Prevalence and Costs of Multimorbidity by Deprivation Levels in the Basque Country: A Population Based Study Using Health Administrative Databases

Abstract

BackgroundMultimorbidity is a major challenge for healthcare systems. However, currently, its magnitude and impact in healthcare expenditures is still mostly unknown.ObjectiveTo present an overview of the prevalence and costs of multimorbidity by socioeconomic levels in the whole Basque population.MethodsWe develop a cross-sectional analysis that includes all the inhabitants of the Basque Country (N = 2,262,698). We utilize data from primary health care electronic medical records, hospital admissions, and outpatient care databases, corresponding to a 4 year period. Multimorbidity was defined as the presence of two or more chronic diseases out of a list of 52 of the most important and common chronic conditions given in the literature. We also use socioeconomic and demographic variables such as age, sex, individual healthcare cost, and deprivation level. Predicted adjusted costs were obtained by log-gamma regression models.ResultsMultimorbidity of chronic diseases was found among 23.61% of the total Basque population and among 66.13% of those older than 65 years. Multimorbid patients account for 63.55% of total healthcare expenditures. Prevalence of multimorbidity is higher in the most deprived areas for all age and sex groups. The annual cost of healthcare per patient generated for any chronic disease depends on the number of coexisting comorbidities, and varies from 637 € for the first pathology in average to 1,657 € for the ninth one.ConclusionMultimorbidity is very common for the Basque population and its prevalence rises in age, and unfavourable socioeconomic environment. The costs of care for chronic patients with several conditions cannot be described as the sum of their individual pathologies in average. They usually increase dramatically according to the number of comorbidities. Given the ageing population, multimorbidity and its consequences should be taken into account in healthcare policy, the organization of care and medical research.

Multimorbilidad: bases conceptuales, modelos epidemiológicos y retos de su medición

“…En este camino, el desarrollo de índices que consideran la gravedad de la enfermedad es muy relevante, aunque podrían tener poca aplicabilidad en la población general Es importante considerar, igualmente, que las condiciones socioeconómicas y los factores psicosociales pueden definir diversos perfiles de distribución de la multimorbilidad; en esta perspectiva, sería importante utilizar análisis basados en el modelo de los factores sociales determinantes en salud (69). Las diferencias de los perfiles podrían, incluso, constituir nuevos indicadores de inequidad en salud y constituirían un campo emergente de estudio.…”

Managing the Needs of Older Patients with Multimorbidity—A Systematic Review of the Challenges Faced by the Healthcare Services

“…Six studies stated that multimorbidity was high and constituted a significant problem in older adults [28]- [32] [34]. Orueta et al [28] added that the distribution of the population by age group, as well as the average number of chronic diseases per patient, was 0.97 overall.…”

Estimación de la prevalencia de hipotiroidismo según diferentes métodos: dosis diaria definida, dosis diaria prescrita y registro de pacientes en tratamiento

“…Orueta y cols 13 revisaron la prevalencia de nueve condiciones crónicas en el País Vasco durante 2008, manejando diversas bases de datos. Aportan una prevalencia de HT del 2,71% cuando utilizan solo el registro de prescripción de medicamentos y aumenta al 3,21% cuando combinan varias.…”

“…Teniendo en cuenta los datos previos 4 , en los que Cádiz se encontraba entre las provincias de menor prevalencia del país, y los distintos años de realización, nuestros resultados concuerdan con las publicaciones españolas1 13,14 o europeas [20][21][22][23] .…”

“…A los largo de estos años se han ido publicando diversos trabajos [5][6][7][8][9][10][11][12][13][14] en referencia a la prevalencia de HT, pero realizados bien en territorios pequeños bien en grupos poblacionales muy específicos. Por otra parte, en la práctica clínica actual dentro del Sistema Público de Salud (SPS) se dispone de medios informáticos con capacidad de almacenar información en la historia clínica sobre las prescripciones 18 , lo que permite un análisis pormenorizado del consumo de medicamentos 19 .…”