How does Multimorbidity affect Middle-Aged Adults? A Cross-Sectional Survey in the Singapore Primary Healthcare Setting.

Abstract

Background Multimorbidity is of increasing prevalence and importance. It has been associated with poorer health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity at midlife, defined as those between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore. Methods A cross-sectional study involving 40-64 year old participants was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol 5 dimensions 3-levels questionnaire (EQ5D-3L). The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses. Results The study included 297 participants, aged 40-64 years, of which 124 (42.7%) had multimorbidity. Participants with multimorbidity had lower mean EQ5D Utilities Index (UI) and mean Visual Analogue Scale (VAS) scores (UI = 0.804 ±0.251, VAS = 64.9 ±16.8) compared to those without multimorbidity (UI = 0.871 ±0.198, VAS = 68.5 ±16.0). After adjusting for sociodemographic factors, those with multimorbidity had significantly lower EQ5D UI, (β-coefficient = -0.064 (C.I -0.125, -0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient = -0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort. Conclusion Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population.