Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study

Christofoletti, Marina; Duca, Giovani Firpo Del; Benedetti, Tânia Rosane Bertoldo; Malta, Deborah Carvalho

doi:10.1590/1516-3180.2021.0105.R1.31052021

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Sao Paulo Medical Journal

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Original Article • Sao Paulo Med. J. 140 (1) • Jan-Feb 2022 • https://doi.org/10.1590/1516-3180.2021.0105.R1.31052021 copy

Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Multimorbidity due to non-communicable chronic diseases (NCDs) constitutes a significant challenge for healthcare systems. To attenuate its impacts, it is essential to identify the sociodemographic determinants of this condition, which can discriminate against population segments that are more exposed.

OBJECTIVE:

To identify associations between multimorbidity conditions and sociodemographic indicators among Brazilian adults and older adults.

DESIGN AND SETTING:

Cross-sectional telephone-based survey in 26 Brazilian state capitals and the federal district.

METHODS:

The Vigitel 2013 survey was used, with data collected via a questionnaire. The outcome was multimorbidity (2, 3 or 4 NCDs), and the exposures were sociodemographic indicators (age, sex, skin color, marital status and education). The analysis consisted of multinomial logistic regression (odds ratio), stratified by age.

RESULTS:

Among adults, multimorbidity comprising two, three or four diseases was associated with advancing age (P < 0.001); two and three diseases, with having a partner (P = 0.004 and P < 0.001, respectively); and two, three or four diseases, with lower education (P < 0.001). Among older adults, two, three or four diseases were associated with female sex (P < 0.001); three diseases, with living with a partner (P = 0.018); two diseases, with black skin color (P = 0.016); and two or three diseases, with lower education (P < 0.001).

CONCLUSIONS:

To control and prevent multimorbidity, strategies for individuals with existing chronic diseases, with partners and with lower education levels are needed. Particularly for adults, advancing age should be considered; and for older adults, being a woman and having black skin color.

KEYWORDS (MeSH terms):
Chronic disease; Diagnosis-related groups; Socioeconomic factors; Cross-sectional studies; Risk factors; Health surveys

AUTHORS’ KEYWORDS:
Chronic illness; Social determinants; Epidemiology studies

Variables		Adults (n = 37,947)				Older adults (n = 14,982)
Variables		n	%^a a Values weighted for the inverse of existence of landline telephones and the number of adults living in the household of the interviewee	95% CI^b b 95% confidence interval in weighted sample.	% missing	n	%^a a Values weighted for the inverse of existence of landline telephones and the number of adults living in the household of the interviewee	95% CI^b b 95% confidence interval in weighted sample.	% missing
Sex					0.0				0.0
	Male	15,368	47.1	(46.2; 48.1)		4.908	40.5	(38.7; 42.2)
	Female	22,579	52.9	(51.9; 53.8)		10.074	59.5	(57.8; 61.3)
Marital status					1.1				1.5
	Living without a partner	18,210	52.0	(51.0; 53.0)		7.557	43.1	(41.4; 44.8)
	Living with a partner	19,304	48.0	(47.0; 49.0)		7.204	56.9	(55.2; 58.6)
Skin color					1.1				18.6
	White	14,867	44.9	(43.8; 45.9)		7.402	61.3	(59.4; 63.2)
	Black	18,983	55.1	(54.1; 56.2)		4.790	38.7	(36.8; 40.6)
Educational level, years					0.8				2.9
	0-8	7,115	30.6	(29.6; 31.6)		7.405	69.3	(67.8; 70.7)
	9-11	15,532	41.1	(40.2; 42.0)		3.761	17.3	(16.3; 18.5)
	≥ 12	14,984	28.3	(27.5; 29.2)		3.381	13.4	(12.4; 14.4)
Demographic macroregion					0.0				0.0
	North	10,896	10.5	(10.2; 10.9)		2.805	7.0	(6.6; 7.5)
	Northeast	12,729	25.7	(25.0; 26.3)		4.884	22.2	(21.1; 23.2)
	Southeast	5,327	44.1	(43.1; 45.2)		2.574	51.8	(50.1; 53.5)
	South	3,457	7.9	(7.5; 8.2)		2.399	9.5	(8.9; 10.1)
	Center-West	5,538	11.8	(11.3; 12.2)		2.320	9.5	(8.9; 10.1)

Variables		2 NCDs versus 0 and 1		3 NCDs versus 0 and 1		4 NCDs versus 0 and 1
Variables		OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Sex			0.641^a a Heterogeneity		0.775^a a Heterogeneity		0.841^a a Heterogeneity
	Male	1.00		1.00		1.00
	Female	0.94 (0.83; 1.12)		0.96 (0.74; 1.25)		1.06 (0.60; 1.88)
Age group, years			< 0.001^b b Tendency.		< 0.001^b b Tendency.		< 0.001^b b Tendency.
	18-29	1.00		1.00		1.00
	30-39	4.36 (0.44; 5.52)		5.00 (2.62; 9.44)		1.50 (0.34; 6.59)
	40-49	7.07 (5.67; 8.82)		11.44 (6.27; 20.86)		13.76 (3.49; 54.21)
	50-59	13.71 (11.04; 17.03)		28.57 (15.90; 51.34)		30.01 (8.01; 112.5)
Marital status			0.004^a a Heterogeneity		< 0.001^a a Heterogeneity		0.889^a a Heterogeneity
	Living without a partner	1.00		1.00		1.00
	Living with a partner	1.27 (1.08; 1.50)		1.70 (1.28; 2.26)		1.04 (0.77; 2.64)
Skin color			0.230^a a Heterogeneity		0.226^a a Heterogeneity		0.264^a a Heterogeneity
	White	1.00		1.00		1.00
	Black	1.10 (0.94; 1.29)		1.18 (0.90; 1.55)		1.42 (0.77; 2.65)
Educational level, years			< 0.001^b b Tendency.		< 0.001^b b Tendency.		< 0.001^b b Tendency.
	0-8	1.00		1.00		1.00
	9-11	0.73 (0.62; 0.86)		0.57 (0.43; 0.74)		0.40 (0.22; 0.74)
	≥ 12	0.67 (0.56; 0.81)		0.47 (0.34; 0.64)		0.30 (0.15; 0.60)
Demographic macroregion			0.638^a a Heterogeneity		0.097^a a Heterogeneity		0.638^a a Heterogeneity
	North	1.00		1.00		1.00
	Northeast	1.07 (0.91; 1.26)		1.22 (0.88; 1.68)		0.97 (0.51; 1.83)
	Southeast	1.02 (0.85; 1.22)		1.45 (1.00; 2.09)		1.49 (0.78; 2.87)
	South	1.03 (0.84; 1.25)		1.52 (1.06; 2.17)		1.13 (0.54; 2.34)
	Center-West	0.92 (0.74; 1.15)		1.02 (0.68; 1.55)		1.17 (0.53; 2.59)

Variables		2 NCDs versus 0 and 1		3 NCDs versus 0 and 1		4 NCDs versus 0 and 1
Variables		OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Sex			< 0.001 ^a a Heterogeneity		< 0.001 ^a a Heterogeneity		0.002 ^a a Heterogeneity
	Male	1.00		1.00		1.00
	Female	1.62 (1.33; 1.96)		1.68 (1.28; 2.21)		2.52 (1.39; 4.57)
Age group, years			0.420^b b Tendency.		0.356^b b Tendency.		0.143^b b Tendency.
	60 to 69	1.00		1.00		1.00
	70 to 79	1.10 (0.89; 1.37)		1.33 (0.98; 1.81)		0.65 (0.39; 1.10)
	≥ 80	0.76 (0.56; 1.04)		1.03 (0.61; 1.75)		0.57 (0.21; 1.58)
Marital status			0.580^a a Heterogeneity		0.018 ^a a Heterogeneity		0.278^a a Heterogeneity
	Living without a partner	1.00		1.00		1.00
	Living with a partner	1.06 (0.85; 1.33)		1.45 (1.06; 1.98)		0.74 (0.43; 1.28)
Skin color			0.016 ^a a Heterogeneity		0.380^a a Heterogeneity		0.814^a a Heterogeneity
	White	1.00		1.00		1.00
	Black	1.31 (1.05; 1.62)		1.14 (0.86; 1.51)		0.94 (0.59;1.52)
Educational level, years			< 0.001 ^b b Tendency.		< 0.001^b b Tendency.		0.369^b b Tendency.
	0-8	1.00		1.00		1.00
	9-11	0.68 (0.56; 0.83)		0.58 (0.45; 0.77)		0.73 (0.38;1.38)
	≥ 12	0.63 (0.50; 0.79)		0.49 (0.35; 0.69)		0.79 (0.40; 1.57)
Demographic macroregion			0.581^a a Heterogeneity		0.327^a a Heterogeneity		0.504^a a Heterogeneity
	North	1.00		1.00		1.00
	Northeast	0.07 (0.87; 1.31)		1.04 (0.77; 1.40)		0.70 (0.42; 1.17)
	Southeast	0.92 (0.72; 1.17)		1.00 (0.70; 1.43)		0.52 (0.28; 0.97)
	South	1.18 (0.93; 1.49)		1.24 (0.89; 1.73)		0.93 (0.54; 1.61)
	Center-West	0.92 (0.74; 1.15)		0.97 (0.71; 1.33)		0.37 (0.20; 0.69)

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