Abstract
(1) Background: The management of multiple chronic diseases challenges China’s health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants’ HRQOL, and χ2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old (P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases (P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants (P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants (P < 0.001), and daily tooth-brushing for middle (P < 0.05) and young-old participants (P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients (P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.
Highlights
Chronic diseases challenge public health systems and individual well-being around the world.In China, chronic diseases accounted for 89% of all deaths and 70% of disability-adjusted life-years lost, with devastating impacts on individuals, the public health system, and the social economy [1,2,3,4].With population ageing, and lifestyle changes driving health risk factors, the prevalence of multimorbidity, or two or more chronic conditions, is intensifying, and multimorbidity is a major concern for chronic diseases management [5]
Multimorbidity prevalence around the world varies by age, ranging from 2.6% to over 95%, and data from China estimate that multimorbidity ranges from 6.4% to 76.5% among people aged over 60 years old [1,6]
We found that the overall prevalence of multimorbidity was 13.80% for all participants, 6.89% for middle-aged participants, and 20.60% for old-aged participants aged 60 years and above
Summary
Chronic diseases challenge public health systems and individual well-being around the world.In China, chronic diseases accounted for 89% of all deaths and 70% of disability-adjusted life-years lost, with devastating impacts on individuals, the public health system, and the social economy [1,2,3,4].With population ageing, and lifestyle changes driving health risk factors, the prevalence of multimorbidity, or two or more chronic conditions, is intensifying, and multimorbidity is a major concern for chronic diseases management [5]. Chronic diseases challenge public health systems and individual well-being around the world. In China, chronic diseases accounted for 89% of all deaths and 70% of disability-adjusted life-years lost, with devastating impacts on individuals, the public health system, and the social economy [1,2,3,4]. Lifestyle changes driving health risk factors, the prevalence of multimorbidity, or two or more chronic conditions, is intensifying, and multimorbidity is a major concern for chronic diseases management [5]. Multimorbidity prevalence around the world varies by age, ranging from 2.6% to over 95%, and data from China estimate that multimorbidity ranges from 6.4% to 76.5% among people aged over 60 years old [1,6]. Whether for individuals, households, the health system, or society, the multimorbidity presents severe challenges
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