The association between multimorbidity and health-related quality of life: a cross-sectional survey among community middle-aged and elderly residents in southern China

Relative importance of selected predictors of health-related quality-of-life (HRQOL) among U.S. adults

PURPOSE

Many factors have been associated with health-related quality of life (HRQOL), and researchers often have tried to rank these contributing factors. Variable importance quantifies the net independent contribution of each individual predictor in a set of predictors to the prediction accuracy of the outcome. This study assessed relative importance (RI) of selected contributing factors to respondents' physically unhealthy days (PUD), mentally unhealthy days (MUD), activity limitation days (ALD), and EuroQol EQ-5D index derived from the Healthy Days measures (dEQ-5D).

METHODS

Using data from the 2021 Behavioral Risk Factor Surveillance Systems (BRFSS), we estimated the RI of seven socio-demographics and seventeen chronic conditions and risk behaviors. A variable's importance was measured as the average increase in the coefficient of determination after adding the variable to all possible sub-models.

RESULTS

After controlling for socio-demographics, arthritis and no physical activity were the most important variables for PUD with a RI of 10.5 and 10.4, respectively, followed by depression (RI = 8.5) and COPD (RI = 8.3). Depression was the most important variable for MUD with RI = 23.0 while all other 16 predictors had a RI < 7.0. Similar results were observed for ALD and dEQ-5D: depression was the most important predictor (RI = 16.3 and 15.2, respectively), followed by no physical activity, arthritis, and COPD (RI ranging from 7.1 to 9.2).

CONCLUSION

This study quantified and ranked selected contributing factors of HRQOL. Results of this analysis also can be used to validate HRQOL measures based on domain knowledge of HRQOL.

Multimorbidity patterns and health-related quality of life among community-dwelling older adults: evidence from a rural town in Suzhou, China

PURPOSE

The high prevalence of multimorbidity in aging societies has posed tremendous challenges to the healthcare system. The aim of our study was to comprehensively assess the association of multimorbidity patterns and health-related quality of life (HRQOL) among rural Chinese older adults.

METHODS

This was a cross-sectional study. Data from 4,579 community-dwelling older adults aged 60 years and above was collected by the clinical examination and questionnaire survey. Information on 10 chronic conditions was collected and the 3-Level EQ-5D (EQ-5D-3L) was adopted to measure the HRQOL of older adults. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of multimorbidity patterns with specific health dimensions and overall HRQOL.

RESULTS

A total of 2,503 (54.7%) participants suffered from multimorbidity, and they reported lower HRQOL compared to those without multimorbidity. Three kinds of multimorbidity patterns were identified including cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases. The associations between psycho-cognitive diseases/organic diseases and overall HRQOL assessed by EQ-5D-3L index score were found to be significant (β = - 0.097, 95% CI - 0.110, - 0.084; β = - 0.030, 95% CI - 0.038, - 0.021, respectively), and psycho-cognitive diseases affected more health dimensions. The impact of cardiovascular-metabolic diseases on HRQOL was largely non-significant.

CONCLUSION

Multimorbidity was negatively associated with HRQOL among older adults from rural China. The presence of the psycho-cognitive diseases pattern or the organic diseases pattern contributed to worse HRQOL. The remarkable negative impact of psycho-cognitive diseases on HRQOL necessiates more attention and relevant medical assistance to older rural adults.

The relationship between health literacy and health-related quality of life in Chinese older adults: a cross-sectional study

Background

This study aimed to examine the relationship between health literacy and health-related quality of life in older adults.

Methods

A cross-sectional survey design was used. We used a self-administered questionnaire to assess sociodemographic factors of older adults, the Chinese Citizen Health Literacy Questionnaire (HLQC) and the 36-item Chinese version of the Short Form 36 (SF-36) to measure health literacy and quality of life, respectively, among older adults. Between September 2011 and June 2012, information was collected from 1,396 older adults in 44 nursing homes in four cities through face-to-face interviews.

Results

The mean health literacy level of older adults in nursing homes was relatively low (71.74 ± 28.35). Health-related quality of life scores were moderate (104.77 ± 16.92). There were statistically significant differences in the effects of health literacy, education level, former occupation (professional), marital status (widowed) and race on health-related quality of life.

Conclusion

Improving health literacy is considered an important intervention to promote health-related quality of life in older adults in nursing homes.

Exploration of subgroups and predictors of loneliness among older adults in rural China: A latent profile analysis

BACKGROUND

Loneliness is a negative emotional state that can lead to physical and mental health problems. This study's objective was to acquire an in-depth understanding of the heterogeneity and the predictors of loneliness among older adults in rural China and provide valuable references for practical interventions.

METHODS

Older rural adults in China (N = 680) were recruited between January and April 2023. Latent profile analysis (LPA) was employed to identify subgroups of loneliness among participants. Single-factor and multinomial logistic regression analyses were conducted to investigate predictors of loneliness.

RESULTS

The loneliness of rural older adults could be divided into three subgroups: low interaction loneliness group (55.0%), moderate emotional loneliness group (31.8%), and high loneliness group (13.2%). The subgroup predictors included age, gender, religious beliefs, marital status, living alone, number of chronic diseases, and smartphone use (P < 0.05).

CONCLUSION

This study identified a classification pattern for loneliness among older adults in rural areas of China, revealed the characteristics of different demographic variables in loneliness categories, and highlighted the heterogeneity of loneliness in this population. It serves as a theoretical reference for formulating intervention plans aimed at addressing various loneliness categories for local rural older adults.

CLINICAL TRIAL REGISTRATION

ChiCTR2300071591.

Association between Multimorbidity and Psychological Distress among Older Adults in India: The Moderating Role of Elder Abuse

OBJECTIVES

In this study, we examine the association between multimorbidity and psychological distress and to what extent elder abuse mediates the association.

METHODS

We analyzed cross-sectional nationally representative data from the "Building Knowledge Base on Population Ageing in India (BKPAI)." Multivariate logistic regression was used to understand the association between multimorbidity and psychological distress. We used Karlson-Holm- Breen (KHB) method to understand the role of elder abuse in mediating the association between multimorbidity and psychological distress.

RESULTS

Older adults who ever experienced abuse (OR = 1.92 95%CI = 1.62, 2.26, p < .001) or in last one month (OR = 2.09 95%CI = 1.65, 2.64, p < .001) reported higher odds of psychological distress. Further, older adults with four or more chronic diseases are thrice more likely to report psychological distress (OR = 3.03 95%CI = 2.38, 3.82, p < .001). The results further suggest the mediating role of abuse on the association between multimorbidity and psychological distress.

CONCLUSIONS

The results suggest the role of elder abuse on the association between multimorbidity and psychological distress among older population in India.

CLINICAL IMPLICATIONS

Creating an environment to reduce the abuse among older adults who have multimorbidity will be essential to reducing the psychological distress among older adults in India.

Trajectories of quality of life and cognition in different multimorbidity patterns: Evidence from SHARE

OBJECTIVES

The study aimed to observe the trajectory of quality of life (QoL) and cognition, and to a analyze the bidirectional association between cognition and QoL for diverse multimorbidity patterns.

METHODS

In total, 16,153 older participants age ≥50 years were included from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used latent class analysis (LCA) to identify multimorbidity patterns in the baseline population. We used linear mixed models (LMM) to examine the trajectory of cognition and QoL in different multimorbidity patterns. A cross-lagged model was employed to analyze the bidirectional association between cognition and QoL in diverse multimorbidity patterns.

RESULTS

Latent class analysis identified four multimorbidity patterns: high and low comorbidity burden (HC and LC), cardiometabolic (CA), and osteoarthrosis (OS). The HC group had the poorest cognitive function and QoL (p for trend < 0.001). Delayed and immediate episodic memory in the OS group declined at a highest rate (p for trend < 0.001). Additionally, a bidirectional association between cognition and QoL was observed. The effect of cognitive function on QoL was relatively stronger than the reverse in the CA and LC groups.

CONCLUSIONS

The rate of decline in cognition and QoL over the time differs in diverse multimorbidity patterns, and patients with four or more chronic diseases should be specially considered. Notably, early monitoring of cognitive function and can help break the vicious cycle between cognitive deterioration and poor QoL in patients with OS or CA diseases.

Relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases: mediating effects of death anxiety

BACKGROUND

Many studies have explored the relationship between self-esteem and quality of life. However, few studies have elucidated the mechanisms underlying the relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases. The present study aimed to explore the mediating role of death anxiety in this relationship.

METHODS

Middle-old-aged patients with chronic diseases were selected as the respondents by using a multi-stage sampling method, random number table method from October 2021 to February 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine. The Cumulative Disease Rating Scale, the Self-Esteem Scale (SES), the Chinese version of the Death Anxiety Scale (CT-DAS), and the Simplified version of the Quality of Life Scale (SF-12) were used as the researching tools to conduct the survey. SPSS26.0 was used to analysis data. AMOS 23.0 software was used to construct structural equation modeling.

RESULTS

294 valid questionnaires were collected. There were significant differences in quality of life among middle-aged and elderly patients with chronic diseases who have different physical activities, socialization, and chronic pain (P < 0.01); Self-esteem was positively associated with quality of life (r = 0.330, P < 0.01), self-esteem was negatively associated with death anxiety (r = -0.222, P < 0.01), and death anxiety was negatively associated with quality of life (r = -0.263, P < 0.01); Death anxiety partially mediated the relationship between self-esteem and quality of life, with the mediating effect accounting for 18.40% of the total effect.

CONCLUSION

Death anxiety partially mediates the relationship between self-esteem and quality of life. Interventions to improve self-esteem and reduce death anxiety should be used to improve the quality of life of middle-aged and senior patients with chronic diseases.

Psychosocial factors associated with health-related quality of life in patients with chronic disease: Results of a cross-sectional survey

OBJECTIVE

The impact of various psychosocial factors (sense of coherence, illness perception, patient enablement, self-efficacy, health literacy, personality) is not fully understood across a wide range of chronic diseases, and in particular in patients with multimorbidity. As such, this study assessed the key psychosocial factors associated with impaired health-related quality of life (HRQoL) in patients with one or more chronic diseases based on cross-sectional data collected in Flanders (Belgium).

METHODS

Cross-sectional data on 544 chronically ill patients were analysed. Multiple linear regression models were built to analyze the key psychosocial factors associated with HRQoL (EQ-5D-5Lindex as dependent factor).

RESULTS

Overall, the strongest independently associated factor with HRQoL was illness perceptions (β = -0.52, P < 0.001). In addition, sense of coherence (β = 0.14, P = < 0.05) was independently positively associated with HRQoL. Moreover, after stratification for multimorbidity, the negative association of illness perceptions with HRQoL was stronger when multimorbidity is present compared to when it is absent (β = -0.62, P < 0.001 vs β = -0.38, P < 0.001).

CONCLUSIONS

This study revealed interesting associations of the modifiable psychosocial factors of illness perceptions and sense of coherence with HRQoL in a population of chronically ill persons. Given that the burden of chronic diseases will rise in the next decades, designing and implementing interventions that enhance these psychosocial abilities of patients, especially illness perceptions in multimorbid patients, is needed in order to reduce the burden of chronic diseases in terms of impaired HRQoL.

Social factors of health-related quality of life in older adults: a multivariable analysis

PURPOSE

The objective of the analysis was to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental health-related quality of life (HRQOL) in older adults.

METHODS

The analysis was based on recent cross-sectional data of 1687 community residents from a whole population postal survey of German adults aged 65 years and older (33% response rate, 52% female, mean age 76 years). HRQOL was assessed using the 36-Item Short Form Survey (SF-36v2). For a differentiated analysis, hierarchical multiple linear regressions were performed.

RESULTS

An internal health locus of control, physical activity, social support, and income were positively associated with physical HRQOL (Adj. R2 = 0.34; p < 0.001) and mental HRQOL (Adj. R2 = 0.18; p < 0.001), whereas an external health locus of control and age were negatively associated with both. Alcohol use and educational level were positively associated only with physical HRQOL, whilst female gender was negatively associated only with mental HRQOL.

CONCLUSION

Sociodemographic, socioeconomic, psychosocial, and behavioural factors were associated with physical and mental HRQOL. These results highlight the importance of social factors in HRQOL and provide approaches for policy and practice to develop and implement tailored health interventions for older adults. Our findings may be transferable to municipalities in metropolitan areas of high-income European countries.

CLINICAL TRIAL REGISTRATION

Not applicable.

Spanish version of the self-care self-efficacy scale: A validation study in community-dwelling older adults with chronic multimorbidity

OBJECTIVE

To test the psychometric properties of the Spanish version of the Self-Care Self-Efficacy Scale (SCSES-Sp) in community-dwelling older adults with chronic multimorbidity.

METHODS

A sample of 1013 community-dwelling older adults with chronic multimorbidity participated in an observational cross-sectional study that was carried out in 3 phases.

RESULTS

Confirmatory factor analysis showed that the SCSES-Sp has 4 dimensions: "self-efficacy in self-care behaviours based on clinical knowledge", "self-efficacy in self-care maintenance", "self-efficacy in self-care monitoring", and "self-efficacy in self-care management". A panel of independent experts considered the content of the SCSES-Sp valid. Convergent validity analysis showed moderate-strong correlations between all of the SCSES-Sp's dimensions and the reference criteria chosen. Reliability was good for the SCSES-Sp and all its dimensions. Test-retest reliability analysis showed that the SCSES-Sp was temporally stable.

CONCLUSIONS

The SCSES-Sp is a valid and reliable tool to assess self-efficacy in self-care in Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

Cross-cultural adaptation and psychometric evaluation of the Thai version of Self-Care of Chronic Illness Inventory Version 4.c

Objectives

To translate and validate the Thai Self-Care of Chronic Illness Inventory version 4.c (Thai SC-CII v4.c) in individuals with chronic illnesses.

Methods

A scale translation and cross-sectional validation study was conducted. The English version was translated for Thai involved nine steps: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing and finalization, and proofreading. A cross-sectional study was conducted from July to November 2022 at 16 primary care centers in southern Thailand, involving 410 participants with at least one chronic condition. Validity assessments included structural, convergent, and discriminant validity. Concurrent validity examined correlations between SC-CII v4.c with the Self-Care Self-Efficacy Scale (SCSES) and self-perceived health. Internal coherence reliability was calculated using Cronbach's α coefficient, item-total correlation coefficients, and the composite reliability (CR) index.

Results

Thai SC-CII v4.c demonstrated excellent translational validity (κ = 0.99). The specified Self-Care Maintenance model fit well, with minor differences in health promoting behavior and illness-related behavior items compared to the original model. The original Self-Care Monitoring, and Self-Care Management models fit well with Thai data. Simultaneous confirmatory factor analysis confirmed a satisfactory fit of the full SC-CII v4.c. Convergent validity had partial support (average variance extracted = 0.23-0.51), and discriminant validity was established (heterotrait-monotrait ratios = 0.37-0.88). Concurrent validity was supported by positive correlations between each scale and overall SC-CII v.4c with SCSES (r = 0.25-0.65) and self-perceived health (r = 0.09-0.35). The Cronbach's α coefficient were adequate for all scales except the Self-Care Maintenance scale (Cronbach's α = 0.68), but the CR estimate improved the reliability of all three scales (ranging 0.80-0.82). All items had satisfactory item-total correlation coefficients (ranging 0.34-0.71), except the one pertaining to sleep.

Conclusions

The Thai SC-CII v4.c is valid and reliable for assessing self-care in various chronic illnesses. Further testing is recommended for patients with specific diseases.

Experience of living with multimorbidity and health workers perspectives on the organization of health services for people living with multiple chronic conditions in Bahir Dar, northwest Ethiopia: a qualitative study

BACKGROUND

Multimorbidity-the simultaneous occurrence of two or more chronic Non-Communicable Diseases) in an individual is increasing globally and challenging health systems. Although individuals living with multimorbidity face a range of adverse consequences and difficulty in getting optimal health care, the evidence base in understanding the burden and capacity of the health system in managing multimorbidity is sparse in low-and middle-income countries (LMICs). This study aimed at understanding the lived experiences of patients with multimorbidity and perspective of service providers on multimorbidity and its care provision, and perceived capacity of the health system for managing multimorbidity in Bahir Dar City, northwest Ethiopia.

METHODS

A facility-based phenomenological study design was conducted in three public and three private health facilities rendering chronic outpatient Non-Communicable Diseases (NCDs) care in Bahir Dar City, Ethiopia. Nineteen patient participants with two or more chronic NCDs and nine health care providers (six medical doctors and three nurses) were purposively selected and interviewed using semi-structured in-depth interview guides. Data were collected by trained researchers. Interviews were audio-recorded using digital recorders, stored and transferred to computers, transcribed verbatim by the data collectors, translated into English and then imported into NVivo V.12 software for data analysis. We employed a six-step inductive thematic framework analysis approach to construct meaning and interpret experiences and perceptions of individual patients and service providers. Codes were identified and categorized into sub-themes, organizing themes and main themes iteratively to identify similarities and differences across themes, and to interpret them accordingly.

RESULTS

A total of 19 patient participants (5 Females) and nine health workers (2 females) responded to the interviews. Participants' age ranged from 39 to 79 years for patients and 30 to 50 years for health professionals. About half (n = 9) of the participants had three or more chronic conditions. The key themes produced were feeling dependency, social rejection, psychological distress, poor medication adherence and poor quality of care. Living with multimorbidity poses a huge burden on the physical, psychological, social and sexual health of patients. In addition, patients with multimorbidity are facing financial hardship to access optimal multimorbidity care. On the other hand, the health system is not appropriately prepared to provide integrated, person-centered and coordinated care for people living with multiple chronic conditions.

CONCLUSION AND RECOMMENDATIONS

Living with multimorbidity poses huge impact on physical, psychological, social and sexual health of patients. Patients seeking multimorbidity care are facing challenges to access care attributable to either financial constraints or the lack of integrated, respectful and compassionate health care. It is recommended that the health system must understand and respond to the complex care needs of the patients with multimorbidity.

Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis

BACKGROUND

Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults.

METHODS

We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I² statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945).

FINDINGS

We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally.

INTERPRETATION

The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa.

FUNDING

None.

Healthcare Costs and Health-Related Quality of Life in Older Multimorbid Patients After Hospitalization

Objectives

We identified factors associated with healthcare costs and health-related quality of life (HRQoL) of multimorbid older adults with polypharmacy.

Methods

Using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid older people) trial, we described the magnitude and composition of healthcare costs, and time trends of HRQoL, during 1-year after an acute-care hospitalization. We performed a cluster analysis to identify groups with different cost and HRQoL trends. Using multilevel models, we also identified factors associated with costs and HRQoL.

Results

Two months after hospitalization monthly mean costs peaked (CHF 7'124) and HRQoL was highest (0.67). They both decreased thereafter. Age, falls, and comorbidities were associated with higher 1-year costs. Being female and housebound were negatively associated with HRQoL, while moderate alcohol consumption had a positive association. Being independent in daily activities was associated with lower costs and higher HRQoL.

Conclusion

Although only some identified potential influences on costs and HRQoL are modifiable, our observations support the importance of prevention before health deterioration in older people with multimorbid illness and associated polypharmacy.

Association between Sense of Loneliness and Quality of Life in Older Adults with Multimorbidity

BACKGROUND

Multimorbidity has been associated with adverse health outcomes, such as reduced physical function, poor quality-of-life (QoL), poor self-rated health.

OBJECTIVE

The association between quality of life, social support, sense of loneliness and sex and age in older adult patients affected by two or more chronic diseases (multimorbidity) was evaluated.

METHODS

Patients n. 162 with multimorbidity and living with family members.

TESTS

MMSE-Mini-Mental-State-Examination; ADL-Activities of Daily Living; Social Schedule: demographic variables; Loneliness Scale -de Jong Gierveld; Quality-of-Life-FACT-G; WHOQOL-BRIEF Social relationships.

STATISTICAL ANALYSIS

Multivariate Regression Analysis.

RESULTS

The patients with three or more diseases have worse dimensions of FACT-G total score (p = 0.029), QoL Physical-well-being (p = 0.003), Social well-being (p = 0.003), Emotional-well-being (p = 0.012), Functional-well-being (p < 0.001), than those with two. Multiple linear regression QoL: FACT_G total score, PWB, SWB, EWB, FWB as dependent variables. In the presence of multimorbidity with an increase in the patient's age FACT-G total score (B = -0.004, p = 0.482), PWB (B = -0.024, p = 0.014), SWB (B = -0.022, p = 0.051), EWB (B = -0.001, p = 0.939), FWB (B = -0.023, p = 0.013) decrease by an average of 0.1, and as the sense of solitude increases FACT-G total score (B = -0.285, p < 0.000), PWB (B = -0.435, p < 0.000), SWB(B = -0.401, p < 0.000), EWB(B = -0.494, p < 0.000), FWB(B = -0.429, p < 0.000) decrease by 0.4.

CONCLUSIONS

A sense of loneliness and advancing age are associated with bad quality-of life in self-sufficient elderly patients with multimorbidity.

IMPLICATIONS FOR PRACTICE

Demonstrating that loneliness, as well as in the presence of interpersonal relations, is predictive of worse quality of life in patients with multimorbidity helps identify people most at risk for common symptoms and lays the groundwork for research concerning both diagnosis and treatment.

The impact of depression and physical multimorbidity on health-related quality of life in China: a national longitudinal quantile regression study

The co-occurrence of mental and physical chronic conditions is a growing concern and a largely unaddressed challenge in low-and-middle-income countries. This study aimed to investigate the independent and multiplicative effects of depression and physical chronic conditions on health-related quality of life (HRQoL) in China, and how it varies by age and gender. We used two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 9227 participants aged ≥ 45 years, 12 physical chronic conditions and depressive symptoms. We used mixed-effects linear regression to assess the effects of depression and physical multimorbidity on HRQoL, which was measured using a proxy measure of Physical Component Scores (PCS) and Mental Component Scores (MCS) of the matched SF-36 measure. We found that each increased number of physical chronic conditions, and the presence of depression were independently associated with lower proxy PCS and MCS scores. There were multiplicative effects of depression and physical chronic conditions on PCS (- 0.83 points, 95% CI - 1.06, - 0.60) and MCS scores (- 0.50 points, 95% CI - 0.73, - 0.27). The results showed that HRQoL decreased markedly with multimorbidity and was exacerbated by the presence of co-existing physical and mental chronic conditions.

Multimorbidity and health-related quality of life among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia: The application of partial proportional odds model

BACKGROUND

Multimorbidity, the presence of two or more chronic non-communicable diseases (NCDs) in a given person affects all aspects of people's lives. Poor quality of life (QoL) is one of the major consequences of living with multimorbidity. Although healthcare should support multimorbid individuals to achieve a better quality of life, little is known about the effect of multimorbidity on the QoL of patients living with chronic conditions. This study aimed to determine the influence of multimorbidity on QoL among clients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia.

METHODOLOGY

A multi-centered facility-based study was conducted among 1440 participants aged 40+ years. Two complementary methods were employed to collect sociodemographic and disease related data. We used the short form (SF-12 V2) instrument to measure quality of life (QoL). The data were analyzed by STATA V.16, and a multivariate partial proportional odds model was fitted to identify covariates associated with quality of life. Statistical significance was considered at p-value <0.05.

PRINCIPAL FINDINGS

Multimorbidity was identified in 54.8% (95% CI = 52.2%-57.4%) of the sample. A significant proportion (33.5%) of the study participants had poor QoL and a quarter (25.8%) of them had moderate QoL. Advanced age, obesity and living with multimorbidity were the factors associated with poor QoL. Conversely, perceived social support and satisfaction with care were the variables positively associated with better QoL.

CONCLUSION

The magnitude of multimorbidity in this study was high and individuals living with multimorbidity had a relatively poorer QoL than those without multimorbidity. Care of people with chronic multiple conditions has to be oriented to the realities of multimorbidity burden and its implication on QoL. It is also imperative to replicate the methods we employed to measure and analyze QoL data in this study for facilitating comparison and further development of the approaches.

Community prevalence and dyad disease pattern of multimorbidity in China and India: a systematic review

BACKGROUND

Driven by the increasing life expectancy, China and India, the two most populous countries in the world are experiencing a rising burden of multimorbidity. This study aims to explore community prevalence and dyad patterns of multimorbidity in China and India.

METHODS

We conducted a systematic review of five English and Chinese electronic databases. Studies involving adults 18 years or older at a community level, which reported multimorbidity prevalence and/or patterns were included. A modified Newcastle-Ottawa Scale was used for quality assessment. Despite large heterogeneity among reported studies, a systematic synthesis of the results was conducted to report the findings.

RESULTS

From 13 996 studies retrieved, 59 studies met the inclusion criteria (46 in China, 9 in India and 4 in both). The median prevalence of multimorbidity was 30.7% (IQR 17.1, 49.4), ranging from 1.5% to 90.5%. There was a large difference in multimorbidity prevalence between China and India, with median prevalence being 36.1% (IQR 19.6, 48.8) and 28.3% (IQR 8.9, 56.8), respectively. Among 27 studies that reported age-specific prevalence, 19 studies found multimorbidity prevalence increased with age, while 8 studies observed a paradoxical reduction in the oldest age group. Of the 34 studies that reported sex-specific prevalence, 86% (n=32) observed a higher prevalence in females. The most common multimorbidity patterns from 14 studies included hypertensive diseases combined with diabetes mellitus, arthropathies, heart diseases and metabolic disorders. All included studies were rated as fair or poor quality.

CONCLUSION

Multimorbidity is highly prevalent in China and India with hypertensive diseases and other comorbidities being the most observed patterns. The overall quality of the studies was low and there was a lack of representative samples in most studies. Large epidemiology studies, using a common definition of multimorbidity and national representative samples, with sex disaggregation are needed in both countries.

PROSPERO REGISTRATION NUMBER

CRD42020176774.

The effect of subjective social status on health-related quality of life decline in urban Chinese older adults: a four-year longitudinal study from Hong Kong

Background

Improving health-related quality of life (HRQOL) is becoming a major focus of old age care and social policy. Researchers have been increasingly examining subjective social status (SSS), one’s self-perceived social position, as a predictor of various health conditions. SSS encompasses not only concrete socio-economic (SES) factors but also intangible aspects of status. This study’s main objective was to examine the association between SSS and long-term change in HRQOL in older Chinese adults.

Methods

A longitudinal Hong Kong study recruited 2934 community-dwelling adults (age > 65 years). Participants completed SF-12 physical health (PCS) and mental health (MCS) HRQOL scales. This study analyzed baseline SSS-Society (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one’s own social network) as predictors of long-term HRQOL decline. After stratifying for sex, multiple-linear-regression was performed on 4-year follow-up SF-12 PCS and MCS scores after adjusting for baseline SF-12 scores, traditional SES indicators, demographic variables, clinical conditions, and lifestyle variables.

Results

In the multivariable analyses, lower SSS-Society was associated with declines in MCS in males (β_standardized = 0.08, p = 0.001) and declines in PCS (β_standardized = 0.07, p = 0.006) and MCS (β_standardized = 0.12, p < 0.001) in females.

SSS-Community was associated with declines in PCS in males (β_standardized = 0.07, p = 0.005) and MCS in females (β_standardized = 0.14, p < 0.001).

Conclusions

SSS may be a useful supplementary tool for predicting risk of long-term HRQOL decline in older Chinese adults. Strategies to reduce perceived social inequalities may improve HRQOL in older adults.

The Impact of Multimorbidities on Catastrophic Health Expenditures among Patients Suffering from Hypertension in China: An Analysis of Nationwide Representative Data

Background: Patients with hypertension are sensitive to multimorbidities (i.e., the existence of ≥2 chronic diseases), and the related treatment can create enormous economic burdens. We sought to examine the distribution of multimorbidities, the prevalence and factors of catastrophic health expenditure (CHE), the impact of multimorbidities on CHE, and the variation in this relationship across age groups, work status, and combinations of socioeconomic status and health insurance types. Methods: Socioeconomic-related inequality associated with CHE was estimated by concentration curve and concentration index. We examined the determinants of CHE and the impact of age groups, work status, and combinations of socioeconomic groups and health insurance schemes against the relationship with multimorbidities and CHE using logistic regression. Results: 5693 (83.3%) participants had multimorbidities. In total, 49.8% of families had experienced CHE, and the concentration index was −0.026 (95% confidence interval [CI], −0.032 to −0.020). Multimorbidities were related to the increased odds of CHE (odds ratio [OR], 1.21; 95% CI, 1.18–1.25). The relationship between multimorbidities and CHE persisted across age groups, work status, and combinations of socioeconomic status and health insurance schemes. Conclusions: More than 80% of patients with hypertension had multimorbidities. The protection of health insurance schemes against financial risks is very limited.

Prevalence and patterns of multimorbidity in chronic diseases in Guangzhou, China: a data mining study in the residents' health records system among 31 708 community-dwelling elderly people

OBJECTIVES

Examination of the prevalence, influence factors and patterns of multimorbidity among the elderly people in Guangzhou, China.

DESIGN

Cross-sectional study.

PARTICIPANTS

31 708 community-dwelling elderly people aged 65 and over.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence, influence factors and patterns of multimorbidity in seven chronic conditions among the participants. A multistage, stratified random sampling was adopted for selection of health records in the residents' health records system of Guangzhou. Data mining by association rule mining analysis was used to explore the correlations and multimorbidity patterns between seven chronic diseases.

RESULTS

The prevalence of morbidity was 55.0% (95% CI 40.1% to 60.1%) and the multimorbidity was 15.2% (95% CI 12.4% to 18.4%) among the participants. Elderly, women, higher education level, being single, living in urban areas and having medical insurance were more likely to have chronic diseases and multimorbidity. Data mining by association rule mining analysis reveals patterns of multimorbidity among the participants, including coexistence of hypertension and diabetes (support: 12.5%, confidence: 17.6%), hypertension and coronary heart disease (support: 4.4%, confidence: 5.7%), diabetes and coronary heart disease (support: 1.6%, confidence: 5.7%), diabetes, coronary heart disease and hypertension (support: 1.4%, confidence: 4.4%).

CONCLUSIONS

A high prevalence of morbidity (especially on hypertension and diabetes) and a relatively low multimorbidity of chronic diseases exist in elderly people. Data mining of residents' health records will help for strengthening the management of residents' health records in community health service centres of Guangzhou, China.

Frequency and types of clusters of major chronic diseases in 0.5 million adults in urban and rural China

Background

Little is known about the frequency and types of disease clusters involving major chronic diseases that contribute to multimorbidity in China. We examined the frequency of disease clusters involving major chronic diseases and their relationship with age and socioeconomic status in 0.5 million Chinese adults.

Methods

Multimorbidity was defined as the presence of at least two or more of five major chronic diseases: stroke, ischaemic heart disease (IHD), diabetes, chronic obstructive pulmonary disease (COPD) and cancer. Multimorbid disease clusters were estimated using both self-reported doctor-diagnosed diseases at enrolment and incident cases during 10-year follow-up. Frequency of multimorbidity was assessed overall and by age, sex, region, education and income. Association rule mining (ARM) and latent class analysis (LCA) were used to assess clusters of the five major diseases.

Results

Overall, 11% of Chinese adults had two or more major chronic diseases, and the frequency increased with age (11%, 24% and 33% at age 50-59, 60-69 and 70-79 years, respectively). Multimorbidity was more common in men than women (12% vs 11%) and in those living in urban than in rural areas (12% vs 10%), and was inversely related to levels of education. Stroke and IHD were the most frequent combinations, followed by diabetes and stroke. The patterns of self-reported disease clusters at baseline were similar to those that were recorded during the first 10 years of follow-up.

Conclusions

Cardiometabolic and cardiorespiratory diseases were most common disease clusters. Understanding the nature of such clusters could have implications for future prevention strategies.

Spatiotemporal Analysis of the Prevalence and Pattern of Multimorbidity in Older Chinese Adults

Background

Multimorbidity presents an enormous problem to societal and healthcare utilization under the context of aging population in low- and middle-income countries (LMICs). Currently, systematic studies on the profile of multimorbidity and its characteristics among Chinese elderly are lacking. We described the temporal and spatial trends in the prevalence of multimorbidity and explored chronological changes of comorbidity patterns in a large elderly population survey.

Methods

Data were extracted from the Chinese Longitudinal Healthy Longevity Study (CLHLS) conducted between 1998 and 2018 in a random selection of half of the counties and city districts. All the elderly aged 65 and older were included in the survey of eight waves. We used 13 investigated chronic diseases to measure the prevalence of multimorbidity by means of geography, subpopulation, and chronological changes. The patterns of multimorbidity were assessed by computing the value of relative risk (RR indicates the likelihood of certain diseases to be associated with multimorbidity) and the observed-to-expected ratio (O/E indicates the likelihood of the coexistence of a multimorbidity combination).

Results

From 1998 to 2018, the prevalence of multimorbidity went from 15.60 to 30.76%, increasing in the fluctuation across the survey of eight waves (p_{for trend} = 0.020). Increasing trends were observed similarly in a different gender group (p_male = 0.009; p_female = 0.004) and age groups among female participants (p_~80 = 0.009; p₈₁₋₉₀ = 0.004; p₉₁₋₁₀₀ = 0.035; p_101~ = 0.018). The gap in the prevalence of multimorbidity between the north and the south was getting narrow across the survey of eight waves. Hypertension was the highest prevalent chronic condition while diabetes was most likely to coexist with other chronic conditions in the CLHLS survey. The most frequently occurring clusters were hypertension and heart disease, hypertension and cataract, and hypertension and chronic lung disease. And, the cancer, TB, and Parkinson's disease cluster took the domination of O/E rankings over time, which had a higher probability of coexistence in all the multimorbidity combinations.

Conclusions

The prevalence of multimorbidity has been increasing nationwide, and more attention should be paid to a rapid growth in the southern part of China. It demands the effective diagnosis and treatment adopted to the highly prevalent comorbidities, and strategies and measures were adjusted to strongly relevant clusters.

Persistent pain and long-term physical and mental conditions and their association with psychological well-being; data from 10,744 individuals from the Lolland-Falster health study

INTRODUCTION

Persistent pain (PP) and long-term conditions are all associated with psychological well-being. Less is known about their associations with reduced psychological well-being when co-occurring. We investigated how PP and long-term physical and mental conditions relate to psychological well-being when occurring together.

METHOD

Data collected in the Danish population-based Lolland-Falster Health study were used in this cross-sectional study. Participants aged ≥18 years completing questions concerning PP, long-term conditions and psychological well-being were included. PP and long-term conditions were defined as conditions lasting 6 months or longer. Psychological well-being was assessed by the World Health Organization Well-Being Index (WHO-5). Multiple linear regression investigated combinations of PP and physical and mental long-term conditions and their associations with WHO-5.

RESULTS

Of 11,711 participants, 10,744 had available data. One third had PP (n = 3250), while 6144 (57%), 213 (2%) and 946 (9%) reported having only physical conditions, only mental conditions or both, respectively. All combinations of PP and long-term conditions were negatively associated with WHO-5. PP in combination with mental (-23.1 (95% CI -28.3 to -17.8)) or both physical and mental conditions (-25.1 (-26.7 to -23.52) yielded the strongest negative associations. Two or more pain sites together with long-term physical and mental conditions was associated with a lower WHO-5 score (-6.2 (-8.9 to -3.5) compared to none or one pain site.

CONCLUSION

The presence of PP and long-term conditions, in particular mental conditions, were strongly associated with worse psychological well-being. This highlights the importance of assessing psychological well-being in individuals with PP and long-term conditions.

Multimorbidity is associated with fragility fractures in women 50 years and older: A nationwide cross-sectional study

INTRODUCTION

Multimorbidity is a worldwide health problem, especially in elderly patients who have a higher risk of fragility fracture. Currently, there is insufficient knowledge about the burden of multimorbidity in patients with previous fragility fracture. The aim of this study was to evaluate the association between multimorbidity and previous fragility fracture, and to assess the effect of fragility fracture and/or multimorbidity in the perception of quality-of-life and physical function, in women 50 years of age and older.

METHODS

Women aged ≥50 years from the EpiReumaPt study (2011-2013), a nationwide population-based study, were evaluated. Self-reported data regarding sociodemographics, health-related quality of life, physical functioning, fragility fracture, and multimorbidity were collected using a semi-structured questionnaire. Multimorbidity was defined as 2 or more chronic non-communicable diseases. Descriptive exploratory analysis of the data was performed using hypothesis testing. Multiple logistic regression modelling was used to assess the association between multimorbidity and fragility fractures, and linear regression was used for the quality-of-life and physical function outcomes.

RESULTS

The estimated prevalence of fragility fracture in women older than 50 years was 17.5%. A higher prevalence of multimorbidity (74.6%) was found in the group of women with previous fragility fracture than in those without previous fragility fracture. Multivariate logistic regression analysis revealed that women with multimorbidity had a higher odds of fragility fracture (adjusted odds ratio, 1.38; 95% confidence interval, 1.12-1.69), compared with women with 1 or no self-reported non-communicable chronic diseases. In women with previous fragility fracture, rheumatic diseases (62.7%) and hypertension (58.6%) were the most frequently self-reported non-communicable chronic diseases. The combination of fragility fracture and multimorbidity was associated with a lower quality of life and higher degree of disability.

CONCLUSIONS

Women 50 years and older with multimorbidity had a significantly increased odds of fragility fracture. Fragility fracture combined with multimorbidity was negatively associated with quality of life and positively associated with disability. This study emphasizes the need to redesign health services to care for patients to prevent non-communicable chronic diseases and fragility fracture, particularly in women 50 years and older, in whom these diseases are likely to potentiate the risk of fragility fracture.

Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.

Predictors of Quality of Life Among People Living With Multimorbidity in Karachi, Pakistan: A Cross-Sectional Study

Introduction

Multimorbidity is defined as the coexistence of more than one chronic condition in one individual. It is related to enhanced rates of disability and mortality, enhanced disease burden, decreased function levels, and it can affect the wellbeing and daily activities of people, including loss of autonomy and independence. The aim of the current study is to determine the predictors of quality of life among patients with multimorbidity in Karachi, Pakistan.

Methodology

It was a cross-sectional study conducted in 12 health care facilities of six districts in Karachi, Pakistan. Two health care facilities were selected from each district using a convenient sampling technique. The total sample size of this study was 690, equally distributed among 12 health care facilities.

Results

The majority of participants (33.47%) belonged to the age group of 40 to 49 years, while 29.85% of participants had an age between 30 to 39 years. More than half of the participants were females (50.87%). Overall, the multivariate analysis showed being male, married, younger, high educational status and employed were positively associated with quality of life. While having lower family income is negatively associated with quality of life.

Conclusion

The findings of this study had important implications for identifying distinct multimorbidity individuals who were at risk of a lower quality of life, and they emphasized the need for disease detection and treatment at an early stage. The study can also give important evidence for decision-makers when it comes to allocating health resources more efficiently, and health administrative departments can improve chronic disease management.

Associations between depressive symptoms, anxiety symptoms, their comorbidity and health-related quality of life: a large-scale cross-sectional study

Background

There were few studies exploring the associations between depressive symptoms, anxiety symptoms and health-related quality of life (HRQoL) in the general population, especially in resource limited area. The aims of this study were to assess the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL in rural area.

Methods

A total of 23,496 eligible participants from Henan rural cohort were included. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were employed to assess depressive and anxiety symptoms, respectively. HRQoL was measured via European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). Tobit regression and generalized linear model were utilized to explore the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL.

Results

A total of 1320 individuals were identified as depressive symptoms with a prevalence rate of 5.62%, while 1198 participants were classified as anxiety symptoms with a prevalence rate of 5.10%. After multiple adjustment, the regression coefficients (β) and 95% confidence interval (CI) of utility index for depressive and anxiety symptoms were − 0.166 (− 0.182, − 0.149) and − 0.132 (− 0.149, − 0.114), respectively. The β and 95% CI of VAS score for depressive and anxiety symptoms were − 7.65 (− 8.60, − 6.70) and − 5.79 (− 6.78, − 4.80), respectively. Additionally, the comorbidity was strongly associated with low utility index and VAS score. These findings were observed robustly in men and women.

Conclusion

Depressive symptoms, anxiety symptoms and their comorbidity were associated with low HRQoL in rural population, which needed further efforts on preventive and treatment interventions.

Clinical trial registration

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11969-1.

The Determinants of Living with Long-Term Conditions: An International Cross-Sectional Study

It is essential that healthcare and social professionals understand the daily lives of people with chronic diseases, and the variables that influence them. The aim of this study was to identify the determinants influencing the process of living with long-term conditions. To investigate this, an observational, international, cross-sectional study was carried out. A consecutive sample of 1788 Spanish-speaking population living with chronic obstructive pulmonary disease, chronic heart failure and type 2 diabetes mellitus were included. Descriptive statistics and multiple linear regression models were performed. The linear regression models identified that social support (β = 0.39, p < 0.001) and the satisfaction with life (β = 0.37, p < 0.001) were the main determinants in the process of living with a long-term condition (49% of the variance). Age (β = -0.08, p = 0.01) and disease duration (β = 0.07, p = 0.01) were determinants only in the chronic heart failure subgroup, and country was significant in the chronic obstructive pulmonary disease subgroup (β = -0.15, p = 0.002). Satisfaction with life and social support were key determinants influencing the process of living with long-term conditions. As such, those aspects should be included in the design of interventions focused on the achievement of a positive living in people with long-term conditions.

Reference data among general population and known-groups validity among hypertensive population of the EQ-5D-5L in Vietnam

Purpose

This study aims to provide EQ-5D-5L population norms among the general population in Vietnam and to test EQ-5D-5L’ construction validity among people living with hypertension there.

Methods

Descriptive statistics of the five dimensions and five levels, EQ-VAS and EQ-5D-5L indexes were categorised into gender and age groups for the EQ-5D-5L population norms. Known-groups testing was set for lower EQ-5D-5L outcomes among people who were aware of their hypertensive status, females, people with more comorbidities, less education, older ages, and higher body mass indexes. Level of confident interval was 95%.

Results

The mean EQ-VAS and EQ-5D-5L indexes were 81.10 (SD: 13.35) and 0.94 (SD: 0.09) among the general population. The EQ-5D-5L outcomes were better among younger people, males, people with more education, employees, and single people. Respondents reported fewer problems with self-care and usual activities and tend to have problems at higher levels across older ages. The known-group testing showed statistically significant results. The mean EQ-VAS and EQ-5D-5L indexes of people in the diagnosed hypertensive group (71.48 and 0.94, respectively) were statistically significantly smaller than they were in the non-hypertensive and undiagnosed hypertensive group (76.65 and 0.97; 76.95 and 0.96 accordingly). Statistically significant associations of lower EQ-5D-5L indexes and EQ-VAS were found among people diagnosed for hypertension, people suffering from an incremental comorbidity, and obese people.

Conclusion

This study has provided EQ-5D-5L population norms for the general population and evidence for known-groups validity of the EQ-5D-5L instrument among hypertensive people in Vietnam.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02959-2.

Multimorbidity in the elderly in China based on the China Health and Retirement Longitudinal Study

This study aimed to investigate the spatial distribution and patterns of multimorbidity among the elderly in China. Data on the occurrence of 14 chronic diseases were collected for 9710 elderly participants in the 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). Web graph, Apriori algorithm, age-adjusted Charlson comorbidity index (AAC), and Spatial autocorrelation were used to perform the multimorbidity analysis. The multimorbidity prevalence rate was estimated as 49.64% in the elderly in China. Three major multimorbidity patterns were identified: [Asthma/Chronic lungs diseases]: (Support (S) = 6.17%, Confidence (C) = 63.77%, Lift (L) = 5.15); [Asthma, Arthritis, or rheumatism/ Chronic lungs diseases]: (S = 3.12%, C = 64.03%, L = 5.17); [Dyslipidemia, Hypertension, Arthritis or rheumatism/Heart attack]: (S = 3.96%, C = 51.56, L = 2.69). Results of the AAC analysis showed that the more chronic diseases an elderly has, the lower is the 10-year survival rate (P < 0.001). Global spatial autocorrelation showed a positive spatial correlation distribution for the prevalence of the third multimorbidity pattern in China (P = 0.032). The status of chronic diseases and multimorbidity among the elderly with a spatial correlation is a significant health issue in China.

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Background

Assessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China.

Methods

The cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods.

Results

In 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (− 46.11% in outpatient, −76.56% in inpatient).

Conclusion

There were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10879-6.

Chronic disease multimorbidity among the Canadian population: prevalence and associated lifestyle factors

Background

Chronic diseases is increasingly becoming one of the most pressing public health concerns in most part of the world, including the Canadian population. The purpose of this study was to estimate the prevalence of multimorbidity in the general population based on 14 major chronic diseases and examine associations with lifestyle/behavioral factors.

Methods

The data source was the 2015–2016 Canadian Community Health Survey (CCHS). The CCHS is a cross sectional, complex multi-stage survey based on information collected from 109,659 participants aged 12+, covering all provinces and territories. Multimorbidity was defined as the co-occurrence of two or more chronic diseases within a person. Multiple logistic regression was used to examine the key determinants of multimorbidity.

Results

The prevalence of multimorbidity was 33 %. Adjusting for sociodemographic variables, there was an increased odd of multimorbidity for those having a sedentary lifestyle (AOR = 1.06; CI:1.01–1.11) and being obese (AOR = 1.37; CI:1.32–1.43) or overweight (AOR = 2.65; CI: 2.54–2.76). There were two statistically significant interactions, between sex and smoking, and between immigration status and alcohol intake. Smoking was more strongly associated with multimorbidity in females than males. The association between alcohol intake and multimorbidity was also dependent upon immigration status.

Conclusions

Given the high prevalence of multimorbidity among the general Canadian population, policy makers and service providers should give more attention to the behavioral/lifestyle factors which significantly predicted multimorbidity. Policy and program efforts that promote a healthy lifestyle should be a priority.

Prevalence and Patterns of Comorbidity Among Middle-Aged and Elderly People in China: A Cross-Sectional Study Based on CHARLS Data

INTRODUCTION

Under the background of the accelerated aging of the population, comorbidity in the elderly has gradually become a social problem. At present, the related studies on chronic diseases are mainly focused on a single disease. This study aimed to investigate the prevalence of common chronic diseases, the conditions and patterns of comorbidity in middle-aged and elderly people in China.

METHODS

We extracted the data from China Health and Retirement Longitudinal Study (CHARLS). A total of 14 diseases were included, and the prevalence was assessed by self-report. We calculate different disease combinations and perform descriptive statistics analysis of chronic disease and comorbidity status.

RESULTS

Among the 6754 subjects, 2833 (42.0%) people had at least one chronic disease, and 1138 (17.0%) people had two or more diseases at the same time. The top three diseases of prevalence were hypertension (15.4%), arthritis or rheumatism (11.0%), and stomach or digestive diseases (9.3%). Common dual disease combinations were hypertension and dyslipidemia, hypertension and arthritis or rheumatism, arthritis or rheumatism and stomach or digestive diseases.

CONCLUSION

Comorbidity is common in the population, and the pattern of chronic disease comorbidity is complex. Hypertension exists in a variety of comorbidity patterns, and its screening and prevention should be strengthened.

The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis

Background

The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China.

Methods

Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes.

Results

After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss.

Conclusion

Mental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10414-7.

Physical frailty and health-related quality of life among Chinese rural older adults: a moderated mediation analysis of physical disability and physical activity

OBJECTIVES

The purpose of this study is to explore the mediating effect of physical disability as well as the role of physical activity (PA) as a moderator in the relationship between physical frailty and health-related quality of life (HRQoL) among rural older adults in China.

DESIGN

Cross-sectional analysis.

SETTING

Rural households in Shandong of China (Rushan, Qufu, Laolin).

PARTICIPANTS AND METHODS

A survey was conducted among 3243 rural older adults. The data were collected using questionnaires measuring physical frailty, physical disability, HRQoL and PA. Bootstrap analyses were employed to explore the mediating effect of physical disability and also the moderating role of PA on physical frailty and HRQoL.

RESULTS

After controlling for age and education, physical disability partially mediated the effect of physical frailty on HRQoL (indirect effect=-0.143, 95% CI -0.175 to -0.113), with the mediating effect accounting for 33.71% of the total effect. PA moderated the relationship between physical frailty and physical disability as well as the relationship between physical disability and HRQoL. Specifically, the interaction term between physical frailty and PA significantly predicted physical disability (β=-0.120, t=-7.058, p<0.001), and the interaction term between physical disability and PA also had a significant predictive effect on HRQoL (β=0.115, t=6.104, p<0.001).

CONCLUSIONS

PA appears to moderate the indirect effect of physical disability on the association between physical frailty and HRQoL. This study provides support for potential mechanisms in the association between physical frailty and HRQoL. Encouraging rural older adults to increase PA appropriately might improve HRQoL for older adults with physical frailty and physical disability problems.

Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

(1) Background: The management of multiple chronic diseases challenges China's health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants' HRQOL, and χ² tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old (P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases (P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants (P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants (P < 0.001), and daily tooth-brushing for middle (P < 0.05) and young-old participants (P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients (P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.

Prevalence and associated socioeconomic factors of multimorbidity in 10 regions of China: an analysis of 0.5 million adults

BACKGROUND

The epidemiology of multiple chronic conditions in China is poorly understood. We investigated the prevalence of multimorbidity among the middle-aged and elderly population in China and analyzed its demographic and socioeconomic correlates.

METHODS

Data were obtained from the baseline of the China Kadoorie Biobank Study, which recruited over 0.5 million participants between 2004 and 2008. We calculated the prevalence by the characteristics of multimorbidity. The demographic and socioeconomic correlates were analyzed using a multivariable logistic regression model.

RESULTS

15.9% of the participants were multimorbid. Although the prevalence of multimorbidity increased with age, the absolute number of people with multimorbidity was much higher among middle-aged adults (30-60 years, n = 42 041) than the elderly group (>60 years, n = 38 834). The odd of multimorbidity was higher in males (aOR =1.09, 95% CI: 1.07-1.11) and among those who were unemployed (aOR = 1.58, 95% CI: 1.55-1.62). Those who received the highest level of education were most likely to be multimorbid compared with those with no education (aOR = 1.14, 95% CI: 1.09-1.19). Such an association was similar when treating multimorbidity as multinomial variable.

CONCLUSIONS

Multimorbidity is a public health concern, with higher prevalence among the elderly, males and those who belong to a lower socioeconomic stratum. Actions are needed to curb multimorbidity epidemic in China.

Health-Related Quality of Life and Its Correlation With Depression Among Chinese Centenarians

Background: As evidence on depression and health-related quality of life (HRQoL) among the oldest-old is currently limited, this study aimed to re-examine the association between depression and HRQoL among centenarians.

Methods: We analyzed cross-sectional data from the China Hainan Centenarian Cohort Study (CHCCS). The 15-item Geriatric Depression Scale (GDS-15) and three-level EuroQol five-dimensions (EQ-5D-3L) were used to evaluate depression and HRQoL, respectively. Poor health states were defined as EQ-5D index <0.665. Based on their GDS-15 score, individuals were categorized into three stages of depression: major depressive disorder (MDD; score ≥10), minor depressive disorder (MnDD; score between 6 and 9), and normal (score ≤ 5). Based on sex and comorbidity stratification, multivariable logistic regression was used to calculate the risk of poor health state in different levels of depression. We also used restricted cubic splines with a knot at 5 points (GDS-15) to flexibly model the association of GDS-15 scores with poor health states.

Results: Totally, 1,002 participants were included in this study for analysis. Participants' median age was 102 years, and 82.04% were female. The median EQ-5D index was 0.68 (range: −0.149–1), and the mean VAS and GDS-15 scores were 61.60 (range: 0–100), and 5.23 (range: 0–15), respectively. Centenarians with MnDD and MDD accounted for 38.12 and 9.98%, respectively. While those with poor health states accounted for 45.11%. For every 1-point increase in GDS-15, the risk of poor health state increased by 20% (P < 0.001) after an adjustment for age, gender, ethnicity, marital status, education, residence type, smoking, drinking, weekly exercise, body mass index category, serum albumin, 25-hydroxyvitamin D, C-reactive protein, and comorbidities. MnDD and MDD were independent risk factors for poor health state (MnDD, OR = 2.76, P < 0.001; MDD, OR = 3.14, P < 0.001). The association was more prominent in centenarians without comorbidity.

Conclusions: This study demonstrated a negative association between depression and HRQoL in Chinese centenarians, especially in centenarians without comorbidity. Large-scale prospective studies are needed to corroborate our findings and provide more information about the causal inference and internal mechanisms of this association.

Associations Between Nutritional Status, Sociodemographic Characteristics, and Health-Related Variables and Health-Related Quality of Life Among Chinese Elderly Patients: A Multicenter Prospective Study

Background: Studies that explore the nutritional status, sociodemographic factors, mental health variables, and physical health variables that affect the health-related quality of life (HRQoL) of elderly patients are scarce in China. Objective: This study aimed to examine the association between health-related quality of life (HRQoL) and nutritional status, sociodemographic characteristics, and health-related variables among Chinese elderly patients. Materials and Methods: Participants were recruited from six tertiary-level hospitals in six provinces or municipalities/cities throughout China from October 2018 to February 2019: a total of 9,996 participants aged 65 years and older were enrolled. The nutritional status and HRQoL were measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and the EuroQoL Five-Dimension Visual Analog Scale, respectively. BMI was taken using standard measurement protocols. Sociodemographic characteristics included age, sex, education, marital status, ethnicity, smoking, alcohol drinking, and current residence. Mental and physical health variables such as frailty and depression were assessed using validated tested instruments. Multiple linear regression analysis was used to analyze whether the nutritional status, sociodemographic characteristics, and health-related variables were associated with HRQoL. Results: According to the MNA-SF scores at the 30- and 90-day follow-up, 9.7% and 9.1% of participants were malnourished, respectively. Higher MNA-SF scores were related to higher HRQoL scores in older patients (regression coefficient; 95% confidence interval) both at the 30-day (0.660; 0.499-0.821) and 90-day (0.622; 0.434-0.809) follow-up. However, there were no significant associations between the body mass index values and HRQoL. Sociodemographic characteristics (such as age, smoking, and current residence), physical health variables (frailty, urinary function, defecation function, sleeping condition, and falling accidents in the past 12 months), and mental health variables (depression) were the main factors influencing HRQoL in this group. Conclusion: There are several factors associated with HRQoL among the population derived from this investigation of a representative sample of the Chinese hospitalized elderly population in tertiary hospitals. These findings could have major importance for the planning of "active aging" policies and programs. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.

How does multimorbidity affect middle-aged adults? A cross-sectional survey in the Singapore primary healthcare setting

Background

Multimorbidity is of increasing prevalence and importance. It has been associated with poorer health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity in the middle-aged population, defined as those aged between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore.

Methods

A cross-sectional study was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol five dimensions 3-levels questionnaire (EQ5D). We defined multimorbidity as the presence of three or more conditions, out of a list of 14 chronic conditions. The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses.

Results

The study included 297 participants, aged 40–64 years, of which 124 (41.7%) had multimorbidity. After adjusting for sociodemographic factors, participants with multimorbidity had significantly lower EQ5D UI, (β-coefficient − 0.064 (C.I -0.125, − 0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient − 0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort.

Conclusion

Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a statistically significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population.

The role of mental health and physical activity in the association between sleep quality and quality of life among rural elderly in China: A moderated mediation model

BACKGROUND

Several studies have found that poor sleep quality appeared to be negatively associated with quality of life in older adults, but the mechanism underlying this association remained unclear. In this study, we aimed to examine whether mental health mediated the association between sleep quality and quality of life among rural elderly and to explore the moderated role of physical activity between mental health and quality of life.

METHODS

Data were extracted from the baseline survey of rural elderly household health services in Shandong province, in which 3,243 older adults aged 60 years and above were included. The moderated mediation models were examined using SPSS PROCESS Version 3.4 software, in which the mediation variable was mental health, and the moderation variable was physical activity.

RESULTS

We found that mental health partially mediated the effect of sleep quality on quality of life [indirect effect = -0.158, 95% confidence intervals (CI) = -0.185, -0.133], with the mediating effect accounting for 51% of the total effect. The indirect effect was moderated by physical activity (β = 0.056, p < 0.001), and a greater effect was observed among older adults with lower level of physical activity.

LIMITATIONS

We included two mediators in one model, and interpretation of the observed associative direction was limited.

CONCLUSIONS

Physical activity moderated the indirect effect of mental health on association between sleep quality and quality of life. Encouraging the rural elderly to increase physical activity appropriately might improve the quality of life for the elderly with poor sleep quality and mental health problems.

Relationship between the Number of Noncommunicable Diseases and Health-Related Quality of Life in Chinese Older Adults: A Cross-Sectional Survey

China has the largest population of older adults, most of whom suffer from one or more noncommunicable diseases (NCDs). The harm of the number of NCDs on the health-related quality of life (HRQOL) of older adults should be taken seriously. A sample of 5166 adults, aged 60 years and older, was included in this study. The Chinese version of the World Health Organization Quality of Life-Old (WHOQOL-OLD) instrument was used to assess the HRQOL. Multiple linear regression models were established to determine the relationship between the number of NCDs and the total score and scores of each dimension of the WHOQOL-OLD scale. After adjusting for confounding factors, suffering from one NCD (B = −0.87, 95% CI = −1.67 to −0.08, p < 0.05), two NCDs (B = −2.89, 95% CI = −3.87 to −1.90, p < 0.001), and three or more NCDs (B = −4.20, 95% CI = −5.36 to −3.05, p < 0.001), all had negative impacts on the HRQOL of older adults. NCDs had significant negative impacts on the HRQOL of older adults, and as the number of NCDs increased, the HRQOL of older adults deteriorated. Therefore, we should pay attention to the prevention and management of NCDs of older adults to prevent the occurrence of multiple NCDs.