Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis

Abstract

BACKGROUND: Information about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro. DESIGN AND SETTING: We conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil. METHODS: The prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population. RESULTS: Greater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men. CONCLUSIONS: Educational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.

Multimorbidity and complex multimorbidity in Brazilian rural workers

“…Among the chronic conditions analyzed, there was a predominance of arterial hypertension and dyslipidemia, similar to other multimorbidity studies performed in Brazil [20] and in countries such as Portugal [21] and Australia [22]. These two morbidities were also more frequent in disease pattern studies conducted for the population of the United States [23] and New York State [24].…”

Multimorbidity of chronic non-communicable diseases in low- and middle-income countries: A scoping review

“…27 Most of the studies (n = 46, 60.5%) had a primary purpose of reporting the prevalence and patterns of multimorbidity. Of the total 76 studies, 52 (68.4%) were conducted in only six middle-income countries: Brazil, 27 –42 China, 43 –54 South Africa, 25,26,55 –64 India, 65 –72 Mexico 73,74 and Iran. 75,76 Studies based on multicountry data (n = 11) were based on data obtained from the World Health Organization’s (WHO’s) Study on Global Ageing and Adult Health (SAGE) and World Health Surveys.…”

“…Regarding data sources, a significant number of studies were conducted based on data primarily collected for other studies, such as the WHO's SAGE data, 25,26,55,67,68,95,96 World Health Survey data [77][78][79][80]97 or national health survey data 31,35,49,52,54,56,57,62,70,82,83,98 or other types of data such as electronic medical records. 50,58,59,73,75,76,82 Four pairs of studies used common data to answer different objectives: Chang et al 25,26 , Pati et al 69,72 , Alimohammadian et al 75,76 and Stubbs et al 78,79 Only 29 (38%) studies used data primarily collected for multimorbidity studies (Table 1).…”

Multimorbidade e uso de serviços de saúde em indivíduos com restrição de atividades habituais: Estudo Pró-Saúde

“…Cad. Saúde Pública 2019; 35 (11):e00155118 Introdução O progressivo processo de envelhecimento da população, a crescente exposição a fatores ambientais, mudanças de estilos de vida e progressos na efetividade dos cuidados de saúde levaram a um aumento na prevalência de doenças crônicas não transmissíveis (DCNT) globalmente 1,2,3 . No Brasil, assiste-se a processo similar, com deslocamento da carga de morbimortalidade dos grupos mais jovens aos mais idosos e advento de um perfil epidemiológico em que a morbidade por DCNT se tornou dominante 4 .…”

“…Nesse contexto, a multimorbidade, definida como a ocorrência de duas ou mais doenças em um mesmo indivíduo, tem sido objeto de crescente interesse 5,6,7,8,9,10,11 . Considerando a sua prevalência, gravidade, impacto na qualidade de vida e a possibilidade de manejo, a multimorbidade tem se tornado uma prioridade para a saúde pública 12 .…”