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. 2014 Oct 23:12:188.
doi: 10.1186/s12916-014-0188-0.

Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China

Harry H X Wang, Jia Ji Wang, Samuel Y S Wong, Martin C S Wong, Fang Jian Li, Pei Xi Wang, Zhi Heng Zhou, Chun Yan Zhu, Sian M Griffiths, Stewart W Mercer

Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China

Harry H X Wang et al. BMC Med. .

Abstract

Background: China, like other countries, is facing a growing burden of chronic disease but the prevalence of multimorbidity and implications for the healthcare system have been little researched. We examined the epidemiology of multimorbidity in southern China in a large representative sample. The effects of multimorbidity and other factors on usual source of healthcare were also examined.

Methods: We conducted a large cross-sectional survey among approximately 5% (N = 162,464) of the resident population in three prefectures in Guangdong province, southern China in 2011. A multistage, stratified random sampling was adopted. The study population had many similar characteristics to the national census population. Interviewer-administered questionnaires were used to collect self-report data on demographics, socio-economics, lifestyles, healthcare use, and health characteristics from paper-based medical reports.

Results: More than one in ten of the total study population (11.1%, 95% confidence interval (CI) 10.6 to 11.6) had two or more chronic conditions from a selection of 40 morbidities. The prevalence of multimorbidity increased with age (adjusted odds ratio (aOR) = 1.36, 95% CI 1.35 to 1.38 per five years). Female gender (aOR = 1.70, 95% CI 1.64 to 1.76), low education (aOR = 1.26, 95% CI 1.23 to 1.29), lack of medical insurance (aOR = 1.79, 95% CI 1.71 to 1.89), and unhealthy lifestyle behaviours were independent predictors of multimorbidity. Multimorbidity was associated with the regular use of secondary outpatient care in preference to primary care.

Conclusions: Multimorbidity is now common in China. The reported preferential use of secondary care over primary care by patients with multimorbidity has many major implications. There is an urgent need to further develop a strong and equitable primary care system.

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Figures

Figure 1
Figure 1
Number of chronic conditions experienced by patients with common, important diseases.
Figure 2
Figure 2
Prevalence of multimorbidity by age and household income per head. Note: Error bars indicate 95% confidence interval.
Figure 3
Figure 3
Prevalence of multimorbidity by age and usual source of healthcare. Note: Error bars indicate 95% confidence interval.
See this image and copyright information in PMC

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