19
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Social determinants of multimorbidity and multiple functional limitations among the ageing population of England, 2002–2015

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          This study explores longitudinal relationships between material, psycho-social and behavioural social determinants of health and multimorbidity of people aged 50 years or older in England. We used data from the English Longitudinal Study of Ageing collected biannually between 2002 and 2015. Apart from the basic measure of multimorbidity (two or more diseases within a person) we constructed two distinct measures of health in order to take into account the biology of ageing (complex multimorbidity and multiple functional limitations).

          We found that the likelihood of multimorbidity and multiple functional limitations was consistently associated with the levels of household wealth, sense of control over one's life, physical activity and loneliness. Larger health inequalities were observed when health was measured as complex multimorbidity and multiple functional limitations than basic multimorbidity. Compared to the population group with the highest wealth, those with the lowest wealth had 47% higher odds of basic multimorbidity (95% C.I. 1.34-1.61), 73% higher odds of complex multimorbidity (95% C.I. 1.52-1.96) and 90% higher odds of having 10 or more functional limitations (95% C.I. 1.59-2.26). We did not find a dose-response relationship between alcohol consumption, smoking and multimorbidity but rather evidence of people in ill health actively moderating their health behaviour.

          We suggest that materialist models of multimorbidity and functional limitation at older age can not, on their own, explain the health inequalities as the behavioural and psycho-social factors play an important role. Policies aiming to reduce the risk of multimorbidity and functional limitation should address the issue at these three levels simultaneously, using the existing national infrastructure of General Practices.

          Highlights

          • Multimorbidity and functional limitation were associated with household wealth, sense of control over life, physical activity, loneliness.

          • We observed larger health inequalities for complex multimorbidity and multiple functional limitation than basic multimorbidity.

          • Materialist models of multimorbidity do not explain inequalities.

          • Behavioural and psycho-social factors play an important role.

          Related collections

          Most cited references45

          • Record: found
          • Abstract: not found
          • Article: not found

          The disablement process

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Understanding the Links Between Social Support and Physical Health: A Life-Span Perspective With Emphasis on the Separability of Perceived and Received Support.

            Social support has been reliably related to physical health outcomes. However, the conceptual basis of such links needs greater development. In this article, I argue for a life-span perspective on social support and health that takes into account distinct antecedent processes and mechanisms that are related to measures of support over time. Such a view highlights the need to distinguish measures of perceived and received support and its links to more specific diseases (e.g., chronic, acute) and stages of disease development (e.g., incidence). I discuss both the novel implications of these theoretical arguments for research on social support and physical health, as well as the potential intervention approaches that are apparent from this perspective.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              The epidemiology of multimorbidity in primary care: a retrospective cohort study

              Background Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available. Aim To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation. Design and setting Retrospective cohort study, undertaken in England. Method The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified. Results In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions. Conclusion Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.
                Bookmark

                Author and article information

                Contributors
                Journal
                SSM Popul Health
                SSM Popul Health
                SSM - Population Health
                Elsevier
                2352-8273
                30 May 2019
                August 2019
                30 May 2019
                : 8
                : 100413
                Affiliations
                [a ]University of Liverpool, Department of Geography and Planning, Liverpool, United Kingdom
                [b ]University of Bristol, Bristol Medical School: Population Health Sciences, United Kingdom
                [c ]University of Exeter, College of Medicine and Health, United Kingdom
                Author notes
                []Corresponding author. University of Liverpool, Department of Geography and Planning, SoES, Chatham Street, Liverpool, L69 7ZT, United Kingdom. l.singer@ 123456liv.ac.uk
                Article
                S2352-8273(19)30027-8 100413
                10.1016/j.ssmph.2019.100413
                6551564
                31194123
                dbe440d0-5c20-4579-89ac-28158e9165be
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 4 February 2019
                : 29 March 2019
                : 14 May 2019
                Categories
                Article

                multimorbidity,complex multimorbidity,multiple functional limitations,social determinansts of health,ageing,health inequalities

                Comments

                Comment on this article