Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China

Zhao, Xiaoke; Zhang, Quan; Ma, Chao; Liu, Huiying; Chen, Yan

doi:10.1016/j.archger.2023.104959

Cited by 8 publications

(10 citation statements)

References 52 publications

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“…Our study, among more than 200,000 hospitalized elderly patients, revealed that circulatory system diseases, especially hypertension and ischemic heart disease, were the most common conditions in multimorbidities. And many studies have suggested that hypertension and heart disease are the most common chronic diseases [12][13][14]. These diseases were often accompanied by endocrine, nutritional, and metabolic disorders, particularly diabetes.…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity characteristics in elderly inpatients and their associated factors in complex networks: a cross-sectional study

Zhang,

Xu,

Zhang

et al. 2024

Preprint

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Background Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the elderly in Jiangsu, China is relatively lacking. Methods We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patternsin old adults. Results The mean age of these patients was 72.0±8.7 years, and the male-to-female ratio was 1:1.53. These patients during the COVID-19 period(from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases(I10-I15)", "Other forms of heart disease(I30-I52)", "Diabetes mellitus(E10-E14)", "lschaemic heart diseases(I20-I25)" and "Cerebrovascular diseases(I60-I69)". The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by Diabetes mellitus, Other forms of heart disease, and lschaemic heart diseases(I20-I25). Conclusion In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in gerontal patients. More efforts to improve the understanding of multimorbidity patterns would help us develop new clinical and family care models.

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Section: Discussionmentioning

confidence: 99%

Multimorbidity characteristics in elderly inpatients and their associated factors in complex networks: a cross-sectional study

Zhang,

Xu,

Zhang

et al. 2024

Preprint

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“…For example, a study on middle-aged and older adults in China that used an LCA yielded 5 multimorbidity patterns: minimal disease (55.05%), arthritis (15.87%), cardiovascular disease (20.21%), lung/asthma (4.59%), and multisystem morbidity (4.29). [ 5 ] First, the cardiovascular disease group was identified, and the proportion was almost the same. Second, the arthritis group was assembled into the musculoskeletal system group in this study, and the proportion was close (13.09%).…”

Section: Discussionmentioning

confidence: 99%

“…Although no studies directly support our results, a relevant study indicates that multisystem and cardiovascular diseases significantly increase catastrophic health expenditure, [27] and the multisystem morbidity group has the highest self-treatment cost. [5] Whether based on extreme poverty or low-and middleincome poverty lines, age > 75 years, registered poor households, and biogas toilets were positively associated with HPV. However, the labor force ratio, number of adults with chronic diseases, and household endowment variables were negatively associated with HPV.…”

Section: Covariatesmentioning

confidence: 96%

“…Multimorbidity [ 1 ] is a condition where an individual has at least 2 chronic diseases. The condition is associated with many disadvantages, such as disability, [ 2 ] poor quality of life, [ 3 ] premature death, [ 4 ] increased health burden, [ 5 ] and prolonged hospital stays. [ 6 ] A few community studies showed that the prevalence of multimorbidity in adults was 15% to 43% in high-, low-, and middle-income countries [ 7 ] and 69.5% among adults aged ≥60 years in 2015 in China.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between the health poverty vulnerability and multimorbidity patterns identified with latent class analysis aged 45 years or more adults in Northwestern China: A cross-section study

Du,

Guo,

Wang

et al. 2024

Medicine

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This study aims to identify multimorbidity patterns and examine whether health poverty vulnerability (HPV) varies among adults aged 45 years or more. Data from 4338 participants were extracted from a Chinese cross-sectional study. Latent class analysis was used to identify multimorbidity patterns based on 11 self-reported chronic diseases. A 3-stage feasible generalized least-squares method was used to measure the HPV. The associations and influencing factors were analyzed using the Tobit model. The mean HPV values were 0.105 ± 0.225 and 0.329 ± 0.357, based on extreme poverty and those of low- and middle-income countries’ poverty line, respectively. Four latent multimorbidity patterns were identified, comprising hypertension (57.33%), cardiovascular diseases (19.94%), the musculoskeletal system (13.09%), and spine (9.64%). The HPV value from hypertension (coefficient [Coef] =0.03, 95% confidence interval (CI) = 0.00–0.05) was significantly higher than that of the musculoskeletal system based on extreme poverty. In addition, the HPV values for hypertension (Coef =0.08, 95% CI = 0.05–0.11), spine (Coef =0.06, 95% CI = 0.02–0.11), and cardiovascular diseases (Coef =0.07, 95% CI = 0.03–0.11) were significantly high based on low- and middle-income countries’ poverty line. Age ≥75 years, registered poor households, catastrophic medical expenditure, and toilet style were major risk factors. Although the multimorbidity pattern-induced HPV has been significant improved on extreme poverty, it still poses a very serious challenge with regard to low- to middle-income countries’ poverty line. The sensitivity analysis proved the robustness of the results. Policymakers should focus on adults with 3 multimorbidity patterns, namely, registered poor households, age ≥75 years, and catastrophic health expenditure, to adopt targeted interventions to prevent and eliminate HPV.

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“…Basu's study showed that the higher the number of chronic diseases, the higher the degree of disability (19). Other studies have also shown that multimorbidity coexistence will lead to increased dementia, and frailty in the elderly people, affecting the overall physical function and quality of life, even produce significant financial burden on healthcare systems (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Effects of multimorbidity coexistence on the risk of mortality in the older adult population in China

Huang

Zhu

et al. 2023

Front. Public Health

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BackgroundMultimorbidity coexistence is a serious public health issue affecting a significant number of older adults worldwide. However, associations between multimorbidity and mortality are rarely studied in China. We assessed the effects of multimorbidity coexistence on mortality among a nationwide sample of older adults from China.ObjectiveWe analyzed 10-year (2008–2018) longitudinal data of 12,337 individuals who took part in China, a nationwide survey of people aged 65 years and above. We used the Cox proportional hazard model to determine the effects of multimorbidity on the all-cause mortality risk. We also examined mortality risk between sex and age obtained through differential analysis.ResultsAt baseline, 30.2, 29.9, and 39.9% of participants had 0, 1, and 2 or more diseases, respectively. The cumulative follow-up of this study was 27,428 person-years (median follow-up = 2.7 years; range, 0.01–11.3 years), with 8297 deaths. The HRs (95% CIs) for all-cause mortality in participants with 1, and 2 or more conditions compared with those with none were 1.04 (0.98, 1.10) and 1.12 (1.06, 1.18), respectively. The heterogeneity analysis indicated that, the mortality risk for 80–94 years and 95–104 years group with multimorbidity coexistence is 1.12 (1.05–1.21) and 1.11 (1.01–1.23), respectively, but the mortality risk for 65–79 years group with multimorbidity coexistence was not statistically significant. The heterogeneity analysis indicated that, the mortality risk for men and women in older adults with multimorbidity coexistence is 1.15 (1.06, 1.25) and 1.08 (1.01, 1.17), respectively.ConclusionMultimorbidity coexistence is associated with an increase in an increased risk of death in older individuals, with the effect being relatively significant in those aged 80–94 years.

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Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China

Cited by 8 publications

References 52 publications

Multimorbidity characteristics in elderly inpatients and their associated factors in complex networks: a cross-sectional study

Multimorbidity characteristics in elderly inpatients and their associated factors in complex networks: a cross-sectional study

Relationship between the health poverty vulnerability and multimorbidity patterns identified with latent class analysis aged 45 years or more adults in Northwestern China: A cross-section study

Effects of multimorbidity coexistence on the risk of mortality in the older adult population in China

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