Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study

Janković, Janko; Mirković, Momčilo; Jovic-Vranes, Aleksandra; Milićević, Milena Šantrić; Terzić-Šupić, Zorica

doi:10.1016/j.puhe.2017.11.014

Cited by 40 publications

(42 citation statements)

References 28 publications

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“…The use of secondary services, measured as utilizing hospitalisations, had a prevalence twice as high among individuals classi ed as having multimorbidity and had a different pattern with regard to sex. In general, our results are in line with the ndings of other studies, which point to a twice as high probability of hospitalisations among individuals with multimorbidity [13,[31][32][33].…”

Section: Discussionsupporting

confidence: 93%

“…In the general population, the use of health services is higher among adults with private insurance, among women and for people with a higher level of education in all years [30]. However, similar to our study, a study carried out in Serbia [31] found that having multimorbidity reduced the differences in the prevalence of medical visits in these variables, indicating a possible reduction in inequalities in the use of health services in populations with greater health needs, such as the case of people with multimorbidity.…”

Section: Discussionsupporting

confidence: 84%

“…al. (2018) [31], found a three times greater probability of having a medical consultation (OR = 3.17 in men, OR = 3.14 in women) and two times greater probability of having been hospitalised in the last 12 months (OR = 2.45 in men, OR = 1.97 in women) in the Serbian population, among individuals with multimorbidity compared to those without any condition.…”

Section: Discussionmentioning

confidence: 97%

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Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013

Souza

Braga

2020

Preprint

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Background Chronic non-communicable diseases (NCDs) are the leading cause of multimorbidity. Access to effective and equitable health services that meet NCDs’ needs is still limited in many countries. This constitutes the main barrier to coping with NCDs, especially in minimising the suffering of those who are already sick. The present study aimed to identify the relationship between multimorbidity and the use of different health services in Brazil from 1998 to 2013. Methods This is a panel study using data from the health supplement of the National Household Sample Survey of 1998, 2003 and 2008 and data from the National Health Survey carried out in 2013. Three health service utilization outcomes were considered: 1. search for health services in the last 15 days (excluding dental services), 2. medical consultation in the previous 12 months and 3. hospitalisations over the last 12 months. Multimorbidity was assessed by counting the number of morbidities from a list of 10 morbidities. Poisson regression models stratified by sex were used to estimate the crude and adjusted prevalence ratios and their respective 95% confidence intervals for each outcome of health service use and multimorbidity, per year. Results There was an increase in the prevalence of demand for health services and medical consultations in the last 12 months between 1998 and 2013, regardless of the multimorbidity classification. The prevalence of hospitalisations has decreased over the study period and increased twofold in individuals with multimorbidity. Having multimorbidity increased the use of health services for the three outcomes under the study, being more expressive among men. Conclusions This study found that individuals with multimorbidity have higher levels of use of health services and better understand the multimorbidity epidemiology. The associated impacts on the use and costs of health services can increase the quality of care provided to these patients and reduce rising health care costs.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 97%

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Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013

Souza

Braga

2020

Preprint

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“…19 It is likely due to the fact that women are better at expressing their conditions 36 and take better care of their health by checking out their illnesses with doctors. 37 In addition, multimorbidity is associated with a range of social and behavioural factors, such as lower education status, former smoking and alcohol consumption, being unmarried or divorced and lacking health insurance coverage.…”

Section: Discussionmentioning

confidence: 99%

Urban–rural disparity in prevalence of multimorbidity in China: a cross-sectional nationally representative study

2020

BMJ Open

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BackgroundTo address the neglect of depression in multimorbidity measurement and the lack of focus on rural population in previous literature about China, this paper aimed to estimate the prevalence of multimorbidity (including depressive disorders) among the country’s rural and urban population.MethodsWe used a cross-sectional design and data from a nationally representative survey conducted in 2015–2016 among Chinese people aged 45 years or older involving 19 656 participants. Multimorbidity was measured with a cut-off point of having two or more among 14 chronic illnesses. In that 13 of them were based on self-reported physician diagnosis. In addition, depressive disorders were assessed with the 10-item Centre for Epidemiologic Studies Depression Scale. The weighted prevalence of multimorbidity was calculated, with a non-response adjustment. Multivariate logistic regression was applied to analyse the relation between covariates and multimorbidity.FindingsMultimorbidity was highly prevalent (54.3%) among the studied population. Contrary to previous studies, we found the prevalence of multimorbidity to be higher among the rural dwellers (58.3%) than among the urban population (50.4%). After adjustment for covariates, rural residents had 7.5% higher odds (95% CI of OR (1.003 to 1.151)) of having multimorbidity than their urban counterparts. Above 70% of patients with any of the 14 chronic illnesses above 45 years old had multimorbidity, while 80.6%–97.9% of chronic patients had multimorbidity.InterpretationFuture health system development in China should transform from preventing and controlling non-communicable diseases as individual diseases to addressing people’s comprehensive health needs under multimorbidity. The rural population should be prioritised as they suffered more from multimorbidity than the urban population.

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“…Regarding data sources, a significant number of studies were conducted based on data primarily collected for other studies, such as the WHO's SAGE data, 25,26,55,67,68,95,96 World Health Survey data [77][78][79][80]97 or national health survey data 31,35,49,52,54,56,57,62,70,82,83,98 or other types of data such as electronic medical records. 50,58,59,73,75,76,82 Four pairs of studies used common data to answer different objectives: Chang et al 25,26 , Pati et al 69,72 , Alimohammadian et al 75,76 and Stubbs et al 78,79 Only 29 (38%) studies used data primarily collected for multimorbidity studies (Table 1).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Multimorbidity of chronic non-communicable diseases in low- and middle-income countries: A scoping review

et al. 2020

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Background: Multimorbidity is rising in low- and middle-income countries (LMICs). However, the evidence on its epidemiology from LMICs settings is limited and the available literature has not been synthesized as yet. Objectives: To review the available evidence on the epidemiology of multimorbidity in LMICs. Methods: PubMed, Scopus, PsycINFO and Grey literature databases were searched. We followed the PRISMA-ScR reporting guideline. Results: Of 33, 110 articles retrieved, 76 studies were eligible for the epidemiology of multimorbidity. Of these 76 studies, 66 (86.8%) were individual country studies. Fifty-two (78.8%) of which were confined to only six middle-income countries: Brazil, China, South Africa, India, Mexico and Iran. The majority (n = 68, 89.5%) of the studies were crosssectional in nature. The sample size varied from 103 to 242, 952. The largest proportion (n = 33, 43.4%) of the studies enrolled adults. Marked variations existed in defining and measuring multimorbidity. The prevalence of multimorbidity in LMICs ranged from 3.2% to 90.5%. Conclusion and Recommendations: Studies on the epidemiology of multimorbidity in LMICs are limited and the available ones are concentrated in few countries. Despite variations in measurement and definition, studies consistently reported high prevalence of multimorbidity. Further research is urgently required to better understand the epidemiology of multimorbidity and define the best possible interventions to improve outcomes of patients with multimorbidity in LMICs.

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Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study

Cited by 40 publications

References 28 publications

Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013

Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998–2013

Urban–rural disparity in prevalence of multimorbidity in China: a cross-sectional nationally representative study

Multimorbidity of chronic non-communicable diseases in low- and middle-income countries: A scoping review

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