The Association Between Multimorbidity, Socioeconomic Factors, And Multimorbidity-Related Excess Healthcare Use - Results From The 2014 National Health Interview Survey

Abstract

In a context of increasing aging of the population and rising number of chronic diseases, it is crucial to better understand multimorbidity and its impact. We measured the association between multimorbidity and socioeconomic factors, self-reported health status, and functional impact. Additionally, we measured the excess healthcare use (HCRU) related to multimorbidity. Our sample included all people aged above 15 years old from mainland Portugal (7,944 men and 10,260 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. We considered the following chronic conditions: hypertension, diabetes, coronary disease, stroke or myocardial infarction in the previous year, arthrosis, chronic back or neck pain, chronic obstructive pulmonary disease, asthma, allergy, kidney disease, urinary incontinence, liver cirrhosis, and depression. Multimorbidity was measured by the presence of two or more of these self-reported conditions. Linear/logistic regression models were used to assess the association between number of chronic diseases/multimorbidity and relevant factors. Overall, 42% of participants reported multimorbidity. The likelihood of having multimorbidity increased with age (OR:1.30, 95%CI:1.27-1.33) and female gender (OR:1.90, 95%CI:1.69-2.14). The number of chronic conditions and multimorbidity were associated with lower educational level, lower income, worse self-rated health status, and lower functional capacity. In addition, participants with multimorbidity reported higher HCRU, namely general practice appointments (86.9% vs. 66.5%; p<0.0001), specialist appointments (58.6% vs. 40.5%; p<0.0001), and hospital admissions (6.1% vs. 3.1%; p<0.0001) in the previous 12 months, compared with those without multimorbidity. We observed a 25% increased risk of hospitalization per additional comorbidity (OR:1.25, 95%CI:1.20-1.29). Multimorbidity is associated with key socioeconomic factors, worse health status and reduced functional capacity. It also seems to generate greater healthcare consumption, particularly hospitalizations. Given the expected rise of this condition, health systems should prioritise patients with multimorbidity as well as those at higher risk, given the identified factors.