Association between marital relationship and multimorbidity in middle-aged adults: a longitudinal study across the US, UK, Europe, and China

Wang, Danyang; Li, Duanhui; Mishra, Shiva Raj; Lim, Carmen C W; Dai, Xiaochen; Chen, Shu; Xu, Xiaolin

doi:10.1016/j.maturitas.2021.09.011

Cited by 18 publications

(15 citation statements)

References 26 publications

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“…Married participants had lower odds of multimorbidity than those unmarried or without a partner. Our finding is supported by a longitudinal study aimed to assess the association between marital relationships and multimorbidity across multiple nations [ 27 ]. The health benefits of marriage could be attributed to the social and financial support received from the spouse [ 28 ].…”

Section: Discussionsupporting

confidence: 78%

Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal

et al. 2022

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Background The number of people with multimorbidity is surging around the world. Although multimorbidity has been introduced in policy and practice in developed countries, developing countries like Nepal have not considered it as a matter of public health urgency due to the lack of enough epidemiological data. Multimorbidity profoundly affects older adults’ wellbeing; therefore, it is crucial to estimate its prevalence and determinants. This study aimed to estimate the prevalence of multimorbidity among older adults in Eastern Nepal and identify its correlates. Methodology A community-based cross-sectional survey was conducted in three districts of Eastern Nepal. Data were collected between July and September 2020, among 847 Nepali older adults, aged 60 and older, where study participants were recruited through a multi-stage cluster sampling technique. Semi-structured interviews were conducted at the community settings to collect data. Logistic regression assessed correlates of multimorbidity. SAS 9.4 was used to run all statistical tests and analyses. Results More than half (66.5%) of the participants had at least one of the five non-communicable chronic conditions; hypertension (31.6%), osteoarthritis (28.6%), chronic respiratory disease (18.0%), diabetes (13.5%), and heart disease (5.3%). The prevalence of multimorbidity was 22.8%. In the adjusted model, increased age (for 70–79 years, OR: 3.11, 95% CI: 1.87–5.18; for 80 + years, OR: 4.19, 95% CI: 2.32–7.57), those without a partner (OR: 1.52, 95% CI: 1.00–2.30), residing in urban areas (OR: 1.71, 95% CI: 1.16–2.51), and distant from health center (OR: 1.66, 95% CI: 1.04–2.64) were significantly associated with multimorbidity. Conclusions This study found one in five study participants had multimorbidity. The findings will assist policymakers and stakeholders in understanding the burden of multimorbidity among the older population and identifying the groups in most need of health promotion intervention. Future interventions may include developing horizontal multimorbid approaches and multisectoral strategies specifically tailored to meet the needs of those populations.

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Section: Discussionsupporting

confidence: 78%

Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal

et al. 2022

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“…At the family and social network layer, widowhood was a risk factor for multimorbidity. It was consistent with previous studies [ 61 ], which indicates that support from a spouse is the most direct way for older adults to receive social support, while widowed older adults who suffer from psychological frustration and a smaller social network, are more likely to be multimorbidity. At the socioeconomic characteristic layer, having a primary education and below was considered to be risk factors for multimorbidity.…”

Section: Discussionsupporting

confidence: 92%

Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective

Chen

Shi

Zheng

et al. 2022

IJERPH

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(1) Background: Multimorbidity has become one of the key issues in the public health sector. This study aims to explore the patterns and health-ecological factors of multimorbidity in China to propose policy recommendations for the management of chronic diseases in the elderly. (2) Methods: A multi-stage random sampling method was used to conduct a questionnaire survey on 3637 older adults aged 60 and older in Shanxi, China. Association rule mining analysis (ARM) and network analysis were applied to analyze the patterns of multimorbidity. The health-ecological model was adopted to explore the potential associated factors of multimorbidity in a multidimensional perspective. A hierarchical multiple logistic model was employed to investigate the association strengths reflected by adjusted odds ratios and 95% confidence. (3) Results: Multimorbidity occurred in 20.95% of the respondents. The graph of network analysis showed that there were 6 combinations of chronic diseases with strong association strengths and 14 with moderate association strengths. The results of the ARM were similar to the network analysis; six dyadic chronic disease combinations and six triadic ones were obtained. Hierarchical multiple logistic regression indicated that innate personal traits (age, history of genetics, and body mass index), behavioral lifestyle (physical activity levels and medication adherence), interpersonal network (marital status), and socioeconomic status (educational level) were the common predictors of multimorbidity for older adults, among which, having no family history was found to be a relative determinant as a protective factor for multimorbidity after controlling the other covariates. (4) Conclusions: multimorbidity was prevalent in older adults and most disease combinations are associated with hypertension, followed by diabetes. This shows that diabetes and hypertension have a high prevalence among older adults and have a wide range of associations with other chronic diseases. Exploring the patterns and associated factors of multimorbidity will help the country prevent complications and avoid the unnecessary use of the health service, adopting an integrated approach to managing multimorbidity rather than an individual disease-specific approach and implementing different strategies according to the location of residence.

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“…The plausible reasons may be that women have strong perceptions of illness for their physical vulnerability ( 28 ), and the convenient accessibility of primary care facilities stimulates them to use primary outpatient care. Thirdly, as demonstrated in this study, married populations were more likely to use primary outpatient care, which was supported by a longitudinal study that assessed the relationship between marriage and multimorbidity across countries ( 54 ). The benefit of marriage is that spouses may provide adequate financial and psychological support, and promptly urge and accompany them to receive the necessary treatment ( 55 ).…”

Section: Discussionsupporting

confidence: 76%

Utilization and out-of-pocket expenses of primary care among the multimorbid elderly in China: A two-part model with nationally representative data

Chen

Liu

2022

Front. Public Health

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BackgroundMultimorbidity has become an essential public health issue that threatens human health and leads to an increased disease burden. Primary care is the prevention and management of multimorbidity by providing continuous, comprehensive patient-centered services. Therefore, the study aimed to investigate the determinants of primary care utilization and out-of-pocket expenses (OOPE) among multimorbid elderly to promote rational utilization of primary care and reduce avoidable economic burdens.MethodsThe study used data from CHARLS 2015 and 2018, which included a total of 4,384 multimorbid elderly aged 60 and above. Guided by Grossman theory, determinants such as education, gender, marriage, household economy, and so on were included in this study. A two-part model was applied to evaluate primary care utilization and OOPE intensity in multimorbid populations. And the robustness testing was performed to verify research results.ResultsPrimary care visits rate and OOPE indicated a decline from 2015 to 2018. Concerning primary outpatient care, the elderly who were female (OR = 1.51, P < 0.001), married (OR = 1.24, P < 0.05), living in rural areas (OR = 1.77, P < 0.001) and with poor self-rated health (OR = 2.23, P < 0.001) had a significantly higher probability of outpatient utilization, whereas those with middle school education (OR = 0.61, P < 0.001) and better household economy (OR = 0.96, P < 0.001) had a significantly less likelihood of using outpatient care. Rural patients (β = −0.72, P < 0.05) may have lower OOPE, while those with better household economy (β = 0.29, P < 0.05; β = 0.58, P < 0.05) and poor self-rated health (β = 0.62, P < 0.001) occurred higher OOPE. Regarding primary inpatient care, adults who were living in rural areas (OR = 1.48, P < 0.001), covered by Urban Employee Basic Medical Insurance (UEBMI) or Urban Rural Basic Medical Insurance (URBMI) (OR = 2.46, P < 0.001; OR = 1.81, P < 0.001) and with poor self-rated health (OR = 2.30, P < 0.001) had a significantly higher probability of using inpatient care, whereas individuals who were female (OR = 0.74, P < 0.001), with middle school education (OR = 0.40, P < 0.001) and better household economy (OR = 0.04, P < 0.001) had a significantly lower tendency to use inpatient care. Significantly, more OOPE occurred by individuals who were women (β = 0.18, P < 0.05) and with better household economy (β = 0.40, P < 0.001; β = 0.62, P < 0.001), whereas those who were covered by URBMI (β = −0.25, P < 0.05) and satisfied with their health (β = −0.21, P < 0.05) had less OOPE.ConclusionTo prompt primary care visits and reduce economic burden among subgroups, more policy support is in need, such as tilting professional medical staff and funding to rural areas, enhancing awareness of disease prevention among vulnerable groups and so on.

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Association between marital relationship and multimorbidity in middle-aged adults: a longitudinal study across the US, UK, Europe, and China

Cited by 18 publications

References 26 publications

Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal

Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal

Patterns and Determinants of Multimorbidity in Older Adults: Study in Health-Ecological Perspective

Utilization and out-of-pocket expenses of primary care among the multimorbid elderly in China: A two-part model with nationally representative data

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