| ObjectivesThe aims of this study are to investigate the prevalence and patterns of multimorbidity and use of health service among community-dwelling older adults aged 60 years and above,to explore how those multimorbidity affect health service utilization,which in order to provide a reference for the health intervention and prevention strategies for the patients with multimorbidity,can be used as a reference for health-related decision-making.MethodsBased on a community health survey conducted in Shenzhen,China,a total of 1334 older adults aged 60 years and above dwelling in the community were selected.The socio-demographic data and health and lifestyle characteristics were extracted using the general situation questionnaire.The Fourth National Health Service Questionnaire was used to assess recent two-week physician visit and annual hospitalization rates.EpiData 3.1 software was used to establish the data.SPSS 22.0 and Mplus 7.4 software were employed to conduct the statistical analysis.Means,standard deviations(SD),frequency and percentage were performed for statistical description.Association rule and latent class analysis(LCA)were used to identify individuals with multimorbidity feature and patterns based on self-reported chronic conditions.Chi-square and several logistic regression models were run in the study.Results1.The average age of 1334 elderly persons aged 60 years and over was(71.61 ±9.39)years.Majority of the participants were female,married and received an education of primary school or lower,had medical insurance.With regard to health-related factors,most did not smoke,drink,exercised regularly.2.719 older adults had two or more chronic diseases and the prevalence of multimorbidity was53.9%,and 45.2% of them had two chronic diseases,28.5% of them had three chronic diseases and 26.3%had four or more chronic diseases.The chi-square test showed that there were statistical differences in gender,marital status,education,medicine insurance,sedentariness,physical examination and hospital distance among the subgroup of different multimorbidity number(P<0.05).On the basis of the association rule analysis,the paired multimorbidity patterns containing heart diseases and hypertension in the subgroup with two chronic diseases;The top three are the combination of obesity,hypertension,diabetes and stroke in the subgroup with three chronic diseases;and of diabetes,bone and connective tissue diseases,hypertension and pain in the subgroup with more than four chronic diseases.3.LCA revealed a three-class model best fit solution.Three multimorbidity classes were identified: high multimorbidity class 319(23.9%),medium multimorbidity class 262(19.6%),low multimorbidity class 753(56.4%).The chi-square test showed that there were statistical differences in age,marital status,education,drinking,physical examinationand and hospital time among the three multimorbidity classes(P<0.05).On the basis of the association rule analysis,the paired multimorbidity patterns covering diabetes and hypertension,diabetes and pain in the low multimorbidity class;The top three are the combination of chronic gastroenteritis,hypertension,chronic obstructive pulmonary diseases,and bone and connective tissue diseases in the medium multimorbidity class,and of obesity,hypertension,diabetes and heart diseases in the high multimorbidity class.4.Among the 1334 older adults,the number of recent 2-week physician visit was 91(6.8%).Themost reason of non-consultation was continue treatment as directed and feeling symptoms light.The rate of hospitalization in last year was 161(12.1%).Different age,marital status,emplorment status,medical insurance,hospital distance and multimorbidity status were associated with the recent 2-week physician visit rate(P<0.05).Different age,gender,emplorment status,medical insurance,drinking,sedentariness,hospital time and multimorbidity status were associated with the hospitalization in last year rate.The results of the multivariate logistic regression analysis showed that age,medical insurance,hospital distance and multimorbidity status related to recent 2-week physician visit rate;gender,medical insurance,drinking,sedentariness,hospital time and multimorbidity status related to hospitalization rate in last year(P<0.05).5.Based on the number of chronic diseases in the elderly in the community.The results of univariate and multivariate logistic regression analysis showed that different number of chronic diseses significantly related to recent two-week physician visit rate and annual hospitalization rate(P <0.05).6.Among the multimorbidity classes based on LCA,the results of univariate and multivariate logistic regression analysis showed that patients in medium multimorbidity class had about 1.1-fold increased risk of recent two-week physician visit rate and 1.2-fold increased risk of annual hospitalization rate,respectively,compared with those in low multimorbidity class in elderly people(P<0.05).Conclusions1.The prevalence of multimorbidity was high in the elderly aged 60 and above.The demand for health service of them is high but health service utilization is relatively low.2.Among the numbers of multimorbidity,2 chronic diseases were common.The rate of health services ultilization increased with the increase of the number of comorbidities.3.The patterns of multimorbidity are different in different classes.what’s more,the main multimorbidity patterns in that are the combination of obesity,hypertension,diabetes and heartdiseases.Heart disease and hypertension are the main multimorbidity patterns in the elderly with two chronic diseases and clinical prevention,control and intervention should be carried out according to the multimorbidity patterns based on different number of chronic diseases.4.Both the number and classes of multimorbidity based on LCA were significantly associated with the utilization of health services. |
PDF Full Text Request