Abstract
BACKGROUND: The longitudinal progression from health to single allergic diseases and subsequently to comorbidities and mortality remains understudied in adults. This study aimed to investigate the impact of social determinants, lifestyle factors, and air pollution on multi-state allergic disease progression.
METHOD: A total of 109,018 adults without allergic diseases at recruitment were extracted from the UK Biobank database. A multi-state Markov proportional hazards model was used to assess the association between multidimensional factors and allergic disease progression. The model specifically analyzed transitions from baseline health to single allergic disease onset, subsequent comorbidities, and mortality.
RESULTS: Over a median follow-up of 11.2 years, 13,815 participants developed at least one allergic disease, 428 progressed to allergic comorbidities, and 18,607 died. Multi-state modeling revealed risk patterns across different disease stages within adult allergic disease trajectories. Specifically, transitions from health to single allergic disease onset and from single allergic disease to mortality were significantly associated with lower socioeconomic status (SES), higher Townsend Deprivation Index (TDI), history of violence victimization, smoking, and NO2 exposure. Regarding progression to allergic comorbidities and mortality among comorbid patients, healthier dietary patterns exhibited significant protective effects. PM10 exposure and lower SES were identified as significant risk factors for development of comorbidities.
CONCLUSION: The onset, progression, and mortality of adult allergic diseases are influenced by multidimensional factors, including social determinants, lifestyle, and air pollution. These findings highlight the critical role of enhancing socioeconomic equity, promoting healthy lifestyles, and controlling air pollution in preventing allergic diseases and mitigating subsequent adverse outcomes.