Temporal Trends in Racial and Ethnic Disparities in Multimorbidity Prevalence in the United States, 1999–2018

Abstract

Background: Multimorbidity, an important health indicator, is a contributor to and result of health inequity. We sought to determine if gaps in multimorbidity by race and ethnicity are decreasing over time. Methods: Serial cross-sectional analysis of the National Health Interview Survey, 1999 to 2018. The study included individuals older than 18 years old, categorized by self-reported race, ethnicity, age, and income. The main outcomes were trends in the prevalence of multimorbidity, defined as 2 or more concurrent chronic conditions. Results: The study included 596,355 adults (4.7% Asian, 11.8% Black, 13.8% Latino/Hispanic, and 69.7% White). In 1999, the estimated prevalence of multimorbidity was 5.9% among Asian, 17.4% among Black, 10.7% among Latino/Hispanic, and 13.5% among White individuals. Prevalence increased for all racial/ethnic groups during the study period (P<0.005 for each), with no significant change in the differences between them. In 2018, when compared with White people, multimorbidity was more prevalent among Black individuals (+2.5 percent points [95% CI: +0.5, +4.6]) and less prevalent among Asian and Latino individuals (-6.6 points [-8.8, -4.4] and -2.1 points [-4.0, -0.2], respectively). The estimated prevalence of reporting at least 1, 2, 3, or 4 conditions all increased with age across all groups, with Black individuals having the greatest prevalence in each age category. Among those older than 35 years, Black people had multimorbidity rates equivalent to those of Latino/Hispanic and White people aged 5 years older, and Asian people aged 10 years older. Conclusions: Over 2 decades, there was no significant progress in eliminating disparities in multimorbidity between Black and White people.

Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018

“…This finding may be explained by persistent racial differences in prevalence and type of underlying health conditions and socioeconomic stressors that could potentially lead to long sleep duration, including multimorbidity profiles (an indicator of multiple concurrent chronic conditions) and unemployment. [39][40][41] Disparities in multimorbidity prevalence and unemployment rates persisted during the study period for Black individuals, 42,43 which could support this explanation. However, further research is needed to understand these patterns and their causes.…”

Temporal Trends in Racial and Ethnic Disparities in Sleep Duration in the United States, 2004–2018

“…This finding may be explained by persistent racial differences in prevalence and type of underlying health conditions and socioeconomic stressors that could potentially led to long sleep duration, including multimorbidity profiles (an indicator of multiple concurrent chronic conditions) and unemployment. 39-41 Disparities in multimorbidity prevalence and unemployment rates persisted over the study period for Black individuals, 42,43 which could support this explanation. However, further research is needed to understand these patterns and their causes.…”

Lessons From the Field. Chronic disease: Action for post‐pandemic wellness and health

“…We found that without concerted efforts to reach underserved clientele, our CDSMP participants tended to be limited to older White females of moderate income who are highly educated. It is critical that we employ ways to serve diverse populations because research shows that racial and ethnic minorities and limited-income populations are disproportionately affected by chronic diseases (Caraballo et al, 2022). Keeping CDSMP inviting and relevant to high-need populations are important considerations both now and in the future.…”

“…Racial and ethnic health disparities in chronic diseases have been persistent over time. Even though the U.S. government made elimination of health disparities a national priority in 1985, research shows that there has been no significant reduction in the racial/ethnic gap over the past 2 decades (Caraballo et al, 2022). Post-pandemic, expanded use of practical behavioral health strategies is needed to reach and support racially/ethnically diverse families with members living with chronic disease.…”