between Sleep duration \u0026nbsp;and Physical Activity and the Incidence of Multimorbidity\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"720\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 207px;\"\u003e\n \u003cp\u003eModel 1:Unadjusted Model (age as timescale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 205px;\"\u003e\n \u003cp\u003eModel 2:Adjusted for sociodemographic variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 207px;\"\u003e\n \u003cp\u003eModel 3:Model 2+behavioral and health-related factor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003esleep duration +physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eHR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eHR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eHR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003egood+moederate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003egood+low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.091(1.008-1.180)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1.182(1.092-1.278)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.057(0.977-1.144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003egood+high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.022(0.959-1.088)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.996(0.935-1.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.055(0.990-1.124)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eshort+low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.537(1.386-1.704)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1.663(1.500-1.845)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.355(1.221-1.504)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eshort+moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.302(1.196-1.417)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1.288(1.182-1.402)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.211(1.112-1.318)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eshort+high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.377(1.268-1.496)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1.361(1.253-1.479)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.340(1.233-1.456)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003elong+low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.871(1.579-2.217）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1.586(1.338-1.880）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.228(1.035-1.545）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003elong+moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.694(1.489-1.926)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1.326(1.165-1.509)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.267(1.114-1.442)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003elong+high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.544(1.344-1.774)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e1.228(1.068-1.412)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eP=0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1.205(1.048-1.386)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eP=0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u0026nbsp; Sensitivity Analysis in Fully Adjusted Model 3\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"423\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eHR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ephysical activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003elow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.045(0.973-1.121)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ehigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.081(1.020-1.145)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003esleep duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eshort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.239(1.168-1.315)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003elong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.202(1.094-1.322)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003esleep duration+physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egood+moederate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egood+low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.035(0.947-1.131)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003egood+high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.094(1.019-1.174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eshort+low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.341(1.193-1.508)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eshort+moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.225(1.114-1.346)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eshort+high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.339(1.221-1.470)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003elong+low\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.263(1.042-1.531)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003elong+moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.268(1.096-1.468)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003elong+high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.234(1.056-1.442)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eP=0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sleep duration, Physical activity, Multimorbidity, UK Biobank","lastPublishedDoi":"10.21203/rs.3.rs-6621017/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6621017/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThe prevention of multimorbidity epidemics has emerged as a significant challenge in both clinical and public health domains worldwide. This study aimed to comprehensively investigate the complex relationships between sleep duration, physical activity (PA), and the incidence of multimorbidity, with the objective of providing evidence-based behavioral recommendations for clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and methods: \u003c/strong\u003eA total of 178,933 participants from the UK Biobank, who were free from 17 diseases at the baseline, were enrolled. Sleep duration and PA levels were self-reported. Multimorbidity was defined as the presence of two or more diseases. Both the Cox risk regression model and the isochronous substitution model were employed for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOver a mean follow-up period of 14.578 years, 7,318 individuals developed multimorbidity. The findings revealed that short sleep (\u0026lt;7 hours) and low levels of PA were significantly linked to an elevated risk of multimorbidity. Notably, the combinations of “short sleep-low PA” and “short sleep-high PA” carried a higher risk compared to “good sleep-moderate PA”. Subgroup analysis and sensitivity analysis confirmed the initial findings.No significant results were observed in the isochronous substitution model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eEnsuring a sleep duration of 7 to 8 hours is optimal for minimizing the risk of multimorbidity. Individuals with poor sleep patterns are advised to adjust their sleep duration to 7-8 hours to decrease the likelihood of multimorbidity and enhance their long-term quality of life.\u003c/p\u003e","manuscriptTitle":"The Relationship Between Sleep duration, Physical Activity and Incidence of Multimorbidity: A Prospective Study of UK Biobank","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 08:48:42","doi":"10.21203/rs.3.rs-6621017/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d0242b8b-3813-4579-b981-e12fffe1f83e","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-03T09:54:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-19 08:48:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6621017","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6621017","identity":"rs-6621017","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}