Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China

Abstract

BackgroundChina, like other countries, is facing a growing burden of chronic disease but the prevalence of multimorbidity and implications for the healthcare system have been little researched. We examined the epidemiology of multimorbidity in southern China in a large representative sample. The effects of multimorbidity and other factors on usual source of healthcare were also examined.MethodsWe conducted a large cross-sectional survey among approximately 5% (N = 162,464) of the resident population in three prefectures in Guangdong province, southern China in 2011. A multistage, stratified random sampling was adopted. The study population had many similar characteristics to the national census population. Interviewer-administered questionnaires were used to collect self-report data on demographics, socio-economics, lifestyles, healthcare use, and health characteristics from paper-based medical reports.ResultsMore than one in ten of the total study population (11.1%, 95% confidence interval (CI) 10.6 to 11.6) had two or more chronic conditions from a selection of 40 morbidities. The prevalence of multimorbidity increased with age (adjusted odds ratio (aOR) = 1.36, 95% CI 1.35 to 1.38 per five years). Female gender (aOR = 1.70, 95% CI 1.64 to 1.76), low education (aOR = 1.26, 95% CI 1.23 to 1.29), lack of medical insurance (aOR = 1.79, 95% CI 1.71 to 1.89), and unhealthy lifestyle behaviours were independent predictors of multimorbidity. Multimorbidity was associated with the regular use of secondary outpatient care in preference to primary care.ConclusionsMultimorbidity is now common in China. The reported preferential use of secondary care over primary care by patients with multimorbidity has many major implications. There is an urgent need to further develop a strong and equitable primary care system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0188-0) contains supplementary material, which is available to authorized users.

What Contributes to the Regularity of Patients with Hypertension or Diabetes Seeking Health Services? A Pilot Follow-Up, Observational Study in Two Sites in Hubei Province, China

“…Current evidence posits that having a usual source of care will translate into a trustful and satisfactory relationships between PLCDs and their providers [35]. A recent community-based study conducted in a southern region in China demonstrated that patients with chronic conditions tended to use secondary care instead of primary care as their regular source of care [36]. Our findings are consistent with this line of evidence.…”

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“…Indeed, multimorbidity was identified in one-third of the participants of our study. Other investigations reported that education was inversely associated with multimorbidity, while aging was directly related [23,24,25,26,27,28]. However, a little more than one-third of participants with multimorbidities from our study were young and middle-aged adults.…”

“…Characteristics associated with gender, age, level of education, employment status, and marital status were examined in recent PHC studies [23,24,25,26,27,28,51]. Consideration of these aspects might be especially relevant in low- and middle-income countries (LMICs), where socioeconomic and cultural inequities may predispose the conditions for the establishment of several risk factors associated with chronic diseases and multimorbidity [51,53,54,55].…”

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