Abstract
BackgroundThe co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China.MethodsPanel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes.ResultsAfter adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss.ConclusionMental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China.
Highlights
The co-occurrence of mental and physical chronic conditions is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries
We examined two work productivity outcomes: (1) early retirement, which is a binary variable that indicates whether the respondent was retired at the time of the interview, and (2) the number of days missed due to sick leave at their primary job, which was calculated based on the questions “How many days of work did you miss last year due to a health problem” and the respondent’s primary work type
We found that an increasing number of physical chronic conditions was independently associated with an increased number of sick leave days
Summary
The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China. A recent nationally representative Chinese study, based on 11 physical chronic conditions, found that the prevalence of multimorbidity increased from 51% in those aged 50–54 years to 71% for those aged 75 years and above [12]. The rising burden of chronic conditions and mental disorders poses a substantial threat to household welfare through increased out-of-pocket (OOP) health expenditures and reduced productivity and income. There exist inequalities in accessing and using health care and receiving financial protection between rural and urban populations [18, 19]
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