Occurrence and inequalities by education in multimorbidity in Brazilian adults between 2013 and 2019: evidence from the National Health Survey

Abstract

Objective: The aims of this study were: 1) to estimate the prevalence of multimorbidity in 2013 and 2019 in adults aged 20–59 years; 2) to assess inequalities in the prevalence of multimorbidity in 2013 and 2019 according to educational level. Methods: Data from two cross-sectional surveys from the Brazilian National Health Survey in 2013 and 2019 were used. Multimorbidity was assessed from 14 lifetime self-reported morbidities (except back problems) and defined using the cutoff point of ≥2 diseases. The prevalence of multimorbidity and individual morbidities were described according to gender, age, skin color, and education. For education, crude, and relative inequalities in prevalence of multimorbidity were calculated using the Slope Index of Inequality and the Concentration Index, respectively. Results: The prevalence of multimorbidity increased from 18.7% (95%CI 18.0–19.3) in 2013 to 22.3% (95%CI 21.7–22.9) in 2019, being higher among women and adults between 30–59 years in both periods. Asthma/bronchitis, depression, and back problems were the conditions that increased the most in the study period. Absolute and relative inequalities by education status were observed in the study period, with worse multimorbidity profiles among the less educated. Conclusion: The prevalence of multimorbidity increased between 2013 and 2019. Inequalities in the prevalence of multimorbidity were observed according to educational level.

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

“…On the other hand, inequalities were absent among women. Unlike the latter study and corroborating the present findings, Delpino et al [ 34 ] found that, for both absolute and relative inequalities, multimorbidity was more concentrated among Brazilian adults with lower educational level in 2013 SII -11.2 (IC95% -13.6; -8.7); CI -0.07 (95% CI -0.09; -0.05) and in 2019 [SII -10.1 (IC95% -12.2; -7.9)]. ; CI -0.05 (95% CI -0.07; -0.04).…”

“…Previous studies using either the SII or CI to evaluate inequalities in multimorbidity used a different combination of diseases and a variety of socioeconomic position measures [i.e. asset index [ 21 , 31 ], income [ 32 ], purchasing power [ 33 ] and schooling [ 33 , 34 ]] making it difficult a direct comparison between the results. In most of the countries evaluated in these studies [ 21 , 31 , 32 , 34 ], the concentration index was negative as in the present study, thereby demonstrating a pro-poor inequality, where the prevalence of multimorbidity is highly concentrated among the poor.…”

“…asset index [ 21 , 31 ], income [ 32 ], purchasing power [ 33 ] and schooling [ 33 , 34 ]] making it difficult a direct comparison between the results. In most of the countries evaluated in these studies [ 21 , 31 , 32 , 34 ], the concentration index was negative as in the present study, thereby demonstrating a pro-poor inequality, where the prevalence of multimorbidity is highly concentrated among the poor. None of the studies exclusively investigated older adults.…”

“…In Brazil, two previous studies used both of these measures of inequalities and found opposite results [ 33 , 34 ]. Findings from a nationwide sample of Brazilian adults, aged 20 to 59 years [ 33 ] reported pro-rich absolute and relative inequality by purchasing power and education among adult men.…”

“…The magnitude of absolute inequalities was higher than the relative ones and the findings also suggest that they are smaller than the ones observed among Brazilian adults in the same year [ 34 ]. These differences may rely on the fact that the prevalence of multimorbidity is higher among older adults which has a direct impact on the estimated indexes.…”