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      Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

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          Abstract

          (1) Background: The management of multiple chronic diseases challenges China’s health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants’ HRQOL, and χ 2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old ( P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases ( P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants ( P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants ( P < 0.001), and daily tooth-brushing for middle ( P < 0.05) and young-old participants ( P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients ( P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.

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          Most cited references39

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          Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

          Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.
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              Aging with multimorbidity: a systematic review of the literature.

              A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients. Copyright © 2011 Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                11 December 2020
                December 2020
                : 17
                : 24
                : 9261
                Affiliations
                [1 ]Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; zhaoqinfeng6@ 123456mail.sdu.edu.cn (Q.Z.); 201835804@ 123456mail.sdu.edu.cn (C.J.)
                [2 ]NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan 250012, China
                [3 ]Dong Fureng Institute of Economics and Social Development, Wuhan University, No. 54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China; wangjian993@ 123456whu.edu.cn
                [4 ]Center for Health Economics and Management, Economics and Management School, Wuhan University, Luojia Hill, Wuhan 430072, China
                [5 ]Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh, NSW 2015, Australia; stephen.nicholas@ 123456newcastle.edu.au
                [6 ]Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, 2 Baiyun North Avenue, Guangzhou 510420, China
                [7 ]School of Economics, Tianjin Normal University, No. 339 Binshui West Avenue, Tianjin 300387, China
                [8 ]School of Management, Tianjin Normal University, No. 339 Binshui West Avenue, Tianjin 300387, China
                [9 ]Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia
                [10 ]School of Management, University of Liverpool, Chatham Building, Chatham Street, Liverpool L697ZH, UK; e.maitland@ 123456liverpool.ac.uk
                [11 ]Shandong Health Commission Medical Management Service Center, Jinan 250012, China; sunjingjie@ 123456shandong.cn
                [12 ]UNSW Medicine, UNSW Sydney, Sydney, NSW 2052, Australia; lizheng.xu@ 123456unsw.edu.au
                [13 ]The George Institute for Global Health, Newtown, NSW 2042, Australia
                [14 ]School of Political Science and Public Administration, Institute of Governance, Shandong University, 72 Binhai Rd, Qingdao 266237, China
                Author notes
                [* ]Correspondence: lenganli@ 123456sdu.edu.cn
                Author information
                https://orcid.org/0000-0001-8769-7928
                https://orcid.org/0000-0001-6770-7105
                https://orcid.org/0000-0002-6775-2085
                Article
                ijerph-17-09261
                10.3390/ijerph17249261
                7764479
                33322307
                5fb4e132-4b1e-42f6-8fd1-58ef49bc0e83
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 19 November 2020
                : 09 December 2020
                Categories
                Article

                Public health
                china,multimorbidity,middle-aged and old-aged adults
                Public health
                china, multimorbidity, middle-aged and old-aged adults

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