Role of social support in the relationship between financial hardship and multimorbidity-a causal mediation analysis

Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol

Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.

Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis

BACKGROUND

The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design.

METHODS

Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL.

RESULTS

Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (β =  - 6.527; Standard Error [SE] = 1.579), mental-component scale (β =  - 3.765; SE = 1.590) and short-form six-dimension utility index (β =  - 0.075; SE = 0.017).

CONCLUSION

This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.

Frequency and Correlates of Multimorbidity Among the Oldest Old: Study Findings from the Representative "Survey on Quality of Life and Subjective Well-Being of the Very Old in North Rhine-Westphalia (NRW80+)"

Purpose

Our aim was to clarify the frequency and correlates of multimorbidity among the oldest old.

Patients and Methods

We used data from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" covering participants ≥80 years living in private households and in institutionalized settings in North Rhine-Westphalia (n = 1484, mean age was 86.3 years). Multimorbidity is defined as the co-occurrence of at least two chronic conditions. Sociodemographic, lifestyle-related, and health-related (including health literacy) correlates were included in regression analysis.

Results

About 79% of the participants were multimorbid. Logistic regressions showed that the likelihood of multimorbidity significantly increased with living in a private household, having a larger network size, worse self-rated health, higher functional impairment, and more depressive symptoms, whereas the remaining sociodemographic and lifestyle-related factors as well as health literacy were not significantly associated with multimorbidity.

Conclusion

A large proportion of participants in very late life is multimorbid. Apart from health-related factors, also two sociodemographic factors (ie, living situation and network size) were associated with multimorbidity among the oldest old. This knowledge may help to identify individuals at risk for multimorbidity in very late life.

Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review

OBJECTIVE

To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity.

DESIGN

Scoping review.

METHODS

A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results.

RESULTS

A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity.

CONCLUSION

Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.