Widening inequalities in multimorbidity? Time trends among the working population between 2005 and 2015 based on German health insurance data

Abstract

BackgroundPrevious research has produced evidence for social inequalities in multimorbidity, but little is known on how these disparities change over time. Our study investigates the development of social inequalities in multimorbidity among the middle-aged and older working population. Special attention is paid to whether differing time trends between socio-economic status (SES) groups have taken place, increasing or decreasing inequalities in multimorbidity.MethodsThe analyses are based on claims data of a German statutory health insurance company covering an observation period from 2005 to 2015. Multimorbidity prevalence risks are estimated using logistic generalized estimation equations (GEE) models. Predicted probabilities of multimorbidity prevalence are used to assess time trends in absolute social inequalities in terms of educational level, income, and occupational group.ResultsThe prevalence risks of multimorbidity rose among all SES groups and social gradients persist throughout the observation period, indicating significantly higher multimorbidity prevalence risks for individuals with lower SES. Widening absolute inequalities are found among men in terms of educational level and among women in terms of occupational groups.ConclusionsThe increases in multimorbidity prevalence among the working population are accompanied by widening social inequalities, pointing towards a growing disadvantage for men and women in lower SES groups. The rising burden and the increasing inequalities among the working population stress the importance of multimorbidity as a major public health concern.Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0815-z) contains supplementary material, which is available to authorized users.

Prevalence, characteristics, and patterns of patients with multimorbidity in primary care: a retrospective cohort analysis in Canada

“…These in-depth analyses contribute to the global research on multimorbidity,1 , 59 and identify distinct ‘types’ of multimorbidity in specific age groups of patients, and support the need for care delivery that accounts for the evolution of multimorbidity over time 60 –. 63 While beyond the scope of the current research, the findings reported in this article could be used to re-examine the potential for effective case management through a more tailored approach to multimorbidity and a more integrated set of health services.…”

Multimorbidity Development in Working People

“…The variable of occupation type was defined based on an occupation classification system developed by Blossfeld [19]. In the present study, following Tezlaff et al [10], the original 12 groups were re-categorized into four groups: highly qualified, specialist, skilled, and unskilled.…”

“…The prevalence of multimorbidity ranged from 3.0% to 30.0% [3]. Tezlaff and colleagues [10], for example, reported the prevalence rate was about 3.0 among the the working German population. The rate was lower than that obtained in a Canadian sample aged 45–49 (about 30.0%) [11].…”

“…In addition, women have been found to have a higher risk of multimorbidity than mem in many studies [1,2,3,11]. This gender difference may be responsible for women’s greater longevity [3,10] or lower SES [11]. Little is known concerning whether the difference existed after controlling for the effect of age and SES.…”

“…Female workers with chronic conditions need to manage tasks associated with symptom prevention, diagnosis, and management, as well as those related to housework, childcare, earning money, and personal care. There is evidence that the work–life burden of female workers is related to health outcomes, including musculoskeletal disease, headache, and fatigue [1,10,11,13].…”