Multimorbidity and use of health services in the oldest old in Brazil

Francisco, Priscila Maria Stolses Bergamo; Assumpção, Daniela de; Bacurau, Aldiane Gomes de Macedo; Silva, Diego Salvador Muniz da; Malta, Deborah Carvalho; Borim, Flávia Silva Arbex

doi:10.1590/1980-549720210014.supl.2

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ORIGINAL ARTICLE • Rev. bras. Epidemiol. 24 (suppl 2) • 2021 • https://doi.org/10.1590/1980-549720210014.supl.2 copy

Multimorbidity and use of health services in the oldest old in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To estimate the prevalence of multimorbidity in long-lived Brazilian individuals (age ≥80 years) and to associated it with the use of health services.

Methods:

Cross-sectional population-based study with data from the 2019 National Survey of Health (n=6,098). Frequencies of use of services were estimated for older people with multimorbidity and according to sex, health insurance ownership, and self-rated health. The prevalence rates, crude and adjusted prevalence ratios, and the respective 95% confidence intervals were calculated.

Results:

The average age of the older adults was 85 years and about 62% were women; the prevalence of multimorbidity was 57.1%, higher in women, in those who have health insurance, and who reside in the southern region of the country (p<0.05). In the oldest old with multimorbidity, the use of services in the last 15 days reached 64.6%, and more than 70% were hospitalized in the last year or did not carry out activities in the previous two weeks for health reasons. Differences were observed for the indicators of service use in relation to sex, health insurance ownership, and self-rated health, according to multimorbidity.

Conclusion:

Indicators for the use of health services were higher in older individuals who have two or more chronic diseases, regardless of sociodemographic conditions and self-rated health, showing the impact of multimorbidity per se in determining the use of services among the oldest old.

Keywords:
Multimorbidity; Health services; Aged, 80 and over; Health of the elderly; Chronic disease; Health surveys

	%	Multimorbidity		p-value
	%	%	95%CI	p-value
Sex
Men	38.0	45.5	41.0–50.1	0.0001
Women	62.0	64.8	61.6–67.9	0.0001
Age group (years)
80–84	54.3	55.8	52.3–59.2	0.4375
85–89	29.9	59.4	54.3–64.3
≥90	15.8	58.6	52.1–64.7
Skin color/ethnicity
White/Asian	56.8	57.9	54.3–61.4	0.5164
Black/Mixed-race/Indigenous	43.2	56.2	52.3–60.0	0.5164
Education level
No formal education	32.0	53.4	48.4–58.4	0.2968
Some elementary school	46.7	59.5	55.7–63.1
Elementary to high school	15.8	56.2	48.9–63.2
Some college/College degree	5.5	59.4	48.4–69.5
Health insurance
No	68.2	54.3	51.0–57.5	0.0031
Yes	31.8	62.9	58.1–67.4	0.0031
Region of residence
North	5.8	47.5	41.1–54.1	0.0028
Northeast	29.0	51.8	47.0–56.5
Midwest	5.2	57.9	50.8–64.6
Southeast	46.3	59.2	54.6–63.6
South	13.7	63.7	58.3–68.8
Self-rated health status
Very good/good	36.7	47.4	43.2–51.7	<0.0001
Fair	43.1	62.5	58.6–66.2
Poor/very poor	17.2	71.6	65.6–76.9

	Multimorbidity (95%CI)	^aPR_crude	^bPR_adjusted (95%CI)
Total
Use of health services*	64.6 (60.0–68.9)	1.20 (1.09–1.31)	1.13 (1.04–1.24)
Medical appointment in the last year	59.5 (56.7–62.3)	2.21 (1.66–2.93)	1.99 (1.53–2.58)
Hospitalization in the last year	74.0 (67.6–79.6)	1.35 (1.23–1.49)	1.30 (1.18–1.42)
No longer perform activities for health reasons*	73.3 (66.6–79.1)	1.35 (1.22–1.49)	1.16 (1.05–1.29)
Men
Use of health services*	53.8 (46.2–61.2)	1.28 (1.05–1.57)	1.15 (0.95–1.40)
Medical appointment in the last year	49.1 (44.8–53.3)	6.02 (3.70–9.78)	5.09 (3.15–8.22)
Hospitalization in the last year	64.9 (52.9–75.2)	1.52 (1.23–1.88)	1.34 (1.09–1.63)
No longer perform activities for health reasons*	59.0 (45.6–71.2)	1.35 (1.06–1.73)	1.09 (0.85–1.41)
Women
Use of health services*	71.7 (66.7–76.3)	1.16 (1.07–1.26)	1.11 (1.01–1.20)
Medical appointment in the last year	66.2 (63.1–69.2)	1.51 (1.17–1.94)	1.44 (1.13–1.83)
Hospitalization in the last year	80.0 (74.0–84.9)	1.28 (1.18–1.39)	1.25 (1.15–1.36)
No longer perform activities for health reasons*	80.1 (74.0–85.0)	1.29 (1.19–1.41)	1.19 (1.08–1.31)

Health insurance	Multimorbidity (95%CI)	^aPR_crude	^bPR_adjusted (95%CI)
Yes
Use of health services*	66.0 (58.2–73.0)	1.08 (0.95–1.22)	1.06 (0.94–1.19)
Medical appointment in the last year	63.9 (59.0–68.5)	1.92 (0.90–4.08)	1.90 (0.94–3.84)
Hospitalization in the last year	70.7 (59.8–79.6)	1.15 (1.00–1.32)	1.13 (0.99–1.28)
No longer perform activities for health reasons*	67.2 (53.3–78.6)	1.08 (0.89–1.32)	0.97 (0.81–1.15)
No
Use of health services*	63.7 (57.9–69.1)	1.26 (1.11–1.42)	1.17 (1.04–1.31)
Medical appointment in the last year	57.2 (53.9–60.4)	2.21 (1.63–2.98)	1.98 (1.51–2.60)
Hospitalization in the last year	76.3 (69.3–82.2)	1.49 (1.33–1.66)	1.43 (1.29–1.58)
No longer perform activities for health reasons*	76.8 (71.0–81.8)	1.52 (1.38–1.67)	1.30 (1.16–1.45)

Self-rated health	Multimorbidity (95%CI)	^aPR_crude	^bPR_adjusted (95%CI)
Very good/good
Use of health services*	49.3 (41.7–57.0)	1.05 (0.88–1.26)	1.04 (0.88–1.24)
Medical appointment in the last year	50.4 (46.1–54.6)	3.12 (2.07–4.70)	2.88 (1.94–4.27)
Hospitalization in the last year	59.5 (47.5–70.6)	1.29 (1.05–1.60)	1.28 (1.04–1.57)
No longer perform activities for health reasons*	54.0 (36.8–70.3)	1.15 (0.83–1.60)	1.15 (0.84–1.57)
Fair
Use of health services*	72.1 (65.9–77.5)	1.24 (1.11–1.40)	1.23 (1.10–1.38)
Medical appointment in the last year	64.6 (61.1–67.9)	1.83 (1.29–2.59)	1.76 (1.27–2.44)
Hospitalization in the last year	79.5 (73.2–84.6)	1.33 (1.21–1.46)	1.32 (1.21–1.45)
No longer perform activities for health reasons*	78.7 (70.9–84.8)	1.32 (1.18–1.47)	1.23 (1.10–1.38)
Poor/very poor
Use of health services*	75.9 (68.6–82.0)	1.11 (0.98–1.25)	1.10 (0.97–1.24)
Medical appointment in the last year	72.0 (67.8–75.8)	1.18 (0.78–1.80)	1.20 (0.87–1.65)
Hospitalization in the last year	85.2 (78.1–90.3)	1.26 (1.13–1.40)	1.32 (1.19–1.47)
No longer perform activities for health reasons*	77.7 (71.0–83.3)	1.15 (1.02–1.30)	1.12 (0.91–1.39)

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[1] Corresponding author: Priscila Maria Stolses Bergamo Francisco. Rua Tessália Vieira de Camargo, 126, Cidade Universitaria Zeferino Vaz, CEP 13083-887, Campinas (SP), Brazil. E-mail: primaria@unicamp.br