Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries

Abstract

Background: with ageing populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and health status in Europe.

Methods: we used cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011-12, which included nationally representative samples of persons aged 50 and older from 16 European nations. Negative binomial and logistic regression models were used to assess the association between number of chronic diseases and healthcare utilisation, self-perceived health, depression and reduction of functional capacity.

Results: overall, 37.3% of participants reported multimorbidity; the lowest prevalence was in Switzerland (24.7%), the highest in Hungary (51.0%). The likelihood of having multimorbidity increased substantially with age. Number of chronic conditions was associated with greater healthcare utilisation in both primary (regression coefficient for medical doctor visits = 0.29, 95% CI = 0.27-0.30) and secondary setting (adjusted odds ratio (AOR) for having any hospitalisation in the last year = 1.49, 95% CI = 1.42-1.55) in all countries analysed. Number of chronic diseases was associated with fair/poor health status (AOR 2.13, 95% CI = 2.03-2.24), being depressed (AOR 1.48, 95% CI = 1.42-1.54) and reduced functional capacity (AOR 2.12, 95% CI = 2.02-2.22).

Conclusion: multimorbidity is associated with greater healthcare utilisation, worse self-reported health status, depression and reduced functional capacity in European countries. European health systems should prioritise improving the management of patients with multimorbidity to improve their health status and increase healthcare efficiency.

Keywords: chronic disease; health status; healthcare utilisation; multimorbidity; older people.

Figure 1.

Prevalence of multimorbidity by age category in 16 European countries. AT, Austria; DE, Germany; SE, Sweden; NL, Netherlands; SP, Spain; IT, Italy; FR, France; DK, Denmark; CH, Switzerland; BE, Belgium; CZ, Czech Republic; PL, Poland; HU, Hungary; PT, Portugal; SL, Slovenia; EE, Estonia; EU POOLED, Europe.

Figure 2.

Association between number of CDs and healthcare utilisation, self-perceived health, depression and functional capacity. Primary care utilisation defined by the number of medical doctor visits, and secondary care utilisation defined by the number of hospitalisations. Regression coefficients and AOR are adjusted for age, gender, number of people living in the same household, residence, educational level and employment status. All the regression coefficients and AOR values were found statistically significant. AT, Austria; DE, Germany; SE, Sweden; NL, Netherlands; SP, Spain; IT, Italy; FR, France; DK, Denmark; CH, Switzerland; BE, Belgium; CZ, Czech Republic; PL, Poland; HU, Hungary; PT, Portugal; SL, Slovenia; EE, Estonia; EU, Pooled data.