What is the burden of multimorbidity and the factors associated with its occurrence in elderly Brazilians?

Oliveira-Figueiredo, Danielle Samara Tavares de; Silva, Matteus Pio Gianotti Pereira Cruz; Feitosa, Paula Yhasmym de Oliveira; Leite, Bruna Cardoso; Rocha, Fabiana Lucena; Andrade, Luciana Dantas Farias de

doi:10.1590/0034-7167-2022-0809

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 77 (1) • 2024 • https://doi.org/10.1590/0034-7167-2022-0809 copy

What is the burden of multimorbidity and the factors associated with its occurrence in elderly Brazilians?

¿Cuál es la carga de multimorbilidad y los factores asociados a su ocurrencia en personas mayores brasileñas?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To estimate the prevalence of multimorbidity in elderly people and its association with sociodemographic characteristics, lifestyle, and anthropometry.

Methods:

This was a cross-sectional study using data from the National Health Survey, 2019. A total of 22,728 elderly individuals from all 27 Brazilian states were randomly selected. Poisson regression models with robust variance were employed, and a significance level of 5% was adopted.

Results:

The prevalence of multimorbidity was 51.6% (95% CI: 50.4-52.7), with the highest estimates observed in the South and Southeast. Multimorbidity was associated with being female (aPR = 1.33; 95% CI: 1.27-1.39), being 80 years old or older (aPR = 1.12; 95% CI: 1.05-1.19), having low education (aPR = 1.16; 95% CI: 1.07-1.25), past cigarette use (aPR = 1.16; 95% CI: 1.11-1.21), insufficient physical activity (aPR = 1.13; 95% CI: 1.06-1.21), and screen use for 3 hours or more per day (aPR = 1.13; 95% CI: 1.08-1.18).

Conclusion:

Multimorbidity affects more than half of the elderly population in Brazil and is associated with social, demographic, and behavioral factors.

Descriptors:
Aged; Multimorbidity; Chronic Disease; Multiple Chronic Conditions; Cross-Sectional Studies

Sociodemographic Variables	n	%^a a Population proportion;	95%CI^b b 95% Confidence Interval;	Multimorbidity
Sociodemographic Variables	n	%^a a Population proportion;	95%CI^b b 95% Confidence Interval;	% ^a	95%CI ^b	p value^c c Probability value for the Chi-square test. * Self-reported yellow or indigenous skin color, with two missing values.
Total	22,728	100	-	51.6	50.4-52.7	-
Gender
Male	10,193	44.5	43.5 - 45.5	43.2	41.6 - 44.8	<0.0001
Female	12,535	55.5	54.5 - 56.5	57.9	56.3 - 59.3
Age Group
60 to 69 years	12,555	54.8	53.8 - 55.9	48.1	46.5 - 49.5	<0.0001
70 to 79 years	7,157	31.1	30.2 - 32.0	55.6	53.6 - 57.4
80 years or more	3,016	14.1	13.4 - 14.8	57.4	54.5 - 60.4
Skin Color
White	9,901	51.3	50.2 - 52.4	51.1	49.4 - 52.7	0.727
Black	2,455	10.2	9.62 - 10.8	52.3	48.8 - 55.7
Brown	10,001	36.7	35.7 - 37.7	51.9	50.1 - 53.6
Other^*	369	1.8	1.6 - 2.1	55.0	46.3 - 63.3
Marital Status
With partner	9,946	43.3	42.3 - 44.3	49.7	48.0 - 51.3	0.0004
Without partner	12,782	56.7	55.7 - 57.7	53.6	52.1 - 55.1
Education
12 years or more	2,701	13.1	12.2 - 14.0	44.8	41.6 - 48.1	<0.0001
9 to 11 years	3,613	16.5	15.8 - 17.4	48.6	45.8 - 51.3
0 to 8 years	16,414	70.4	69.2 -71.5	53.6	52.3 - 54.9
Social Class
A	240	1.5	1.1 - 2.0	39.8	30.0 - 50.6	0.0023
B	2,810	13.8	12.9 - 14.7	47.8	44.9 - 50.8
C. D. and E	19,675	84.7	83.7 - 85.7	52.6	51.4 - 53.7
Residential Area
Urban	17,313	85.5	84.3 - 86.1	52.5	51.2 - 53.7	<0.0001
Rural	5,415	14.5	14.0 - 15.2	46.3	43.7 - 48.9
Region of Residence
Southeast	5,825	47.3	46.3 - 48.4	52.8	50.8 - 54.7	<0.0001
South	3,307	16.2	15.5 - 16.9	54.1	51.8 - 56.5
Central-West	2,373	6.26	5.9 - 6.62	52.3	49.5 - 55.1
North	3,487	5.56	5.3 - 5.9	43.7	40.9 - 46.5
Northeast	7,736	24.7	23.9 - 25.5	49.4	47.4 - 51.3

Variables	Multimorbidity
Variables	Unadjusted PR^a a Unadjusted PR: Unadjusted Prevalence Ratio; (95% CI)	p value	Adjusted PR^b b Adjusted PR: Prevalence Ratio adjusted for all independent variables in the multiple model; 95% CI: 95% Confidence Interval. (95% CI)	p value
Gender (reference: male)
Female	1.36 (1.28-1.40)	<0.001	1.33 (1.27-1.39)	<0.001
Age Group (reference: 60-69)
70-79	1.15 (1.10-1.20)	<0.001	1.11 (1.06-1.16)	<0.001
80 or more	1.19 (1.10-1.27)	<0.001	1.12 (1.05-1.19)	<0.001
Education (reference: 12 or more)
9 - 11	1.08 (0.98-1.19)	0.094	1.06 (0.97-1.17)	0.156
0 - 8	1.19 (1.10-1.28)	<0.001	1.16 (1.07-1.25)	<0.001
Social Class (reference: A)
B	1.20 (0.91-1.57)	0.183	-	-
C, D and E	1.32 (1.01-1.71)	0.038	-	-
Residential Area (reference: urban)
Rural	0.88 (0.83-0.93)	<0.001	0.91 (0.85-0.96)	0.003
Region of Residence (reference: Southeast)
South	1.02 (0.96-1.08)	0.391	1.04 (0.98-1.10)	0.150
Central-West	0.99 (0.92-1.05)	0.766	1.01 (0.95-1.08)	0.629
North	0.82 (0.76-0.89)	<0.001	0.83 (0.78-0.90)	<0.001
Northeast	0.93 (0.88-0.98)	0.015	0.93 (0.88-0.98)	0.012
Smoking (reference: Never smoked)
Currently smokes	0.89 (0.82-0.96)	0.006	0.93 (0.86-1.01)	0.119
Smoked in the past	1.10 (1.06-1.15)	<0.001	1.16 (1.11-1.21)	<0.001
Alcohol Consumption (reference: Never consumes)
Light/Moderate consumption	0.85(0.71-1.03)	0.104	-	-
Heavy consumption	1.11 (0.94-1.31)	0.211	-	-
Physical Activity Practice (reference: Sufficient)
Insufficient	1.18 (1.11-1.26)	<0.001	1.13 (1.06-1.21)	<0.001
Body Mass Index (reference: Normal weight)
Underweight	1.13 (0.90-1.42)	0.270	-	-
Overweight/Obesity	1.12 (0.98-1.27)	0.076	-	-
Screen Time (reference: Less than 3 hours/day)
More than 3 hours/day	1.16 (1.12-1.21)	<0.001	1.13 (1.08-1.18)	<0.001

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[1] Corresponding author: Danielle Samara Tavares de Oliveira-Figueiredo E-mail: danielle.samara@professor.ufcg.edu.br