Sex-specific intergenerational trends in morbidity burden and multimorbidity status in Hong Kong community: an age-period-cohort analysis of repeated population surveys

Abstract

ObjectivesPrevalence of multimorbidity has been increasing worldwide. While population ageing undoubtedly contributes, secular trends have seldom been decomposed into age, period and cohort effects to investigate intergenerational differences. This study examines the birth cohort effect on morbidity burden and multimorbidity in Hong Kong community.DesignSex-specific age-period-cohort analysis with repeated cross-sectional surveys.SettingA territory-wide population survey database.Participants69 636 adults aged 35 or above who participated in the surveys in 1999, 2001, 2005 or 2008.Main outcome measuresMorbidity burden was operationalised as number of chronic conditions from a list of 14, while multimorbidity was defined as a dichotomous status of whether participants had two or more conditions.ResultsFor both sexes, there was an upward inflection (positive change) of risk of increased morbidity burden starting from cohort 1955–1959. For men born after 1945–1954, there was a trend of lower risk (relative risk=0.63, 95% CI 0.50 to 0.80 for 1950–1954 vs 1935–1939) which continued through subsequent cohorts but with no further declines. In women, there had been a gradual increase of risk, although only significant for cohort 1970–1974 (relative risk=1.90, 95% CI 1.08 to 1.34 vs 1935–1939). Similar results were found for dichotomous multimorbidity status.ConclusionsThe trend of lower risk starting from men born in 1945–1954 may be due to a persistent decline in smoking rates since the 1980s. On the other hand, the childhood obesity epidemic starting from the late 1950s coincided with the observed upward inflection of risk for both sexes, that is, notably more drastic increase of risk in women and the levelling-off of the decline of risk in men. These findings highlight that the cohort effects on morbidity burden and multimorbidity may be sex-specific and contextual. By examining such effects in different world populations, localised sex-specific and generation-specific risk factors can be identified to inform policy-making.

Educational inequality in physician-diagnosed hypertension widened and persisted among women from 1999 to 2014 in Hong Kong

“…The rising trend in physician-diagnosed hypertension in Hong Kong could have partially been driven by the heightened health awareness and detection over time 15,17 , along with a growing number of local health education programs in the community as well as an earlier and more proactive detection in the primary care setting 18–20 . While the increasingly prevalent obesity, as a major risk factor to most cardiovascular events, may have contributed to the rise in hypertension, recent local research on validation of self-reported hypertension against the objective clinical data showed an improved case reporting as the level of sensitivity increased between 2003/04 and 2014/15 (Chung GK, 2019, unpublished data), which led to a rise in self-reported prevalence.…”

Trends of multimorbidity in 15 European countries: a population-based study in community-dwelling adults aged 50 and over

“…A trend analysis was realised in Hong Kong with 69,636 adults aged 35 or over who participated in the surveys in 1999, 2001, 2005 and 2008. Multimorbidity was de ned as presenting two or more chronic conditions from a list of 14 8 . Further, a study conducted in Canada with data of 1996-97, 2005 and 2012-13 identi ed an increase in the prevalence of multimorbidity that may be attributed to an increase of obesity 26 .…”

“…This research took into account three types of chronic diseases: diabetes, pulmonary and cardiovascular diseases, and stated that their results may show an underestimation of the real situation, because other chronic multimorbidity diseases, like arthrosis, were left out of consideration 7 . Another aspect that needs to be studied further is the association of multimorbidity with gender, since women have been associated with multimorbidity in some countries 8,9 .…”

How does chronic multimorbidity affect daily routines? An experience sampling study of community‐dwelling adults in Hong Kong

“…Multimorbidity, defined as the co‐occurrence of two or more chronic health conditions, has been shown to be associated with more healthcare utilization (Glynn et al, 2011; Lai, Wong, et al, 2019), lower quality of life (Fortin et al, 2004; Lai, Ma, & Hou, 2019), and frailty (Gobbens, van Assen, Luijkx, Wijnen‐Sponselee, & Schols, 2010). Prevalence of multimorbidity has been increasing worldwide, mainly due to the rapid aging of populations in the developed world (Fu, Huang, & Chou, 2014; Lai, Guthrie, et al, 2019; Van Oostrom et al, 2016). It has been estimated that prevalence among people aged 50 years or more ranged from 45.1% to 71.9% (Garin et al, 2016).…”