Social Determinants of Multimorbidity Patterns in South Spain: Findings from the DEMMOCAD project

Abstract

Multimorbidity is a growing challenge, associated with reduced quality of life, increased disability, increased health care utilisation, and increased mortality. There is a need to identify associations among patterns of chronic conditions and social determinants of health in the local context of specific population groups. This work aims to respond to this gap, detecting patterns of multimorbidity and their inequalities in the province of Cadiz (South Spain). A cross-sectional study was conducted through a telephone interview in population over 50 years of age. We use Latent Class Analysis to identify patterns from 31 health chronic conditions and to detect associations with social determinants. The model derived five patterns, with an entropy of 0.728, which were as follows: ‘Relative Healthy’, ‘Cardiovascular’, ‘Musculoskeletal’, ‘Musculoskeletal and Mental’ and ‘Complex Multimorbidity’. Patterns showed significant differences in the covariates, with results in age, education, income level, and health services use being of particular interest. All four patterns with more conditions also showed lower scores on the two dimensions of SF12 scale. We also found significant differences among patterns and districts in Jerez. These results highlight the existence of social inequalities in multimorbidity at the local level that should be addressed by implementing policies targeting the most vulnerable social groups in Cadiz.