{
  "abstract": "Background\n\nThe co-occurrence of physical diseases, psychological disorders, and cognitive impairment-here termed physical-psychological-cognitive multimorbidity (PPC-M)-poses growing challenges to healthy aging but its upstream, modifiable determinants remain underexplored. Sensory impairments are common in later life and may be associated with the emergence of PPC-M, partly through psychosocial factors such as loneliness. This study aimed to examine the associations of vision, hearing, and dual sensory impairments with incident PPC-M and to assess whether loneliness partly explains these associations in three national ageing cohorts.Methods\n\nWe analyzed 15,022 adults aged ≥ 45 years from three nationally representative aging cohorts-CHARLS (China), HRS (United States), and ELSA (England)-followed for 6-8 years. Vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) were self-reported at baseline. Incident PPC-M patterns included: physical-psychological (P1P2), physical-cognitive (P1C), psychological-cognitive (P2C), and triple comorbidity (P1P2C). We fitted Cox proportional hazards models and multi-state survival models, adjusting for demographic factors, educational level, marital status, and health behaviours. Loneliness was assessed using harmonized measures and tested as a mediator within a counterfactual mediation framework. Sensitivity analyses included propensity score matching, competing risk of death, and alternative definitions of exposures and outcomes.Findings\n\nAt baseline, 52.8% reported no sensory impairment, 10.9% HI only, 17.2% VI only, and 19.1% DSI. A graded association emerged across PPC-M outcomes. Compared with no impairment, DSI showed the strongest associations with P1P2 (HR = 2.18), P2C (HR = 2.36), and P1P2C (HR = 1.56; 95% CI: 1.19-2.03), with VI generally showing stronger associations than HI. Results were directionally consistent across countries and robust in sensitivity analyses. Loneliness statistically accounted for approximately 10-12% of the observed associations across impairment types, suggesting a potential psychosocial explanatory pathway. Multi-state models suggested accelerated transitions from single-domain conditions to combined multimorbidity among those with DSI.Interpretation\n\nSensory impairments-especially dual impairment-were independently associated with the onset and progression of PPC-M. Loneliness accounted for a meaningful share of these associations, suggesting a potential target for risk stratification and intervention. Integrating accessible and affordable vision/hearing services with loneliness-reduction strategies may help identify older adults at elevated risk of complex multimorbidity and inform equitable healthy-aging strategies across diverse settings.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.",
    "Nankai University School of Medicine, Tianjin, China.",
    "Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China.",
    "Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Changchun, China.",
    "Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Changchun, China. beibeidu2012@jlu.edu.cn."
  ],
  "article_type": "research support, non u.s. gov't",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yilin Pan"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Jingru Bi"
    },
    {
      "affs": [
        0
      ],
      "name": "Lili Sun"
    },
    {
      "affs": [
        0
      ],
      "name": "Long Feng"
    },
    {
      "affs": [
        0
      ],
      "name": "Rui Wang"
    },
    {
      "affs": [
        3
      ],
      "name": "Junru Qu"
    },
    {
      "affs": [
        4
      ],
      "name": "Beibei Du"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5wyg6qgjw4c8g.bib",
  "cited_by": 0,
  "doi": "10.1186/s12939-026-02958-0",
  "fulltext_url": "https://europepmc.org/articles/PMC13681873",
  "id": "5wyg6qgjw4c8g",
  "issns": [
    "1475-9276"
  ],
  "landing_url": "https://europepmc.org/article/MED/42902280",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RA1-1270"
    ],
    [
      "openalex",
      "2713|Chronic Disease Management Strategies"
    ]
  ],
  "openalex": "W7170349748",
  "pdf_url": "https://europepmc.org/articles/PMC13681873?pdf=render",
  "pmcid": "PMC13681873",
  "pmid": "42902280",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/5wyg6qgjw4c8g.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:41Z",
      "native_id": "MED:42902280",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42902280"
    },
    {
      "first_seen": "2026-10-30T13:45:41Z",
      "native_id": "067c69b27eda48cb8ddfa30c111c7263",
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      "url": "https://doi.org/10.1186/s12939-026-02958-0"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Chronic Disease Management Strategies",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Sensory impairment, loneliness, and the emergence of physical-psychological-cognitive multimorbidity: a cross-national cohort study in China, the United States, and England.",
  "title_text": "Sensory impairment, loneliness, and the emergence of physical-psychological-cognitive multimorbidity: a cross-national cohort study in China, the United States, and England.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T14:20:41Z",
  "url": "https://research.draconitic.com/paper/5wyg6qgjw4c8g",
  "venue": "International journal for equity in health",
  "versions": []
}