Neighborhood socioeconomic disadvantage is associated with multimorbidity in a geographically-defined community

Abstract

Background: Persons with low socioeconomic status may be disproportionately at risk for multimorbidity. Methods: Adults aged ≥20 years on 4/1/2015 from 7 counties in Minnesota were identified using the Rochester Epidemiology Project (population-based sample). A composite measure of neighborhood socioeconomic disadvantage, the area deprivation index (ADI), was estimated at the census block group level (n = 251). The prevalence of 21 chronic conditions was obtained to calculate the proportion of persons with multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥5 chronic conditions). Hierarchical logistic regression was used to estimate the association of ADI with multimorbidity and severe multimorbidity using odds ratios (OR). Results: Among 198,941 persons (46.7% male, 30.6% aged ≥60 years), the age-and sex-standardized (to the United States 2010 census) median prevalence (Q1, Q3) was 23.4% (21.3%, 25.9%) for multimorbidity and 4.8% (4.0%, 5.7%) for severe multimorbidity. Compared with persons in the lowest quintile of ADI, persons in the highest quintile had a 50% increased risk of multimorbidity (OR 1.50, 95% CI 1.39-1.62) and a 67% increased risk of severe multimorbidity (OR 1.67, 95% CI 1.51-1.86) after adjusting for age, sex, race, and ethnicity. Associations were stronger after further adjustment for individual level of education; persons in the highest quintile had a 78% increased risk of multimorbidity (OR 1.78, 95% CI 1.62-1.96) and a 92% increased risk of severe multimorbidity (OR 1.92, 95% CI 1.72-2.13). There was evidence of interactions between ADI and age, between ADI and sex, and between ADI and education. After age 70 years, no difference in the risk of multimorbidity was observed across quintiles of ADI. The pattern of increasing multimorbidity with increasing ADI was more pronounced in women. Finally, there was less variability across quintiles of ADI for the most highly educated group. Conclusions: Higher ADI was associated with increased risk of multimorbidity, and the associations were strengthened after adjustment for individual level of education, suggesting that neighborhood context plays a role in health above and beyond individual measures of socioeconomic status. Furthermore, associations were more pronounced in younger persons and women, highlighting the importance of interventions to prevent chronic conditions in younger women, in particular.

Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies

“…Three studies defined severe or complex multimorbidity (according to various terms) in addition to overall multi morbidity, with the cutoff point for severe defined as four or more chronic conditions in included in the final review two studies 23,24 and five or more chronic conditions in one study. 25 376 (66•4%) studies used a simple count of conditions to measure multimorbidity, 155 (27•4%) used weighted indices, 27 (4•8%) used both types of measures together, and eight (1•4%) did not report the type of measure used (table 1, appendix pp 5-71). In studies that used a weighted index, 149 used a diseasebased index, and six used a medicationbased index.…”

Measuring frailty in younger populations: a rapid review of evidence

“…Some vulnerable groups with chronic conditions may be at risk of becoming frail earlier in life, while the onset of illness and disability occurs at younger ages for people living in areas of greater deprivation. [18][19][20] There is, therefore, potential for younger groups to be classed as frail, and identification may aid the delivery of timely care. Furthermore, studies are increasingly measuring frailty prevalence across the life span.…”

Neighborhood disadvantage and the sales of unhealthy products: alcohol, tobacco and unhealthy snack food

“…The revised ADI is a validated instrument that has been used by researchers and government agencies such as the Centers for Medicare and Medicaid Services [16]. Recently, a number of studies have been published using the ADI [17][18][19][20][21][22].…”