Background The epidemiology of multimorbidity, inpatient care utilization, and associated factors among inpatients in rural primary health care facilities in China remain unclear, hindering effective prevention and management of multimorbidity in rural inhabitants.
Objective This study aims to investigate multimorbidity patterns, inpatient care utilization, and associated factors among hospitalized patients in township health centers in Guangxi in the hope of offering epidemiology evidence for deeply understanding multimorbidity epidemic facing inpatient care of rural primary health care institutions and improving quality of relative medical care.
Methods A combination of multistage stratified sampling and cluster sampling was employed to randomly sampled 10 township health centers from five cities of Guangxi, including Nanning, Wuzhou, Liuzhou, Yulin, and Guigang. De-identified medical records of all inpatients with multimorbidity from January 1, 2021, to June 30, 2023, of the above 10 sampled township health centers were retrieved from inpatient system and chronic disease management system. Statistical analyses, including the Kruskal-Wallis H test, Mann-Whitney U test, and multinomial Logistic regression, were used to explore the demographic characteristics, multimorbidity prevalence, comorbidity number, multimorbidity patterns, hospitalization frequency, and associated factors among inpatients with multimorbidity.
Results A total of 9 330 inpatients with multimorbidity were included, with an average age of (68.1±11.8) years. The overall prevalence of multimorbidity was 31.24% (9 330/29 865). The most prevalent comorbidity number was 2 (55.22%), followed by 3 (28.76%), 4 (12.92%), and≥5 (5.1%). Hypertension was the most prevalent co-existing chronic disease and the most prevalent multimorbidity patterns included combinations of hypertension, chronic cervical and lumbar spondylosis, chronic gastrointestinal diseases, stroke, diabetes mellitus, hyperlipidemia, and chronic pulmonary diseases. The median number of hospitalization frequency among inpatients with 2, or 3, or 4, or≥5 co-existing chronic diseases ranged from 1 to 3; The median number of hospitalization frequency of the top 10 prevalent multimorbidity patterns identified within inpatients with 2, or 3, or 4 co-existing chronic diseases showed significant differences (P<0.05). Age, high BMI, female, smoking, alcohol consumption, medical insurance, minor ethnicities, and marital status were associated with increased number of co-existing chronic diseases (P<0.05), while age, female, minor ethnicities, marital status, low education level, smoking, alcohol consumption, comorbidity number, and medical insurance were associated with increased hospitalization frequency (P<0.05).
Conclusion The prevalence of multimorbidity among inpatients of township health centers in Guangxi is high. Hypertension was the most prevalent co-existing chronic disease and it comprised the most prevalent multimorbidity patterns by combining any number of the following chronic diseases, including chronic cervical and lumbar spondylosis, chronic gastrointestinal diseases, stroke, diabetes mellitus, hyperlipidemia, and chronic pulmonary diseases. Multiple factors influence both comorbidity number and inpatient care utility, emphasizing the need for comprehensive, multi-faceted strategies to address the challenges of multimorbidity in rural primary health care facilities.
