The disease burden of multimorbidity and its interaction with educational level

Abstract

Introduction Policies to adequately respond to the rise in multimorbidity have top-priority. To understand the actual burden of multimorbidity, this study aimed to: 1) estimate the trend in prevalence of multimorbidity in the Netherlands, 2) study the association between multimorbidity and physical and mental health outcomes and healthcare cost, and 3) investigate how the association between multimorbidity and health outcomes interacts with socio-economic status (SES). Methods Prevalence estimates were obtained from a nationally representative pharmacy database over 2007–2016. Impact on costs was estimated in a fixed effect regression model on claims data over 2009–2015. Data on physical and mental health and SES were obtained from the National Health Survey in 2017, in which the Katz-10 was used to measure limitations in activities of daily living (ADL) and the Mental Health Inventory (MHI) to measure mental health. SES was approximated by the level of education. Generalized linear models (2-part models for ADL) were used to analyze the health data. In all models an indicator variable for the presence or absence of multimorbidity was included or a categorical variable for the number of chronic conditions. Interactions terms of multimorbidity and educational level were added into the previously mentioned models. Results Over the past ten years, there was an increase of 1.6%-point in the percentage of people with multimorbidity. The percentage of people with three or more conditions increased with +2.1%-point. People with multimorbidity had considerably worse physical and mental health outcomes than people without multimorbidity. For the ADL, the impact of multimorbidity was three times greater in the lowest educational level than in the highest educational level. For the MHI, the impact of multimorbidity was two times greater in the lowest than in the highest educational level. Each additional chronic condition was associated with a greater worsening in health outcomes. Similarly, for costs, where there was no evidence of a diminishing impact of additional conditions either. In patients with multimorbidity total healthcare costs were on average €874 higher than in patients with a single morbidity. Conclusion The impact of multimorbidity on health and costs seems to be greater in the sicker and lower educated population.

Sociodemographic Differences in Multimorbidity: A Closer Look from Indonesian Family and Life Survey

“…This finding has a different statement from a study in Indonesia, stating that multimorbidity cases increased along with respondent educational level [7]. Another study in Spain has shown that the impact of multimorbidity was two times greater than at the highest educational level [18]. However, the researchers also found that the prevalence increased in people with university/college degrees.…”

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

“…The accelerated population aging, especially in developing countries, makes multimorbidity one of the greatest challenges for health services, due to its association with functional decline [ 6 , 7 ], use of health care services [ 8 , 9 ] and mortality [ 10 – 12 ]. Among the different determinants of this condition, the impact of socioeconomic conditions has been increasingly studied with mixed results, depending on the measure of socioeconomic position and the country’s economic level [ 13 – 22 ].…”

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

“…In the present study, it was evident that not being literate is a factor significantly associated with a higher prevalence of multimorbidity among the investigated older adults in the year 2021. 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] .…”

“…In addition to health-related repercussions, a Dutch study estimated a significant increase in healthcare costs for individuals with multimorbidity compared to those with only one chronic disease 8 . Therefore, it is believed that the factors affecting health conditions and their repercussions may vary over time due to different levels of information, changes in healthcare, shifts in health policies, which would necessitate periodic reassessments of public health policies.…”