Inequalities in multimorbidity among elderly: a population-based study in a city in Southern Brazil.

Lower socioeconomic level is positively related to multimorbidity and it is possible that the clustering of health conditions carries the same association. The aim of this study was to identify prevalence of multimorbidity and clusters of health conditions among elderly, as well the underlying socioeconomic inequalities. This was a cross-sectional population-based study carried out with 60-year-old individuals. Multimorbidity was defined as the presence of 2+, 3+, 4+ or 5+ health conditions in the same individual. Schooling levels and the National Economic Index were used to investigate inequalities in the prevalence of multimorbidities among elderly. Slope and concentration indexes of inequality were used to evaluate absolute and relative differences. A factorial analysis was performed to identify disease clusters. In every ten older adults, about nine, eight, seven and six presented, respectvely, 2+, 3+, 4+ and 5+ health conditions. Three clusters of health conditions were found, involving musculoskeletal/mental/functional disorders, cardiometabolic, and respiratory factors. Higher inequalities were found the higher amount of health conditions (5+), when considering economic level, and for 3+, 4+ and 5+, when considering educational level. These findings show high multimorbidity prevalence among elderly, highlighting the persistence of health inequalities in Southern Brazil. Strategies by the health services need to focus on elderly at lower socioeconomic levels.

[1]  M. Rzewuska,et al.  Epidemiology of multimorbidity within the Brazilian adult general population: Evidence from the 2013 National Health Survey (PNS 2013) , 2017, PloS one.

[2]  T. Flores,et al.  Multimorbidity and mortality in older adults: A systematic review and meta-analysis. , 2016, Archives of gerontology and geriatrics.

[3]  J. Ayuso-Mateos,et al.  Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. , 2016, The journals of gerontology. Series A, Biological sciences and medical sciences.

[4]  Nobhojit Roy,et al.  Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition , 2015, The Lancet.

[5]  L. Facchini,et al.  Multimorbidity in older adults: magnitude and challenges for the Brazilian health system , 2015, BMC Public Health.

[6]  B. Dimitrov,et al.  Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys , 2015, BMC Public Health.

[7]  S. Basu,et al.  Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey , 2014, Journal of Epidemiology & Community Health.

[8]  B. Nunes,et al.  Desigualdades socioeconômicas no acesso e qualidade da atenção nos serviços de saúde , 2014 .

[9]  Chris Salisbury,et al.  Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies , 2014, PloS one.

[10]  Graeme Miller,et al.  Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice , 2014, BMJ Open.

[11]  Jeffrey A. Johnson,et al.  Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering , 2013, BMC Public Health.

[12]  F. Schellevis,et al.  The Prevalence of Disease Clusters in Older Adults with Multiple Chronic Diseases – A Systematic Literature Review , 2013, PloS one.

[13]  R. Nuño-Solínis,et al.  Prevalence of multimorbidity according to the deprivation level among the elderly in the Basque Country , 2013, BMC Public Health.

[14]  E. Shadmi.  Multimorbidity and equity in health , 2013, International Journal for Equity in Health.

[15]  H. Brand,et al.  Prevalence and socioeconomic correlates of chronic morbidity among elderly people in Kosovo: a population-based survey , 2013, BMC Geriatrics.

[16]  Bernadette A. Thomas,et al.  Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[17]  S. Chatterji,et al.  Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: Results from the World Health Survey , 2012, BMC Public Health.

[18]  H. van den Bussche,et al.  The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study , 2012, BMC Health Services Research.

[19]  Markus Lahtinen,et al.  Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey , 2012, BMC Public Health.

[20]  Martin Fortin,et al.  A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology , 2012, The Annals of Family Medicine.

[21]  J. Valderas,et al.  The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. , 2011, Family practice.

[22]  Bruce Bartholow Duncan,et al.  Chronic non-communicable diseases in Brazil: burden and current challenges , 2011, The Lancet.

[23]  Martin McKee,et al.  Priority actions for the non-communicable disease crisis , 2011, The Lancet.

[24]  Hendrik van den Bussche,et al.  Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany , 2011, BMC public health.

[25]  Hendrik van den Bussche,et al.  Multimorbidity Patterns in the Elderly: A New Approach of Disease Clustering Identifies Complex Interrelations between Chronic Conditions , 2010, PloS one.

[26]  Marjan van den Akker,et al.  Open Access Research Article Prevalence Estimates of Multimorbidity: a Comparative Study of Two Sources , 2022 .

[27]  M. Petticrew,et al.  Socioeconomic inequalities and oral cancer risk: A systematic review and meta‐analysis of case‐control studies , 2008, International journal of cancer.

[28]  Laura Fratiglioni,et al.  Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. , 2008, American journal of public health.

[29]  Aluísio J. D. Barros,et al.  O Mestrado do Programa de Pós-graduação em Epidemiologia da UFPel baseado em consórcio de pesquisa: uma experiência inovadora , 2008 .

[30]  Aluísio J. D. Barros,et al.  Indicador econômico para o Brasil baseado no censo demográfico de 2000 , 2005 .

[31]  E. Regidor,et al.  Measures of health inequalities: part 2 , 2004, Journal of Epidemiology and Community Health.

[32]  Martin Fortin,et al.  Multimorbidity and quality of life in primary care: a systematic review , 2004, Health and quality of life outcomes.

[33]  J. Mackenbach.  An Analysis of the Role of Health Care in Reducing Socioeconomic Inequalities in Health: The Case of the Netherlands , 2003, International journal of health services : planning, administration, evaluation.

[34]  P. Philippot,et al.  Socioeconomic inequalities in depression: a meta-analysis. , 2003, American journal of epidemiology.

[35]  J. Mackenbach,et al.  Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. , 1997, Social science & medicine.

[36]  H. Kaiser,et al.  Little Jiffy, Mark Iv , 1974 .

[37]  H. Kaiser.  A second generation little jiffy , 1970 .

[38]  M. Salive,et al.  Multimorbidity in older adults. , 2013, Epidemiologic reviews.

[39]  J. Macinko,et al.  Predictors of 10-year hospital use in a community-dwelling population of Brazilian elderly: the Bambuí Cohort Study of Aging. , 2011, Cadernos de saude publica.