Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study

Abstract

ObjectivesThe study aims to evaluate the magnitude of multimorbidity in Brazilian adults, as well to measure their association with individual and contextual factors stratified by Brazilian states and regions.MethodsA national-based cross-sectional study was carried out in 2013 with Brazilian adults. Multimorbidity was evaluated by a list of 22 physical and mental morbidities (based on self-reported medical diagnosis and Patient Health Questionnaire-9 for depression). The outcome was analysed taking ≥2 and ≥3 diseases as cut-off points. Factor analysis (FA) was used to identify disease patterns and multilevel models were used to test association with individual and contextual variables.ResultsThe sample comprised 60 202 individuals. Multimorbidity frequency was 22.2% (95% CI 21.5 to 22.9) for ≥2 morbidities and 10.2% (95% CI 9.7 to 10.7) for ≥3 morbidities. In the multilevel adjusted models, females, older people, those living with a partner and having less schooling presented more multiple diseases. No linear association was found according to wealth index but greater outcome frequency was found in individuals with midrange wealth index. Living in states with higher levels of education and wealthier states was associated with greater multimorbidity. Two patterns of morbidities (cardiometabolic problems and respiratory/mental/muscle–skeletal disorders) explained 92% of total variance. The relationship of disease patterns with individual and contextual variables was similar to the overall multimorbidity, with differences among Brazilian regions.ConclusionsIn Brazil, at least 19 million adults had multimorbidity. Frequency is similar to that found in other Low and and Middle Income Countries. Contextual and individual social inequalities were observed.

Socioeconomic determinants of chronic health diseases among older Indian adults: a nationally representative cross-sectional multilevel study

“…The association between shared contextual characteristics and health outcomes have been discussed in public health literature both from developed10 18 and developing countries 19–21. Contextual factors that are an inherent part of the complexities of a community at the PSU in a multicultural country like India might have significant contribution towards individual’s health outcomes.…”

“…Among the various sociodemographic determinants impacting health inequalities, there is ample evidence recognising the gender differences in the prevalence of chronic illnesses among the elderly. Women are found to have low mortality yet reported to be highly affected by chronic illnesses and mental disorders as compared with men 9 10. Rieker and Bird11 explored biopsychosocial and evolutionary explanations to the above health paradox, from association of depression and cardiovascular diseases to role of hormones after menopause 11.…”

Estudo comparativo do perfil de idosos atendidos em um hospital terciário: ambulatório de psiquiatria geriátrica e unidade de internação psiquiátrica

“…Diversos estudos afirmam que a presença de um baixo nível de escolaridade está relacionada com maior prevalência nos transtornos mentais. 4,12,19 Sendo assim, quanto maior a reserva cognitiva, menor a possibilidade de desenvolver demência.…”

“…27,28 A frequência de multimorbidade no Brasil foi de 22,2%. 4 A prevalência de qualquer transtorno de saúde mental aumenta significativamente com o número de condições físicas. 6,29 Segundo os dados encontrados mais de um terço dos paciente apresentaram alguma comorbidade clínica, porém esta variável não se mostrou significativamente diferente entre os grupos ambulatorial e internação.…”

“…3 A multimorbidade, definida como a presença de mais de duas comorbidades clínicas em uma mesma pessoa, é um problema de saúde pública e mundial, e está associada a desfechos negativos, principalmente devido a sua alta prevalência. 4,5 Até 24,2% dos adultos brasileiros possuem multimorbidade de condições crônicas, podendo variar amplamente dependendo do perfil de cada indivíduo. 6 Estima-se que nos próximos 20 anos haverá uma expansão da morbidade, principalmente a multimorbidade, sendo a patologia mental uma das principais, podendo representar dois terços dos casos.…”