Prevalence and factors associated with multimorbidities in Brazilian older adults

Melo, Laércio Almeida de; Lima, Kenio Costa de

doi:10.1590/1413-812320202510.34492018

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ARTICLE • Ciênc. saúde coletiva 25 (10) • Oct 2020 • https://doi.org/10.1590/1413-812320202510.34492018 copy

Prevalence and factors associated with multimorbidities in Brazilian older adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to identify the prevalence of multimorbidity in Brazilian older adults and factors associated with socioeconomic and lifestyle variables. This is a cross-sectional, population-based study carried out with data from the National Health Survey database. Seniors with multimorbidity where the ones with a diagnosis of two or more chronic diseases. The chi-square test was used in data analysis, and then prevalence ratios were estimated through Poisson multiple regression, both with 95% confidence level. In total, 11,697 older adults were evaluated and the multimorbidity prevalence was 53.1%. As a result of the multivariate analysis, female seniors (p < 0.001), the oldest elderly (p = 0.002), those who were not single, more strongly associated with widowers (p = 0.001) and those with a health plan at the interview (p < 0.001) were associated with multimorbidity. Also, in comparison with older adults with two chronic diseases, women are associated with three (p = 0.003) and four or more chronic diseases (p < 0.001). We can conclude that multimorbidity in Brazilian older adults is a widespread condition and that it has been influenced by socioeconomic factors and is poorly related to lifestyle.

Key words
Multimorbidity; Older adults; Associated factors

Variable	Category	Presence of multimorbidity	Absence of multimorbidity	PR	95% CI	p	PR_ADJ	95% CI_ADJ	p^* * P-value adjusted from the Poisson multiple regression.
Variable	Category	%	%	PR	95% CI	p	PR_ADJ	95% CI_ADJ
Gender	Male	45.1	54.9	0.77	0.73-0.82	< 0.001	0.90	0.89-0.91	<0.001
Gender	Female	58.3	41.7
Age	60-69 years	50.8	49.2	1.00	-	0.001			0.001
	70-79 years	56.8	43.2	1.12	1.05-1.19		1.03	1.01-1.04
	80 years or over	53.9	46.1	1.06	0.99-1.15		1.02	1.00-1.02
Skin color or ethnicity	White	54.5	45.5	1.00	-	0.127
	Black	52.9	47.1	0.97	0.89-1.06
	Brown	50.8	49.2	0.93	0.88-0.99
	Other	53.0	47.0	0.97	0.78-1.21
Marital status	Single	44.5	55.5	1.00	-	<0.001	1.00	-	0.001
	Married	52.7	47.3	1.19	1.09-1.29		1.03	1.02-1.04
	Separated/divorced	53.9	46.1	1.21	1.08-1.36		1.01	1.01-1.02
	Widower	56.8	43.2	1.28	1.17-1.40		1.06	1.03-1.09
Schooling	Illiterate	52.6	47.4	1.00		0.005
	Primary school incomplete	55.2	44.8	1.05	0.99-1.12
	Primary school complete or over	50.9	49.1	0.97	0.90-1.04
Health plan	Yes	55.1	44.9	1.10	1.03-1.18	0.007	1.03	1.02-1.05	<0.001
Health plan	No	50.0	50.0
Alcohol use	Yes	46.6	53.5	0.87	0.80-0.94	0.001
Alcohol use	No	53.5	46.5
Tobacco use	Yes	42.0	58.0	0.79	0.70-0.90	<0.001
Tobacco use	No	53.2	46.8
Physical activity	Yes	53.9	46.1	1.06	0.98-1.14	0.185
Physical activity	No	51.1	48.9

Variable	Category	Three chronic diseases	Two chronic diseases	PR	95% CI	p	PR_ADJ	95% CIADJ	p^* * P-value adjusted from the Poisson multiple regression.
Variable	Category	%	%	PR	95% CI	p	PR_ADJ	95% CIADJ
Gender	Male	35.0	65.0	0.85	0.74-0.97	0.014	0.97	0.95-0.99	0.003
Gender	Female	41.2	58.8
Age	60-69 years	37.4	62.6	1.00	-	0.319
	70-79 years	41.1	58.9	1.10	0.96-1.26
	80 years or over	40.0	60.0	1.07	0.91-1.26
Skin color or ethnicity	White	40.2	59.8	1.00	-	0.074	-		0.188
	Black	31.5	68.5	0.78	0.64-0.96		0.82	0.81-0.83
	Brown	39.6	60.4	0.98	0.87-1.11		0.78	0.76-0.79
	Other	26.4	73.6	0.66	0.39-1.11		0.98	0.96-1.01
Marital status	Single	36.1	63.9	1.00	-	0.322
	Married	38.7	61.3	1.07	0.91-1.26
	Separated/divorced	35.3	64.7	0.98	0.81-1.18
	Widower	41.4	58.6	1.15	0.98-1.34
Schooling	Illiterate	37.1	62.9	1.00	-	0.004
	Primary school incomplete	43.6	56.4	1.18	1.04-1.33
	Primary school complete or over	34.7	65.3	0.93	0.80-1.09
Health plan	Yes	40.9	59.1	1.08	0.95-1.22	0.251
Health plan	No	38.0	62.0
Alcohol use	Yes	35.3	64.7	0.88	0.74-1.04	0.125
Alcohol use	No	40.1	59.9
Tobacco use	Yes	29.7	70.3	0.74	0.60-0.92	0.003	0.98	0.95-1.01	0.180
Tobacco use	No	40.0	60.0
Physical activity	Yes	34.1	65.9	0.84	0.72-0.98	0.020	0.99	0.97-1.01	0.536
Physical activity	No	40.6	59.4

Variable	Category	Four chronic diseases or over	Two chronic diseases	PR	95% CI	p	PR_ADJ	95% CI_ADJ	P^* * P-value adjusted from the Poisson multiple regression.
Variable	Category	%	%	PR	95% CI	p	PR_ADJ	95% CI_ADJ
Gender	Male	23.3	76.7	0.76	0.63-0.92	0.005	0.96	0.94-0.97	<0.001
Gender	Female	30.6	69.4
Age	60-69 years	27.7	72.3	1.00	-	0.672
	70-79 years	29.3	70.7	1.06	0.86-1.30
	80 years or over	25.9	74.1	0.93	0.73-1.19
Skin color or ethnicity	White	30.0	70.0	1.00	-	0.202
	Black	23.5	76.5	0.78	0.60-1.03
	Brown	26.3	73.7	0.88	0.72-1.06
	Other	20.9	79.1	0.70	0.38-1.27
Marital status	Single	23.8	76.2	1.00	-	0.327
	Married	28.3	71.7	1.19	0.89-1.61
	Separated/divorced	24.5	75.5	1.03	0.78-1.36
	Widower	30.0	70.0	1.26	0.99-1.61
Schooling	Illiterate	24.3	75.7	1.00	-	0.104	1.00	-	0.105
	Primary school incomplete	30.2	69.2	1.24	1.04-1.48		0.90	0.88-0.92
	Primary school complete or over	29.0	71.0	1.19	0.97-1.46		0.79	0.78-0.79
Health plan	Yes	30.0	70.0	1.12	0.93-1.34	0.247
Health plan	No	26.9	73.1
Alcohol use	Yes	22.9	77.1	0.78	0.60-1.00	0.042
Alcohol use	No	29.5	70.5
Tobacco use	Yes	19.6	80.4	0.68	0.44-1.03	0.054	0.98	0.95-1.00	0.107
Tobacco use	No	28.9	71.1
Physical activity	Yes	26.7	73.3	0.94	0.77-1.15	0.558
Physical activity	No	28.4	71.6

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[1] Collaborations

LA Melo worked on the collection and interpretation of data, on the design and final writing of the manuscript. KC Lima worked on the orientation of the study, data analysis, critical analysis and writing of the manuscript.