Abstract
Socioeconomic inequalities in health are commonly known to decrease at late age. Yet, it remains unclear whether socioeconomic inequalities in health at late age appear in relation to multimorbidity, particularly in Korea where social support remains unsatisfactory for older people. Using three waves of Korea Health Panel, data of 19,942 observations with repeated measure were constructed to ensure a temporal sequence between three socioeconomic measures (i.e., poverty, employment status, and education) and multimorbidity with a t to t+1 year transition. A multilevel multinomial model was applied to quantify the socioeconomic impact across different age, diseases and disease groups, both separately and in combination. There were associations between socioeconomic position (SEP) and multimorbidity, and increasing trends of socioeconomic inequalities not only with greater number of morbidity but also with age. The latter result was only observed with employment status through mid-to-early old age; i.e., between the 40s (odds ratio (OR) = 2.45, 95% confidence interval (CI):1.08–5.57) and 70s (OR = 3.48, 95%CI: 1.24–9.74). The patterns of socioeconomic inequalities in multimorbidity varied for particular pairs of diseases and were stronger in the disease pairs co-occurring with mental and cardiovascular diseases but weaker in the disease pairs co-occurring with cancer. Accumulation of adversity tended to intensify with increase in number of diseases and older age, though this finding was not consistently supported. The labour market should be encouraged to actively participate in actions to promote healthy aging needs to be complemented by the provision of more generous and universal income support to the elderly in Korea.
Highlights
Multimorbidity, defined as the co-occurrence of two or more chronic diseases, is a common clinical feature, among older people [1, 2]
Given the currently insufficient understanding of the association between socioeconomic position (SEP) and multimorbidity, we explored whether 1) socioeconomic inequalities in health increase with an increase in the number of diseases; 2) socioeconomic inequalities are steepened when based on a particular pair of diseases; and 3) socioeconomic inequalities in health are larger among older people than younger people
Note 2: For multimorbidity measures, data were pooled over a period between 2010 and 2011, but for all other measures between 2009 and 2010. *p-value was obtained from Chi-square test
Summary
Multimorbidity, defined as the co-occurrence of two or more chronic diseases, is a common clinical feature, among older people [1, 2]. Another study showed large dissimilarities between two different pairs of disease group; one such pair, comprising mental disorder and a pain cluster, was not related to SEP, while another pair, consisting of cardiovascular and metabolic disorders, was related to SEP [7] Though these studies represent advances in quality in multimorbidity research, analyses conducted therein were limited to a few pre-selected combinations of diseases, with other disease combinations being largely neglected. In Korea, the proportion of the elderly population who are engaged in economic activity was highest among OECD countries [26], often in the form of non-standardized jobs, bridge jobs, and part-time roles This suggests that Korea has different SEP trajectories at old age and may be a suitable place to explore two competing explanations for old age socioeconomic inequalities in health. Given the currently insufficient understanding of the association between SEP and multimorbidity, we explored whether 1) socioeconomic inequalities in health increase with an increase in the number of diseases; 2) socioeconomic inequalities are steepened when based on a particular pair of diseases; and 3) socioeconomic inequalities in health are larger among older people than younger people
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