The prevalence of multiple chronic conditions (MCCs) is continuously increasing among older adults in China, but few studies have explored complex pattern of MCCs from perspectives of patient demand and disease management.
This study aims to investigate the pattern distributions, correlates, and treatment burdens of MCCs.
Data were obtained from the 2018 and 2020 China Health and Retirement Longitudinal Study (CHARLS) waves, and the study sample included older adults aged≥60 years old (n=15 349). The generalized ordered logit model and the generalized linear model were used to examine correlates of MCCs complex pattern and its associations with outpatient/inpatient utilization and expenditure, respectively. All statistical analyses were weighted except for sample size.
Among the total sample of 15 349 older adults, there were 7 147 in 2018 and 8 202 in 2020; 2 054 participants[13.0%, defined as the relatively healthy group (RH group) ] had none of 12 chronic conditions defined in this study, 5 228 participants [33.7%, defined as the simple chronic illness group (SCI group) ] had 1-5 non-complex chronic conditions, 6 737 participants [44.7%, defined as the minor complex chronic illness group (MiCCI group) ] had 1-2 complex chronic conditions, and <6 non-complex chronic conditions, and 1 330 participants[8.6%, defined as the major complex chronic illness group (MaCCI group) ] had ≥3 complex chronic conditions or ≥6 non-complex chronic conditions. The proportion of MiCCI and MaCCI groups had an increase of 2.1% and 1.9% between 2018 and 2020, respectively. Among the SCI and MiCCI groups, the most prevalent chronic conditions were hypertension (49.2% and 56.1%) and arthritis/rheumatism (51.9% and 47.4%), respectively. Among MaCCI group, 82.0% had heart disease, and 67.9% had chronic lung diseases. There were statistically significant differences in the prevalence of chronic conditions among the three groups (P<0.05). Age, sex, education level, annual household expenditure per capita, medical insurance, depression status, and survey year were associated with being in SCI, MiCCI, and MaCCI groups (P<0.05) ; age, education level, urban-rural location, region, annual per capita household expenditure, and survey year were associated with being in MiCCI and MaCCI groups (P<0.05) ; age, region, annual per capita household expenditure, depression status, and survey year were associated with being in MaCCI group (P<0.05). In 2018, compared to the RH group, the MiCCI and MaCCI group had more outpatient numbers, and the SCI, MiCCI, and MaCCI groups had higher outpatient expenses, inpatient numbers and expenses (P<0.05). In 2020, compared to the RH group, the SCI, MiCCI, MaCCI groups utilized more outpatient and inpatient services (P<0.05) .
According to the most recent CHARLS data, over half of older adults in China suffers from complex chronic comorbidities, with 44.7% for the MiCCI group and 8.6% for MaCCI group. The heart disease and chronic lung disease was the most prevalent in the MaCCI group. Furthermore, as the complexity of multimorbidity increases, there is a noticeable increase in outpatient and inpatient utilization as well as medical expenditures. Therefore, it is recommended to explore effective MCC management models based on healthcare demands to improve health outcomes and reduce disease burdens.
With the aggravation of population aging in China, the disease spectrum of the population has changed and the coexistence of multiple chronic diseases has become the norm for the health status of the older population in China. Patient delay refers to the behaviour of an individual who fails to seek medical care in a timely manner after becoming unwell for a variety of subjective or objective reasons, resulting in a decrease in the treatment effectiveness and a decrease in the quality of the patient's survival. At present, there are few researches on patient delay and the associated factors for elderly adults with multimorbidity in China.
To explore the patient delay and the associated factors for older adults with multimorbidity, so as to provide references to further reduce the incidence of patient delay.
Eligible elderly patients attending 27 community health centers in Guangdong Province from September to December 2022 were selected for the study using multi-stage stratified whole cluster random sampling method. A self-designed questionnaire was used to collect patients' general information, disease-related information and delays in seeking medical care. Multivariate Logistic regression analysis and a decision tree model based on the CHAID algorithm were used to analyse the influencing factors of patient delay in older adults with multimorbidity.
A total of 998 patients were included in the study, of which 243 (24.35%) showed delays in seeking medical care. The multivariate Logistic regression results showed that gender (OR=0.701, 95%CI=0.504-0.977, P=0.036), type of household registration (OR=0.590, 95%CI=0.358-0.973, P=0.039), type of health insurance (OR=2.660, 95%CI=1.764-4.010, P<0.001), disease-related self-efficacy (OR=4.378, 95%CI=2.079-9.217, P<0.001), family doctor contract (OR=2.277, 95%CI=1.618-3.206, P<0.001) and self-reported health (OR=1.554, 95%CI=1.073-2.250, P=0.020) were the main factors influencing patient delay in older adults with multimorbidity (P<0.05). The decision tree model has 3 levels and 13 nodes, and a total of 5 influencing factors were screened, including type of health insurance, family doctor contract, gender, self-reported health and age. The results of the two models for predicting patient delay in older adults with multimorbidity showed that the area under receiver operating characteristic curve (AUC) was 0.729 for the multivariate Logistic regression model and 0.721 for the decision tree model. There was no significant difference in AUC between the two models for predicting patients delay in elderly patients with multimorbidity (Z=0.539, P=0.590) .
The incidence of patient delay in older adults with multimorbidity is 24.35% in Guangdong province, and the type of health insurance, the contracting rate of family doctors, gender, and self-reported health status are the main factors influencing patient delay in older adults with multimorbidity. The medical insurance system should be further improved to increase the contracting rate and utilization rate of family doctors in order to reduce the incidence of patient delay.
With the aging of the population and changes in the disease spectrum, the incidence of multimorbidity among the elderly remained high, and have become the focus of the family doctor contracting service at the primary level. At present, there are many studies promoting the signing of family doctors from the perspective of increasing "quantity", but there is still a lack of studies on the factors affecting the effectiveness of family doctor contract services for elderly multimorbidity patients after signing from the perspective of improving "quality".
To explore the important influencing factors of satisfaction and usefulness evaluation of elderly multimorbidity patients with family doctor contract services in urban communities of guangdong province, and to provide a basis for future improvement of multimorbidity management services at the grassroots level.
From September to December 2022, elderly patients with multiple chronic conditions in the community of Guangdong Province (Shenzhen, Zhanjiang and Meizhou) were selected by multi-stage stratified whole cluster random sampling method and surveyed by self-administered questionnaire. Multifactorial Logistic regression analysis was used to explore the influencing factors of satisfaction and usefulness evaluation of family doctor contracting services for elderly multimorbidity patients.
A total of 636 valid questionnaires were collected, with effective recovery rate of 99.69% (636/638). There were 624 family doctors who were relatively satisfied/very satisfied, accounting for 98.11%; The service usefulness evaluation of family doctors was slightly helpful/greatly helpful to 625 people, accounting for 98.27%. The results of multivariate Logistic regression analysis showed that patients with general satisfaction of family doctor contract service were taken as reference. Patients with hyperlipidemia (OR=15.203), disease duration <3 years (OR=48 703 577.681), 4 chronic diseases (OR=135.131), and severe dependence on self-care ability (OR=668 738.913) were more likely to make satisfactory evaluations than patients with complete self-care. Patients with annual personal income of ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), >50 000-100 000 yuan (OR<0.001) were less likely to make a satisfactory evaluation than patients with income >100 000-200 000 yuan (P<0.05). Patients aged 65-69 years (OR=12.573) were more likely to be very satisfied than those aged ≥70 years, and those with 4 chronic diseases (OR=135.131) were more likely to be very satisfied than those with 5 or more chronic diseases. The average annual income of individuals was ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), and some understanding of the disease (OR=0.013) or more understanding (OR=0.035) patients were less likely to give a very satisfactory evaluation (P<0.05). Multivariate Logistic regression analysis of the evaluation of the effectiveness of family doctor contract services by elderly patients with comorbidity of chronic diseases showed that taking the family doctor contract service as not very useful as the dependent variable, patients aged 65-69 years old (OR=28.710) were more likely to make a slightly helpful evaluation than patients aged ≥70 years old. Working patients (OR=0.091) were less likely to give a slightly helpful evaluation than unemployed patients (P<0.05). Patients aged 65 to 69 years (OR=56.795) were more likely to make helpful evaluations than those aged ≥70 years, and patients with chronic heart failure (OR=0.023) were less likely to make helpful evaluations than those without the disease (P<0.05) .
The overall level of satisfaction and usefulness evaluation of family doctors contracted services of elderly multimorbidity patients in urban communities of Guangdong province is relatively high, both above 95%, which is influenced by a combination of factors, including changing the type of chronic disease, annual income, knowledge of the condition, and self-care ability. In the future, we should continue to standardize and improve the connotation of family doctor contracted services, optimize the management mode of key populations such as elderly multimorbidity, improve the satisfaction and sense of gain of patients, so as to ultimately enhance the effectiveness of family doctor contracted services.
As the aging population continues to increase, there has been a rise in the prevalence of multimorbidity in the elderly. The adherence to medication regimens by elderly patients with multimorbidity significantly impacts the effectiveness of chronic disease management.
This study analyses the factors that impact medication adherence among the elderly with multimorbidity in Guangdong province. This study aims to provide a foundation for the management of multimorbidity in this population.
A multi-stage stratified cluster random sampling method was used to survey a population of 998 multimorbid patients aged 60 years and above in Guangdong province from October 2022 to March 2023. Medication adherence was the dependent variable, while patient sex, age, marital status, living conditions, education level, personal annual income, family encouragement for medication adherence, family doctor support, number of diseases, disease awareness, medication awareness, BMI, smoking and alcohol consumption were considered as independent variables. Multivariate Logistic regression analysis was used to identify the factors influencing medication adherence among elderly patients with multimorbidity in Guangdong province.
A total of 1 000 questionnaires were distributed and 998 valid questionnaires were collected, with a valid recovery rate of 99.8%. Among the 998 cases of elderly patients with multimorbidity in Guangdong province, there were 719 cases (72.0%) with good adherence to medication and 279 cases (28.0%) with poor medication adherence; there were 512 cases (51.3%) of males and 486 cases (48.7%) of females. The results of multivariate Logistic regression analysis showed that: education level (high school/secondary school: OR=0.298, 95%CI=0.117-0.762; college and above: OR=0.325, 95%CI=0.127-0.831), personal annual income (>30 000 to 50 000 yuan: OR=7.694, 95%CI=2.071-28.582; >50 000 to 100 000 yuan: OR=12.408, 95%CI=3.229-47.686; >100 000 to 200 000 yuan: OR=4.893, 95%CI=1.174-20.397), and frequency of family members' supervision of medication taking (occasionally: OR=1.842, 95%CI=1.222-2.779), family doctor's help (slightly helpful: OR=2.537, 95%CI=1.531-4.205), understanding of the condition (mostly understood: OR=3.015, 95%CI=1.948-4.667; better understood: OR=3.510, 95%CI=1.955-6.300; some/no understanding: OR=3.469, 95%CI=1.338-8.994), medication concern (mostly concerned: OR=4.928, 95%CI=3.336-7.278; more concerned: OR=3.670, 95%CI=1.915-7.033; somewhat concerned/unconcerned: OR=8.560, 95%CI=2.497-29.339), BMI (too low: OR=2.303, 95%CI=1.154-4.598; overweight/obese: OR=0.598, 95%CI=0.390-0.915), and alcohol consumption (OR=1.959, 95%CI=1.270-3.022) were the influencing factors of medication adherence among elderly patients with multimorbidity in Guangdong province (P<0.05) .
The elderly patients with multimorbidity in Guangdong province had better medication adherence, at 72.0%. Medication adherence was poorer among the elderly patients with multimorbidity in Guangdong province who were high-income earners, occasionally urged to take medication by their family members, slightly assisted by their family doctors, had a low understanding of their condition, paid little attention to the use of medication, had a low BMI, and drank alcohol. All parties in society should join hands to take multiple measures to improve the medication adherence of elderly patients with multimorbidity in all aspects, strengthen the integrated management of multimorbidity, and promote the health of elderly patients.
Multimorbidity has become an important characteristic of chronic diseases, jeopardizing the health of middle-aged and older adults, and posing new challenges to health management of chronic disease. There is a lack of guidelines and intervention programs for multimorbidity in China. In this study, we initially formulated a health management service pathway for multimorbidity among middle-aged and older adults in the community through the literature research method and focus group discussion method. Then, the constructed service pathway was evaluated and revised through the expert consultation method. Finally, a health management service pathway for the multimorbidity of middle-aged and older adults in the community with behavioral change techniques as the core. The pathway optimizes the implementation of multimorbidity health management, and standardizes its health monitoring, assessment and intervention process, providing a theoretical and practical guidance for primary care providers in the health management of multimorbidity.
The severe trend of the aging population, the rapid increase in the prevalence of chronic diseases among older adults, and the greater prominence of multimorbidity have posed challenges to the prevention and treatment of chronic diseases in China. Adverse health-related behaviors are modifiable risk factors for chronic diseases. Exploring the latent classes of health-related behaviors in older adults with multimorbidity and their associations with quality of life will help identify the characteristics of their health-related behaviors and uncover risk behaviors affecting the quality of life, providing references for precise health management to improve the quality of life of older adults.
To explore the latent classes of health-related behaviors in older adults with multimorbidity and the differences in the quality of life among the different classes.
Based on the baseline data from the Community Health and Behavior of the Elderly Panel Study (CHBEPS) conducted by our team in 2021, a total of 1 395 older adults aged 60 years and above with multimorbidity were included as study participants. A self-designed questionnaire was used to collect basic information, including disease status, smoking status, alcohol consumption, and dietary preferences of the participants. The Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire-Short-Chinese Version (IPAQ-S-C), and Lubben Social Network Scale-6 (LSNS-6) were used to assess staying up late, physical activity, and social network of the participants, respectively. The EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) was used to measure the quality of life of the participants. Latent class analysis of health-related behaviors among older adults with multimorbidity was conducted using Mplus 8.3 software. Based on the fitted model, the different latent classes of health-related behaviors among older adults with multimorbidity were used as groups, and the Kruskal-Wallis and Wilcoxon rank-sum tests were performed using SPSS 26.0 software to analyze the differences in quality of life among these groups.
Four latent classes of health-related behaviors were identified among older adults with multimorbidity, which are named the health behavior group (n=280), risk behavior group (n=366), comprehensive behavior group (n=173), and adverse behavior group (n=576). There were statistically significant differences in quality of life among the four latent classes (P<0.05). Specifically, the quality of life in the health behavior group was higher than that in the risk behavior group and adverse behavior group (P<0.05) .
When implementing precise health management for older adults with multimorbidity, the characteristics of their health-related behaviors should be taken into account. Special attention should be given to those with a higher probability of behaviors such as smoking, alcohol consumption, and a preference for sweet, spicy, and salty tastes, as well as those with a lower probability of behaviors such as a balanced diet, regular consumption of vegetables and fruits, and social networks. Additionally, measures targeted at addressing common issues such as insufficient physical activity should be implemented to improve the effectiveness of health management and the quality of life of older adults with multimorbidity.
In recent years, in the context of global aging, the number of patients with chronic diseases in China has increased significantly, and the the coexistence of multiple diseases has become more and more common, which seriously threatens the life safety and quality of life of the older adults in China.
To investigate the status of multimorbidity of older adults, and explore the relationship and pathways of action between sleep, physical activity, social network and multimorbidity of older adults, providing ideas for the effective prevention of multimorbidity and health improvement of older adults.
Elderly people aged≥60 years in the Community Health and Behavior of the Elderly Panel Study (CHBEPS) established by our team in 2021 were selected as the subjects of the survey, a questionnaire was used to investigate the study population, the research objects were investigated by questionnaire, and the general situation was collected by self-designed basic information collection form, IPAQ-S-C, LSNS-6 and PSQI were used to assess the physical activity, social network and sleep of the subjects. AMOS 28.0 statistical software was used to set up the structural equation model.
A total of 3 392 valid questionnaires were collected from 3 531 people over 60 years old, with an effective recovery rate of 96.06%. The average score of physical activity was 2 426.42 (495.00, 3 060.00) MET-min/w, the average score of social network was (15.91±6.43), and the average score of sleep was (5.49±3.53). There were 788 (23.23%) older adults with insufficient social network and 353 (10.41%) older adults with fair or very poor sleep quality. The prevalence of multimorbidity among the survey respondents was 41.13% (1 395/3 392). The results of correlation analysis showed that social network was negatively correlated with sleep level (rs=-0.113, P<0.01) and multimorbidity (rs=-0.049, P<0.01), and was positively correlated with physical activity (rs=0.073, P<0.01). Multivariate Logistic regression analysis showed that physical activity of 0-600 MET-min/w (OR=0.576, 95%CI=0.342-0.970) and good sleep quality (OR=0.409, 95%CI=0.209-0.803) were protective factors for multimorbidity (P<0.05). The results of structural equation modeling showed that social networks could affect physical activity and sleep quality (standardized path coefficient=0.096, t=4.982, P<0.001; standardized path coefficient=-0.043, t=-5.981, P<0.001), physical activity and sleep quality could affect multimorbidity (standardized path coefficient=0.023, t=5.280, P<0.001; standardized path coefficient=0.111, t=9.409, P<0.001). Social network had no direct effect on multimorbidity, but an indirect effect on it through two mediators of physical activity and sleep. The indirect effect of social network on multimorbidity through physical activity accounted for 10% of the total effect, and the indirect effect of social network on multimorbidity through sleep accounted for 36.5% of the total effect.
The prevalence of multimorbidity is high in the older adults (41.13%). The social network of the elderly group should be appropriately expanded to encourage them to maintain a moderate amount of physical activity and a good quality of sleep, alleviate and prevent the occurrence of multimorbidity.
Currently, research on the factors influencing the health status of older adults with multimorbidity in China is scattered, and it is difficult to give a comprehensive consideration from a holistic perspective, and the contribution of factors leading to health disparities is not explored, resulting in the ineffectiveness of current health management often programs in older adults with multimorbidity.
By introducing a health bifactor model, this study aims to understand the endogenous and exogenous influencing factors and their contributions to the health of older adults with multimorbidity and provide a practical basis for developing precise health management plans for older adults with multimorbidity.
In this study, using the China Health and Retirement Longitudinal Survey (CHARLS) 2018 data and introducing the two-factor model of health developed from the Grossman health production function (including both endogenous and exogenous aspects of health determinants). First, the Wilcoxon rank sum test was used to analyze whether there were differences in the health status of older adults with multimorbidity by gender. Secondly, the OLS regression model was used to analyze the mechanism of the two-factor model of health on the health of older adults with multimorbidity. Finally, the Shapley value method was further used to decompose the contribution of health endogenous factors to their health.
The study found that factors such as still drinking alcohol, having no disease control methods, being satisfied with medical services, having a high level of education, having a pension, not using health services, attending free health checks, caring for grandchildren and being satisfied with their children's relationship were more likely to improve the health of older people with multiple chronic conditions. The results of the Shapley decomposition showed that socioeconomic status was the most important factor in the full sample, while family health support, health-related behaviors, and health-related behaviors were the most important factors. Coping strategies was the next most important, and social health resources was the least influential. In the gender subgroup analysis, socioeconomic status remained the most important factor; for older men with multiple chronic illnesses, health-related behaviors were the next most important factor; for older women with multiple chronic illnesses, coping strategies were the next most important.
The health status of older men with multimorbidity is better than that of women, socioeconomic status is the most important factor affecting the health of older adults with multimorbidity, and the remaining four dimensions have different contributions to the health differences between men and women. It is recommended that precise health management should be implemented according to the size of the contribution of each dimension of different health endogenous factors to improve the health status of older adults with multimorbidity with maximum benefit.
