Epidemiology of multimorbidity within the Brazilian adult general population: Evidence from the 2013 National Health Survey (PNS 2013)

Abstract

Middle-income countries are facing a growing challenge of adequate health care provision for people with multimorbidity. The objectives of this study were to explore the distribution of multimorbidity and to identify patterns of multimorbidity in the Brazilian general adult population. Data from 60202 adults, aged ≥18 years that completed the individual questionnaire of the National Health Survey 2013 (Portuguese: “Pesquisa Nacional de Saúde”–“PNS”) was used. We defined multimorbidity as the presence of two or more chronic conditions, including self-reported diagnoses and responses to the 9-item Patient Health Questionnaire for depression. Multivariate Poisson regression analyses were used to explore relationship between multimorbidity and demographic factors. Exploratory tetrachoric factor analysis was performed to identify multimorbidity patterns. 24.2% (95% CI 23.5–24.9) of the study population were multimorbid, with prevalence rate ratios being significantly higher in women, older people and those with lowest educational level. Multimorbidity occurred earlier in women than in men, with half of the women and men aged 55–59 years and 65–69 years, respectively, were multimorbid. The absolute number of people with multimorbidity was approximately 2.5-fold higher in people younger than 65 years than older counterparts (9920 vs 3945). Prevalence rate ratios of any mental health disorder significantly increased with the number of physical conditions. 46.7% of the persons were assigned to at least one of three identified patterns of multimorbidity, including: “cardio-metabolic”, “musculoskeletal-mental” and “respiratory” disorders. Multimorbidity in Brazil is as common as in more affluent countries. Women in Brazil develop diseases at younger ages than men. Our findings can inform a national action plan to prevent multimorbidity, reduce its burden and align health-care services more closely with patients’ needs.

Fatores associados à avaliação da qualidade da atenção primária à saúde por idosos residentes na Região Metropolitana de Belo Horizonte, Minas Gerais, 2010*

“…26 It is therefore clear yet again that the results of evaluation studies need to be interpreted based on the context of the service that is being evaluated, although among the elderly in RMBH there appears to be a relationship between a higher number of diseases and poorer perception of care quality, bearing in mind that a person with multiple morbidities tends to use the service more. 27 The comparisons mentioned should be analyzed with caution. Consideration needs to be given to the differences, possibly substantial, in the methodology used to evaluate PHC, as well as differences in the organization of health systems in each country/ region and differences in the sociodemographic characteristics of the populations studied.…”

Inequalities in multimorbidity among elderly: a population-based study in a city in Southern Brazil

“…A few studies have previously evaluated these indicators (economic and schooling levels) in relation to multimorbidity among elderly 12,29,40,41 . However, they did not estimate inequalities using the SII and the CIX.…”

Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil

“…WHO’s World Health Survey found that 23% of Brazilian adults aged 18 to 45 years reported wheezing in the last year, of whom only 12% had a doctor diagnosis of asthma 3. Comorbidity is increasing,4 with high and growing rates of chronic conditions like cardiovascular disease, diabetes and depression.…”