Multimorbidity, healthcare utilization and socioeconomic status: A register-based study in Denmark.

Anne Frølich,Anders Stockmarr,Michaela Schiøtz,Nermin Ghith,Ramune Jacobsen,Young Dae Kwon

doi:10.1371/journal.pone.0214183

Abstract

BackgroundPeople with multimorbidity have reduced functional capacity, lower quality of life, higher mortality rates and use healthcare resources more intensively than healthy people or those with a single chronic condition. Multimorbidity was defined as the coexistence of two or more chronic conditions in the same person. The aim of this study was to explore associations between multimorbidity and use of healthcare services and the impact of socioeconomic status on utilization of hospitalizations and bed days.MethodsThe study population included all individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services and demographics were obtained from Danish national administrative and health registries. Zero-inflated models were used to calculate anticipated annual use of hospitalizations and bed days.FindingsThe study population comprised 1,397,173 individuals; the prevalence of multimorbidity was 22%. Prevalence was inversely related to educational attainment. For people with multimorbidity, utilization of hospitalizations and bed days increased approximately linearly with the number of chronic conditions. However, a steep increase in utilization of bed days was observed between five and six or more chronic conditions. An educational gradient in hospitalization rates and use of bed days was observed regardless of the number of chronic conditions. Educational attainment was strongly associated with healthcare utilization.ConclusionMultimorbidity was associated with a significant increase in utilization of all healthcare services in Denmark. In addition, a socioeconomic gradient was observed in utilization of hospitalizations and bed days.

Highlights

Multimorbidity is often defined as the coexistence of two or more chronic conditions in the same person [1, 2]
Multimorbidity was associated with a significant increase in utilization of all healthcare services in Denmark
A socioeconomic gradient was observed in utilization of hospitalizations and bed days

Summary

Introduction

Multimorbidity is often defined as the coexistence of two or more chronic conditions in the same person [1, 2]. People with multimorbidity have decreased functional competence [3], lower quality of life [4], higher mortality rates [5] and use healthcare resources more intensively than healthy people or those with just one chronic condition [6]. The prevalence of multimorbidity is increasing internationally. A study from the Netherlands reported an increase in multimorbidity prevalence from 12.7% to 16.2% between 2004 and 2011 [10]. Expected continuing increases in the prevalence of multimorbidity are recognized as a major public health and healthcare challenge for modern societies [9]. People with multimorbidity have reduced functional capacity, lower quality of life, higher mortality rates and use healthcare resources more intensively than healthy people or those with a single chronic condition. The aim of this study was to explore associations between multimorbidity and use of healthcare services and the impact of socioeconomic status on utilization of hospitalizations and bed days.

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Conclusion