Epidemiologic Characteristics of Multimorbidity and Sociodemographic Factors Associated With Multimorbidity in a Rapidly Aging Asian Country

Abstract

Importance: Multimorbidity is a growing health care problem in aging societies and is strongly associated with epidemiologic characteristics and sociodemographic factors. Knowledge of these associations is important for the design of effective preventive and management strategies.

Objectives: To determine the association between multimorbidity and sociodemographic factors (age, socioeconomic status [SES], sex, and race/ethnicity) and the association between mental health diseases and physical diseases, as well as their implications for the types and costs of health care use.

Design, setting, and participants: This population-based cross-sectional study used deidentified Singapore Eastern Regional Health System data collected between January 1, 2012, and December 31, 2016. Patients who were alive as of January 1, 2016, and residing in the Regional Health System region in 2016 (N = 1 181 024) were included. Patients who had no year of birth records (n = 573), were born in 2017 (n = 93), or died before January 1, 2016 (n = 47 322), were excluded.

Main outcomes and measures: Multimorbidity, age, sex, SES, mental health, race/ethnicity, and health care use.

Results: In the study population of 1 181 024 individuals, the mean (SD) age was 39.6 (22.1) years, 51.2% were women, 70.1% were Chinese, 7.1% were Indian, 13.5% were Malayan, and 9.3% were other races/ethnicities. Multimorbidity, present in 26.2% of the population, was more prevalent in female (26.8%; 95% CI, 26.7%-26.9%) than in male (25.6%; 95% CI, 25.5%-25.7%) patients and among patients with low SES (41.6%) than those with high SES (20.1%). Mental health diseases were significantly more prevalent among individuals with low SES (5.2%; 95% CI, 5.1%-5.2%) than high SES (2.1%; 95% CI, 2.0%-2.1%; P < .001). The 3 most prevalent disease combinations were chronic kidney disease and hypertension, chronic kidney disease and lipid disorders, and hypertension and lipid disorders. Although chronic kidney disease, hypertension, lipid disorders, and type 1 and/or type 2 diabetes-related diseases had a low cost per capita, the large number of patients with these conditions caused the overall proportion of the cost incurred by health care use to be more than twice that incurred in other diseases.

Conclusions and relevance: These findings emphasize the association between multimorbidity and sociodemographic factors such as increasing age, lower SES, female sex, and increasing number of mental disorders. Health care policies need to take sociodemographic factors into account when tackling multimorbidity in a population.

Figure 1.. Prevalence of Multimorbidity by Age, Varied by Socioeconomic Status, Race/Ethnicity, and Sex

Low socioeconomic status indicates a monthly household income of 1100 Singapore dollars (SGD) and below (for households with income), middle socioeconomic status indicates a monthly household income of 1101 to 1800 SGD (for households with income), and high socioeconomic status indicates a monthly household income of more than 1800 SGD (for households with income). (Exchange Rate as of December 31, 2016, is 1 US dollar = 1.4465 SGD). CHAS indicates Community Health Assistance Scheme.

Figure 2.. Physical and Mental Health Diseases and the Association With Socioeconomic Status, Race/Ethnicity, and Sex

Low socioeconomic status indicates a monthly household income of 1100 Singapore dollars (SGD) and below (for households with income), middle socioeconomic status indicates a monthly household income of 1101 to 1800 SGD (for households with income), and high socioeconomic status indicates a monthly household income of more than 1800 SGD (for households with income). (Exchange Rate as of December 31, 2016, is 1 US dollar = 1.4465 SGD).