Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries

Abstract

Background: with ageing populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and health status in Europe. Methods: we used cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011-12, which included nationally representative samples of persons aged 50 and older from 16 European nations. Negative binomial and logistic regression models were used to assess the association between number of chronic diseases and healthcare utilisation, self-perceived health, depression and reduction of functional capacity. Results: overall, 37.3% of participants reported multimorbidity; the lowest prevalence was in Switzerland (24.7%), the highest in Hungary (51.0%). The likelihood of having multimorbidity increased substantially with age. Number of chronic conditions was associated with greater healthcare utilisation in both primary (regression coefficient for medical doctor visits = 0.29, 95% CI = 0.27-0.30) and secondary setting (adjusted odds ratio (AOR) for having any hospitalisation in the last year = 1.49, 95% CI = 1.42-1.55) in all countries analysed. Number of chronic diseases was associated with fair/poor health status (AOR 2.13, 95% CI = 2.03-2.24), being depressed (AOR 1.48, 95% CI = 1.42-1.54) and reduced functional capacity (AOR 2.12, 95% CI = 2.02-2.22). Conclusion: multimorbidity is associated with greater healthcare utilisation, worse self-reported health status, depression and reduced functional capacity in European countries. European health systems should prioritise improving the management of patients with multimorbidity to improve their health status and increase healthcare efficiency.

The Great Recession And Increased Cost Sharing In European Health Systems

“…[8] Evaluating the impact of cost-sharing policies is important because cost sharing could cause patients to delay seeking treatment, which in turn could lead to higher health care costs in the long term and adverse effects on health. [7,[10][11][12] The policies may have a pronounced impact on older people, who are more likely than younger ones to have chronic diseases and greater health care utilization [13] but who have limited resources to pay for health care. Out-of-pocket expenditures may reduce health system efficiency (for example, through the need for administrative systems to collect money).…”

“…[13] Respondents are nationally representative samples of people ages fifty and older in twenty European countries. The survey draws its representative samples from national or regional population registries or from multistage sampling strategies.…”

Sarcopenia, long‐term conditions, and multimorbidity: findings from UK Biobank participants

“…Multimorbidity, commonly defined as the presence of two or more long‐term conditions, is the norm among users of health care and those aged 65 and above . It is associated with a range of adverse outcomes including all‐cause mortality, increased health care costs, reduced quality of life, depression, and functional limitation . There has been comparatively little research into the overall relationship between sarcopenia and multimorbidity.…”

Ethnic inequalities in doctor-patient communication regarding personal care plans: the mediating effects of positive mental wellbeing

“…A history of chronic illness has been associated with greater healthcare utilisation, in both primary and secondary settings (Palladino et al 2016). Self perceived health has also been implicated in this context (Thomas and Borrayo 2007).…”