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. 2019 Aug 1;14(8):e0214183.
doi: 10.1371/journal.pone.0214183. eCollection 2019.

Multimorbidity, healthcare utilization and socioeconomic status: A register-based study in Denmark

Anne Frølich  1   2 , Nermin Ghith  3 , Michaela Schiøtz  4 , Ramune Jacobsen  5 , Anders Stockmarr  6
Affiliations

Multimorbidity, healthcare utilization and socioeconomic status: A register-based study in Denmark

Anne Frølich et al. PLoS One. .

Abstract

Background: People with multimorbidity have reduced functional capacity, lower quality of life, higher mortality rates and use healthcare resources more intensively than healthy people or those with a single chronic condition. Multimorbidity was defined as the coexistence of two or more chronic conditions in the same person. The aim of this study was to explore associations between multimorbidity and use of healthcare services and the impact of socioeconomic status on utilization of hospitalizations and bed days.

Methods: The study population included all individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services and demographics were obtained from Danish national administrative and health registries. Zero-inflated models were used to calculate anticipated annual use of hospitalizations and bed days.

Findings: The study population comprised 1,397,173 individuals; the prevalence of multimorbidity was 22%. Prevalence was inversely related to educational attainment. For people with multimorbidity, utilization of hospitalizations and bed days increased approximately linearly with the number of chronic conditions. However, a steep increase in utilization of bed days was observed between five and six or more chronic conditions. An educational gradient in hospitalization rates and use of bed days was observed regardless of the number of chronic conditions. Educational attainment was strongly associated with healthcare utilization.

Conclusion: Multimorbidity was associated with a significant increase in utilization of all healthcare services in Denmark. In addition, a socioeconomic gradient was observed in utilization of hospitalizations and bed days.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Relationship between numbers of chronic conditions and hospitalizations (1A) and between numbers of chronic conditions and bed days (1B).
(1A) The black line indicates the observed number of hospitalizations by the number of chronic conditions. The red line indicates the reference regression line that shows the mean number of hospitalizations multiplied by the number of chronic conditions. (1B) The black line indicates the observed number of bed days by number of chronic conditions. The red line indicates the reference regression line that shows the mean number of bed days multiplied by the numbers of chronic conditions.
Fig 2
Fig 2. Number of chronic conditions associated with the modeled rate of hospitalizations by educational attainment levels.
Black line, no education; red line, short education; green line, medium education; blue line, long education.
Fig 3
Fig 3. Number of chronic conditions associated with the modeled rate of bed days by educational attainment.
Black line, no education; red line, short education; green line, medium education; blue line, long education.
See this image and copyright information in PMC

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