Multimorbidity patterns and associated factors in a megacity: a cross-sectional study

Aguiar, Ricardo Goes de; Simões, Daniela; Castro, Shamyr Sulyvan; Goldbaum, Moises; Cesar, Chester Luiz Galvão; Lucas, Raquel

doi:10.11606/s1518-8787.2024058006058

Brasil

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Original Article • Rev. Saúde Pública 58 • 2024 • https://doi.org/10.11606/s1518-8787.2024058006058 linkcopy

Multimorbidity patterns and associated factors in a megacity: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo.

METHODS This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression.

RESULTS The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern.

CONCLUSION The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies.

Multimorbidity; Comorbidity; Latent Class Analysis

Characteristics	n (3032)	% (100.00)	95%CI
Sex
Female	1753	53.46	51.43–55.48
Male	1279	46.54	44.52–48.57
Age range
20–29	549	22.7	20.97–24.52
30–39	597	24.23	22.47–26.09
40–49	499	19.49	17.89–21.19
50–59	445	15.71	14.31–17.23
60–69	530	10.29	9.38–11.28
≥70	412	7.58	6.81–8.43
Race/skin color
White	1560	52.35	50.33–54.36
Brown	974	32.16	30.33–34.05
Black	313	10.28	9.15–11.54
Other	168	5.2	4.39–6.16
Marital status
With a partner	1738	59.04	57.05–61.01
With no partner	1287	40.96	38.99–42.95
Schooling
Preschool (0–4 y.o.)	513	11.85	10.77–13.02
Elementary (5–9 y.o.)	800	22.76	21.24–24.36
High school or technical school	1031	36.56	34.64–38.53
Unfinished Higher education	222	9.41	8.19–10.79
Higher education and/or Postgraduate studies	451	19.41	17.67–21.27
Body mass index (BMI)
Underweight	239	5.75	4.93–6.69
Normal	1241	41.76	39.76–43.78
Overweight	864	31.97	30.09–33.91
Obesity	625	20.52	18.92–22.21
WHO recommended physical activity (≥150 min/week)
Yes	2408	81.29	79.7–82.79
No	598	18.71	17.21–20.30
Smoking
No	2010	67.18	65.27–69.04
Yes	1019	32.82	30.96–34.73
Employment status
Employed	1767	65.61	63.73–67.44
Unemployed	1257	34.39	32.56–36.27
Median household income
1st quartile	579	22.74	20.94–24.64
2nd quartile	590	24.25	22.38–26.22
3rd quartile	557	23.87	22.01–25.84
4th quartile	562	29.14	26.93–31.45
Common Mental Disorder (CMD)
Yes	634	19.41	17.89–21.01
No	2315	80.59	78.99–82.11
Health status
Excellent/very good	568	21.0	19.33–22.77
Good	1539	51.9	49.88–53.91
Normal	798	23.7	22.09–25.39
Bad/very bad	122	3.4	2.81–4.12
Health status comparison (≥ 60 y.o.)
Better than 1 year before	234	23.78	20.96–26.85
Same as 1 year before	505	54.68	51.16–58.15
Worse than 1 year before	200	21.54	18.76–24.61
Functional or Activity Limitations
Yes	228	39.0	34.57–43.62
No	364	61.0	56.38–65.43
Bedridden
No	463	78.01	73.83–81.68
Yes	129	21.99	18.32–26.17
Last-time health care service utilization
Less than 2 weeks	572	18.36	16.84–19.99
15–30 days	449	14.43	13.10–15.87
1–months	711	22.49	20.87–24.20
3–6 months	462	16.00	14.54–17.58
6–12 months	424	14.74	13.35–16.25
More than 1 year	402	13.97	12.63–15.43
Surgeries and hospitalization
No	2788	91.59	90.31–92.72
Yes	242	8.41	7.28–9.69

Variables	Pattern 1	Pattern 2	Pattern 3
	Respiratory conditions	Cardiovascular conditions	Rheumatic, muscular/skeletal, and mental conditions
	PR (95% CI)	PR (95% CI)	PR (95% CI)
Age group
20–29	1	1	1
30–39	4.85 (4.85–4.85)	2.91 (2.91–2.91)	1.02 (1.02–1.02)
40–49	15.56 (15.56–15.56)	14.62 (14.62–14.62)	1.26 (1.26–1.26)
50–59	84.3 (84.3–84.3)	47.42 (47.42–47.42)	1.85 (1.85–1.85)
60–69	164.69 (164.69–164.69)	125.77 (125.77–125.77)	2.13 (2.13–2.13)
70+	473.67 (473.67–473.67)	316.05 (316.05–316.05)	4.4 (4.4–4.4)
Gender
Female	1	1	1
Male	0.46 (0.22–0.96)	1.52 (0.72–3.21)	2.25 (1.59–3.18)
Race/skin color
White	1	1	1
Black	0.53 (0.28–1)	0.69 (0.37–1.28)	1.21 (0.95–1.53)
Other	1.29 (0.72–2.33)	1.3 (0.66–2.54)	0.89 (0.7–1.14)
Brown	0.54 (0.3–0.99)	0.57 (0.31–1.05)	1.24 (0.99–1.56)
Marital status
With a partner	1	1	1
With no partner	1.3 (0.55–3.11)	1.34 (0.55–3.26)	0.88 (0.47–1.67)
Schooling
Preschool (0 to 4 y.o.)	1	1	1
Elementary (5 to 9 y.o.)	0.36 (0.13–0.96)	0.24 (0.09–0.66)	0.55 (0.21–1.44)
High school or technical school	0.09 (0.04–0.19)	0.06 (0.02–0.15)	0.45 (0.22–0.93)
Incomplete higher education	0.05 (0.02–0.15)	0.04 (0.01–0.11)	0.25 (0.12–0.52)
Complete higher education and/or post-graduation	0.12 (0.05–0.33)	0.12 (0.05–0.3)	0.34 (0.14–0.83)
Work status
Employed	1	1	1
Unemployed	5.69 (2.46–13.16)	4.59 (2.29–9.23)	0.98 (0.67–1.42)
Medium household income
1st quartile	1	1	1
2nd quartile	0.82 (0.37–1.82)	0.63 (0.31–1.27)	0.81 (0.63–1.06)
3rd quartile	0.61 (0.29–1.26)	0.6 (0.25–1.41)	0.7 (0.49–0.98)
4th quartile	0.69 (0.37–1.28)	0.73 (0.36–1.48)	0.56 (0.45–0.69)
Self-rated health compared with the previous year
Excellent/very good	1	1	1
Good	2.35 (1–5.52)	1.6 (0.77–3.35)	0.83 (0.59–1.18)
Normal	3.34 (1.34–8.32)	1.96 (0.87–4.41)	0.37 (0.25–0.55)
Bad or very bad	3.5 (1.33–9.25)	2.15 (0.92–5.01)	0.2 (0.11–0.35)
Self-rated health compared to the previous year (>60 y.o.)
Same as 1 year ago	1	1	1
Better than 1 year ago	0.68 (0.49–0.95)	0.51 (0.38–0.7)	0.4 (0.29–0.55)
Worse than 1 year ago	1.7 (1.05–2.76)	1.37 (0.89–2.1)	0.57 (0.38–0.86)
Functional or Activity Limitations
No	1	1	1
Yes	0.61 (0.35–1.07)	1.27 (0.67–2.41)	0.69 (0.48–1.01)
Bedridden
No	1	1	1
Yes	0.85 (0.39–1.85)	1.2 (0.56–2.54)	0.74 (0.41–1.32)
Body mass index (BMI)
Normal	1	1	1
Underweight	4.29 (2.02–9.11)	4.04 (2.12–7.7)	1.61 (0.7–3.71)
Overweight	0.59 (0.25–1.37)	0.5 (0.24–1.03)	0.88 (0.62–1.24)
Obese	1.95 (1–3.83)	1.69 (0.8–3.6)	1.06 (0.77–1.45)
WHO recommended physical activity (≥ 150 min/week)
No	1	1	1
Yes	0.37 (0.16–0.87)	0.3 (0.12–0.71)	0.76 (0.55–1.05)
Smoking
No	1	1	1
Yes	1.65 (0.78–3.49)	1.29 (0.62–2.67)	1.14 (0.81–1.59)
Last-time health care service utilization
Less than 2 weeks	1	1	1
15–30 days	1.31 (0.71–2.44)	1.29 (0.6–2.78)	1.73 (1.19–2.51)
1–3 months	1.2 (0.65–2.23)	1.03 (0.48–2.23)	1.54 (1.05–2.26)
3–6 months	0.87 (0.47–1.63)	0.72 (0.35–1.48)	1.63 (1.2–2.21)
6–12 months	0.43 (0.23–0.81)	0.55 (0.26–1.14)	1.86 (1.27–2.72)
More than 1 year	0.23 (0.1–0.49)	0.22 (0.09–0.58)	2.87 (2–4.12)
Hospitalizations and/or surgeries
No	1	1	1
Yes	0.97 (0.47–2.03)	1.21 (0.49–2.98)	0.65 (0.46–0.91)
Emotional health condition
No	1	1	1
Yes	1.51 (0.64–3.52)	0.65 (0.3–1.4)	0.35 (0.26–0.48)

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[TFN1] 95% CI: 95% confidence interval.