Multimorbidity, healthcare utilization and socioeconomic status: A register-based study in Denmark

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Abstract

Background

People with multimorbidity have reduced functional capacity, lower quality of life, higher mortality rates and use healthcare resources more intensively than healthy people or those with a single chronic condition. Multimorbidity was defined as the coexistence of two or more chronic conditions in the same person. The aim of this study was to explore associations between multimorbidity and use of healthcare services and the impact of socioeconomic status on utilization of hospitalizations and bed days.

Methods

The study population included all individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services and demographics were obtained from Danish national administrative and health registries. Zero-inflated models were used to calculate anticipated annual use of hospitalizations and bed days.

Findings

The study population comprised 1,397,173 individuals; the prevalence of multimorbidity was 22%. Prevalence was inversely related to educational attainment. For people with multimorbidity, utilization of hospitalizations and bed days increased approximately linearly with the number of chronic conditions. However, a steep increase in utilization of bed days was observed between five and six or more chronic conditions. An educational gradient in hospitalization rates and use of bed days was observed regardless of the number of chronic conditions. Educational attainment was strongly associated with healthcare utilization.

Conclusion

Multimorbidity was associated with a significant increase in utilization of all healthcare services in Denmark. In addition, a socioeconomic gradient was observed in utilization of hospitalizations and bed days.

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Most cited references 31

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Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study

Caroline Bähler, Carola A Huber, Beat Brüngger … (2015)

Background Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors. Methods The study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency. Results Prevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient. Conclusions Multimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0698-2) contains supplementary material, which is available to authorized users.

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Time Trends in Prevalence of Chronic Diseases and Multimorbidity Not Only due to Aging: Data from General Practices and Health Surveys

Sandra van Oostrom, Ronald Gijsen, Irina Stirbu-Wagner … (2016)

Introduction Chronic diseases and multimorbidity are common and expected to rise over the coming years. The objective of this study is to examine the time trend in the prevalence of chronic diseases and multimorbidity over the period 2001 till 2011 in the Netherlands, and the extent to which this can be ascribed to the aging of the population. Methods Monitoring study, using two data sources: 1) medical records of patients listed in a nationally representative network of general practices over the period 2002–2011, and 2) national health interview surveys over the period 2001–2011. Regression models were used to study trends in the prevalence-rates over time, with and without standardization for age. Results An increase from 34.9% to 41.8% (p<0.01) in the prevalence of chronic diseases was observed in the general practice registration over the period 2004–2011 and from 41.0% to 46.6% (p<0.01) based on self-reported diseases over the period 2001–2011. Multimorbidity increased from 12.7% to 16.2% (p<0.01) and from 14.3% to 17.5% (p<0.01), respectively. Aging of the population explained part of these trends: about one-fifth based on general practice data, and one-third for chronic diseases and half of the trend for multimorbidity based on health surveys. Conclusions The prevalence of chronic diseases and multimorbidity increased over the period 2001–2011. Aging of the population only explained part of the increase, implying that other factors such as health care and society-related developments are responsible for a substantial part of this rise.

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Multimorbidity of chronic diseases and health care utilization in general practice

Sandra van Oostrom, H. Susan J. Picavet, Simone R. de Bruin … (2014)

Background Multimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older. Methods Data on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N = 32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008. Results Patients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases. Conclusion Multimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.

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Author and article information

Contributors

Anne Frølich:

ORCID: http://orcid.org/0000-0002-0500-9923

Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Nermin Ghith: Role: ConceptualizationRole: InvestigationRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Michaela Schiøtz: Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing

Ramune Jacobsen: Role: ConceptualizationRole: InvestigationRole: Writing – original draftRole: Writing – review & editing

Anders Stockmarr: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Young Dae Kwon: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 1 August 2019

Publication date Collection: 2019

Volume: 14

Issue: 8

Electronic Location Identifier: e0214183

Affiliations

[1 ] The Knowledge Center for Multimorbidity and Chronic Conditions, Slagelse Hospital (NSR), Slagelse, Region Zealand, Denmark

[2 ] Institute for Public Health, University of Copenhagen, Copenhagen, Denmark

[3 ] Research Unit for Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark

[4 ] Section for Intersectoral Health Services Research, Center for Clinical Research and Prevention, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark

[5 ] Department of Pharmacy, Bispebjerg Frederiksberg University Hospital, University of Copenhagen, Copenhagen, Denmark

[6 ] Department of Applied Mathematics and Computer Science, The Technical University of Denmark, Lyngby, Denmark

Catholic University of Korea College of Medicine, REPUBLIC OF KOREA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: Anne.Froelich@ 123456regionh.dk

Author information

Anne Frølich http://orcid.org/0000-0002-0500-9923

Article

Publisher ID: PONE-D-19-06836

DOI: 10.1371/journal.pone.0214183

PMC ID: 6675513

PubMed ID: 31369580

SO-VID: 57eebc95-cfd4-4d57-b0f5-e067c6414379

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 8 March 2019

Date accepted : 10 July 2019

Page count

Figures: 3, Tables: 3, Pages: 15

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100005275, Region Hovedstaden;

Award Recipient :

ORCID: http://orcid.org/0000-0002-0500-9923

Anne Frølich

This work was supported by grants for AF from the 50 million Crown Foundation from the Capital Region of Denmark. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Due to restrictions related to Danish law and protecting patient privacy, the combined set of data as used in this study can only be made available through a trusted third party, Statistics Denmark. This state organisation holds the data used for this study. Danish scientific organisations can be authorized to work with data within Statistics Denmark and such organisations can provide access to individual scientists inside and outside of Denmark. Requests for data may be sent to Statistics Denmark: http://www.dst.dk/en/OmDS/organisation/TelefonbogOrg.aspx?kontor=13&tlfbogsort=sektion. Additional requests can be sent to the authors with permission from Statistic Denmark, the Danish Health and medicines Authority, and the Research Centre for Prevention and health at the Capital Region of Copenhagen. Project number I-suite and ID number 03344 and BBH 2014-07.

Multimorbidity, healthcare utilization and socioeconomic status: A register-based study in Denmark

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Most cited references 31

Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study

Time Trends in Prevalence of Chronic Diseases and Multimorbidity Not Only due to Aging: Data from General Practices and Health Surveys

Multimorbidity of chronic diseases and health care utilization in general practice

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