🟠 Moderate Evidence
British Bangladeshi and Pakistani populations in the UK show distinct patterns of combined mental and physical illness that differ significantly by sex and age, according to a longitudinal analysis published in PLOS Medicine. Over 10 years of follow-up, researchers from the Genes and Health study and The LIfespaN Multimorbidity Research Collaborative (LINC) tracked 23,554 British Bangladeshi and Pakistani participants to identify genetic and social factors that predict who develops simultaneous mental and cardiometabolic conditions.
Key takeaways
- 13.4% of British Bangladeshi and Pakistani participants developed internalising mental health conditions paired with cardiometabolic disease over 10 years
- Women were significantly more likely to develop combined mental and physical illness, but less likely to experience cardiovascular or renal events than men
- A genetic risk score combining variants across multiple genes helped predict who would develop multimorbidity, alongside sociodemographic factors
- Younger age at baseline was associated with higher risk of developing internalising conditions first, followed by cardiometabolic disease
Study at a Glance
| Source | PLOS Medicine |
| Study type | Longitudinal cohort study with multistate modelling |
| Sample size | N = 23,554 British Bangladeshi and Pakistani participants |
| Follow-up period | Median 10.2 years (April 1997–November 2024) |
| Primary outcome | Development of internalising and cardiometabolic multimorbidity (ICM-MM) |
Health outcomes in British South Asian cohort over 10 years
Proportion of 23,554 British Bangladeshi and Pakistani participants who developed specific health conditions or experienced major events, April 1997–November 2024
Source: PLOS Medicine (2025) | Stow et al., Genes and Health cohort | Georgian Medical Journal News
Sex differences show paradoxical cardiovascular risk
Women in the cohort demonstrated a markedly different disease trajectory than men, according to the analysis conducted by researchers including Dr. Daniel Stow and colleagues from the Genes and Health Research Team and LINC. Women were significantly less likely to remain free of disease and had higher probabilities of developing internalising mental health conditions—including depression, anxiety, and somatoform disorders—followed by cardiometabolic disease. However, once the pathways were established, women showed lower risk of major cardiovascular or renal events (CVR) compared to men.
This pattern suggests that while women in this population face greater burden of combined mental and physical illness, the severity of cardiovascular complications may manifest differently by sex. The researchers note that these differences may reflect both biological pathways and social or healthcare access factors that remain incompletely understood in South Asian populations.
Genetic risk variants identified across multiple conditions
The research team developed a polygenic risk score (PRS) for internalising and cardiometabolic multimorbidity (ICM-MMPRS) by combining genetic variants associated with the co-occurrence of mental and physical conditions, as detailed in the PLOS Medicine study. This approach identified that genetic predisposition, beyond individual disease variants, contributes to the simultaneous emergence of depression, hypertension, obesity, type 2 diabetes, chronic kidney disease, and dyslipidaemia in this population.
The integration of genetic data with longitudinal health records from the UK National Health Service (NHS) enabled researchers to model the lifetime pathways to multimorbidity with greater precision than previous cross-sectional studies. Recent research across diverse populations increasingly emphasizes that multimorbidity is not random but follows identifiable biological and social patterns that can be predicted and potentially modified through targeted interventions.
Age at baseline and socioeconomic factors shape disease trajectories
Younger age at study entry was counterintuitively associated with higher risk of developing internalising conditions first, which then progressed to cardiometabolic disease, according to the multistate model results. Researchers adjusted for sociodemographic factors including age, sex, education, employment, and income, finding that social circumstances substantially modified genetic risk. The baseline median age of 31.1 years in this cohort—younger than many multimorbidity studies in older populations—afforded a unique opportunity to observe disease emergence over the full life course.
The analysis also documented 103 non-CVR deaths (0.4%) and 1,522 major cardiovascular or renal events (6.5%) over the follow-up period. Health policy frameworks addressing disparities in UK South Asian populations may need to incorporate these sex-specific and age-specific risk patterns to improve early identification and prevention of multimorbidity.
Over 10.2 years of follow-up, 13.4% of 23,554 British Bangladeshi and Pakistani participants developed combined internalising mental health and cardiometabolic multimorbidity, with distinct patterns by sex and age that were predicted by both genetic risk scores and sociodemographic factors.
— Dr. Daniel Stow, principal investigator, Genes and Health Research Team and LINC (PLOS Medicine, 2025)
What this means
Frequently asked questions
Why do women in this study develop mental health conditions more often, but have fewer cardiovascular events?
The study does not definitively explain this paradox, but it suggests that the pathways linking mental and physical health may differ by sex. Women may have different patterns of disease progression, biological responses to risk factors, or healthcare engagement. Further mechanistic research is needed to understand whether this reflects differences in presentation, severity, diagnosis, or treatment.
What is a polygenic risk score and how does it help predict multimorbidity?
A polygenic risk score (PRS) is a sum of genetic effects across hundreds or thousands of DNA variants associated with a condition. By combining many small genetic influences, a PRS can estimate an individual’s inherited predisposition to disease. In this study, the ICM-MMPRS captured genetic variants linked to both mental and cardiometabolic conditions simultaneously, helping identify people at higher lifetime risk of developing both problems together.
Should British South Asian individuals be screened for mental health conditions as part of cardiometabolic care?
This research supports the case for integrated screening, particularly in primary care. However, clinical screening decisions should be guided by NICE and other guideline bodies. Individual risk assessment should consider family history, personal health history, lifestyle factors, and genetic risk where available. Discussing mood, anxiety, and stress alongside routine blood pressure and glucose checks is reasonable practice in this population.
The Genes and Health study, which recruited over 100,000 British Bangladeshi and Pakistani adults with linked genetic and NHS health records, represents one of the largest and most detailed investigations of disease patterns in a UK South Asian population. The findings underscore that multimorbidity in this group is not simply a consequence of age or individual disease prevalence, but emerges through predictable pathways shaped by genetic architecture, sex, and social context. Future research integrating intervention trials and qualitative studies of barriers and enablers to early intervention may translate these risk predictions into improved clinical and public health outcomes.
Was this article helpful?
Disclaimer. This article is health journalism intended for general information and education. It is not medical advice and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your individual circumstances. Full disclaimer →
Related Coverage
Editorial standards. This article was produced under the GMJ News editorial process, with oversight by the GMJ Editorial Board. Our editorial process. Spotted an error? Contact the editorial team.
