Education and income-related inequalities in multimorbidity among older Brazilian adults

Abstract

Objectives This study aimed to evaluate the existence of socioeconomic inequalities related to the prevalence of multimorbidity in the Brazilian population aged 60 and older. Methods This was a cross-sectional study with data from the last Brazilian National Health Survey (PNS) collected in 2019. Multimorbidity was the dependent variable and was defined as the presence of two or more chronic diseases. All the diseases were assessed based on a self-reported previous medical diagnosis. Education and per capita family income were the measures of socioeconomic position. Socioeconomic inequalities related to multimorbidity were assessed using two complex measures of inequality; the Slope Index of Inequality (SII) and the Concentration Index (CI). Results The prevalence of multimorbidity in Brazil was 56.5% 95% CI (55.4; 57.6) and varied from 46.9% (44.3; 49.6) in the North region to 59.3% (57.0; 61.5) in the South region. In general, individuals with higher socioeconomic positions had a lower prevalence of multimorbidity. Significant absolute and relative income inequalities were observed in the South region [SII -9.0; CI -0.054], Southeast [SII -9.8; CI -0.06], and Middle-east [SII -10.4; CI -0.063]. Absolute and relative education inequalities were significant for the country and two of its regions (Southeast [SII -12.7; CI -0.079] and South [SII -19.0; CI -0.109]). Conclusions The prevalence of multimorbidity is high in Brazil and all of its macro-regions. The significant findings concerning the inequalities suggest that the distribution of this condition is more concentrated among those with lower education and income.

Multimorbidity in older adults and its associated factors in 2010 and 2021

“…Furthermore, it is indicated that the percentage of older adults who are illiterate, dependent on ADL and IADL, and who remain in the workforce, was lower in 2021 compared to the reality observed in 2010. Similarly, in the present study, in contrast to the literature, income did not show significance regarding multimorbidity 3,15,16 . This reinforces that in the present study, educational level was a determining factor, unlike income reported by the individual.…”

“…This interrelation between factors can be corroborated by the study of Chen et al 8 which indicates that multimorbidity affects individuals with lower educational attainment more severely, with the negative impact on activities of daily living being about three times greater in individuals with lower educational attainment. Regarding education, it is recognized as a variable that consistently influences health-related aspects 7,[15][16][17] .…”

Multimorbidade em idosos e seus fatores associados em 2010 e 2021

“…Ainda, aponta-se que o percentual de idosos que não saber ler e escrever, dependentes para ABVD e AIVD e que continuam inseridos no mercado de trabalho, mostrou-se inferior em 2021 em comparação a realidade encontrada no ano de 2010. Igualmente, no presente estudo, contrapondo-se à literatura, a renda não representou significância frente a multimorbidade 3,15,16 . Reforçando que no presente estudo o nível de instrução foi determinante, diferentemente da renda referida pelo indivíduo.…”

Association between exposure to Occupational hazard factors and multimorbidity in steelworkers: A Cross-Sectional Study

“…From ndings of this study, we deduced that multimorbidity in steelworkers was substantially correlated with age, gender, smoking, alcohol use, sleep quality, BMI, educational attainment, and per capita monthly income. In particular, it is clear that the frequency of multimorbidity among steelworkers declines as economic income levels rise and that multimorbidity has a negative correlation with education level [30][31][32][33]. Multimorbidity is more likely in steelworkers as they get older, use more alcohol and tobacco, get less sleep, have higher BMI, and have a history of multiple diseases in their families.…”