Implications of multimorbidity patterns on health care utilisation and quality of life in middle-income countries: cross-sectional analysis

Abstract

Background Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.

Prevalence and patterns of multi-morbidity in the productive age group of 30-69 years: A cross-sectional study in Pathanamthitta District, Kerala.

“…However, we find differences in the second and third most common dyads and triads of co-existing chronic conditions between males and females. Multi-morbidity assessment in management of chronic conditions is essential given its high prevalence and the differences in health care utilization and quality of life in individuals with different combinations of co-existing chronic conditions 20 .…”

Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

“…This study did not adjust for the number of visits to a general practitioner in clinics to avoid possible over-adjustment bias. The associations between more comorbidities with better detection of previously undiagnosed NCDs [51], could be mediated by more clinic visits and interactions with healthcare professionals from having more comorbidities [12,25,26,52]. The study was based on 9 NCDs, so future work could examine more conditions.…”

“…Policies also need to address continual accessibility to healthcare after first diagnosis. In MICs, it is not uncommon for patients to travel from rural residences to the urban areas to seek medical treatment, limiting their ability to regularly visit healthcare services and continue treatment, which results in suboptimal control of NCDs [52,70,71]. In addition, there are complexities of insurance policies.…”

Prevalence of multimorbidity in South Africa: a systematic review protocol

“…4 The prevalence of multimorbidity places additional stress on already severely strained health systems in LMICs 5 by driving up healthcare utilisation and costs. [6][7][8][9] Furthermore, multimorbidity alters the patterns of individual health behaviours and access of health services; which in turn, has further implications for health systems responsiveness and pressing the urgency for further health reforms away from a programmatic approach to comprehensive, integrated services delivery. The need for reforms to integrate the treatment of various chronic conditions has been acknowledged.…”