Abstract
Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional São Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physical-mental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual- and area-level variables. Three patterns of clustering were found for women: ‘irritable mood and headache’, ‘chronic diseases and pain’, and ‘substance use disorders’. Among men, the patterns were: ‘chronic pain and respiratory disease’, ‘psychiatric disorders’, and ‘chronic diseases’. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.
Highlights
Multimorbidity is a taxing concept to delimitate[1], but it can be defined as a non-random association pattern between diseases[2]
Chronic non-communicable diseases represent a large share of disease burden in LMICs8, which start during peak economically active years of age
The presence of multiple conditions affecting the same individual is an important problem in the Brazilian population, even in younger brackets, and around one-fourth of adults aged 18–64 years-old presents a pattern of multimorbidity encompassing physical, mental illnesses or both
Summary
Multimorbidity is a taxing concept to delimitate[1], but it can be defined as a non-random association pattern between diseases[2]. Multimorbidity is conceptualized as the co-occurrence of multiple chronic or long-term medical conditions. Multimorbidity includes both physical and mental illnesses and is distinguished from comorbidity due to the absence of an index disease or condition as is the case of the second[3]. All this burden of chronic multimorbidity contradicts the preceding belief that mortality-related burden still prevails in LMICs. The complex service needs of growing multimorbid populations in low-resource countries challenge policymakers to restructure health-care delivery. Hypertension and asthma are the strongest predictors for psychiatric multimorbidity In this sense, the extent of multimorbidity has been associated with age, sex, educational level, country’s income, and social inequality[6,13,14]. The majority of studies examining patterns of multimorbidity and area-level determinants were performed with clinical samples in developed countries, where social inequality is deemed to be lower than in LMICs6,17
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