Multimorbidity and healthcare utilization: A register-based study in Denmark

Abstract

20Background 21 People with multimorbidity have reduced functional capacity, lower quality of life, and higher 22 mortality rates and use healthcare resources more intensively than healthy people or those with a 23 single chronic condition. The aim of this study was to explore associations between multimorbidity 24 and use of healthcare services and the impact of socioeconomic status on utilization of 25 hospitalizations and bed days. 26 Methods 27The study population included all individuals aged 16 years and older who lived in the Capital 28Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services 29 and demographics were obtained from Danish national administrative and health registries. Zero-30 inflated models were used to calculate anticipated annual use of hospitalizations and bed days. 31 Findings 32The study population comprised 1,397,173 individuals; the prevalence of multimorbidity was 22%. 33Prevalence was inversely related to educational attainment. For people with multimorbidity, 34 utilization of hospitalizations and bed days increased approximately linearly with the number of 35 chronic conditions. However, a steep increase in utilization of bed days was observed between five 36 and six or more chronic conditions. An educational gradient in hospitalization rates and use of bed 37 days was observed regardless of the number of chronic conditions. Educational attainment was 38 strongly associated with healthcare utilization. 39 Conclusion 3 40 Multimorbidity was associated with a significant increase in utilization of all healthcare services in 41 Denmark. In addition, a socioeconomic gradient was observed in utilization of hospitalizations and 42 bed days. 43 4 45 Introduction 46Multimorbidity is often defined as the coexistence of two or more chronic conditions in the 47 same person [1, 2]. People with multimorbidity have decreased functional competence [3], 48 lower quality of life [4], higher mortality rates [5] and use healthcare resources more 49 intensively than healthy people or those with just one chronic condition [6]. Most diseases 50 and consequences of poor health are unequally distributed among socioeconomic population 51 groups, and socioeconomic differences are obvious in the prevalence and consequences of 52 multimorbidity [7, 8]. The prevalence of multimorbidity is increasing internationally. The 53 overall prevalence of multimorbidity in Ontario, Canada increased in nearly all age groups, 54 reflecting a 40% total increase between 2003 and 2009 from 17.4% to 24.3% [9]. A study 55 from the Netherlands reported an increase in multimorbidity prevalence from 12.7% to 56 16.2% between 2004 and 2011 [10]. An American study showed that the prevalence of 57 multimorbidity rose between 2000 and 2010 from 22% to 30%, a trend that was most 58 pronounced among people younger than age 65 [11]. Expected continuing increases in the 59 prevalence of multimorbidity are recognized as a major public health and healthcare 60 challenge for modern societies [9]. 61...

Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data

“…This paper is concerned with the impact of multimorbidity on healthcare utilization, a topic for which detailed knowledge is incomplete [16]. Lehnert et al's systematic review [13] found that the majority of the 35 included (observational) studies showed a positive association between multimorbidity and service use/cost in older adults.…”

The effect of the employment of consultants in the Emergency Department on quality of care and equity – a quasi-experimental retrospective cohort study

“…The effect of Acute Medical Consultants on the quality of care distributed across patients' SES status has not previously been subject to investigation, though the association between SES and patient outcomes is of considerable interest given that educational level is identi ed as a predictor of additional hospitalisations 43 , readmissions, and mortality 44,45 . Our ndings of equity in ED quality of care stand in contrast to previous ndings from retrospective studies from an ED in Ireland; the Irish studies did not observe any association between LOS and lower SES of admitted patients when adjusted for comorbidities 23,46 , but they found a social gradient in in-hospital mortality 23,46 and 30-day mortality 46 .…”

Effects of individual and parental educational levels on multimorbidity classes: a register-based longitudinal study in a Danish population

“…Multimorbidity, the co-occurrence of chronic conditions within the same individual, is an increasing public health challenge associated with decreased quality of life and functional ability,1–3 increased healthcare utilisation4 5 and increased risk of mortality 6. Social inequality in multimorbidity has been reported, whereby individuals of low socioeconomic status have a higher likelihood of having multimorbidity compared with individuals of higher socioeconomic status.…”