Association between multimorbidity and healthcare utilisation and health outcomes among elderly people in Europe

Abstract

Background The prevalence of multimorbidity (MM), the coexistence of two or more chronic conditions, is rising globally. Healthcare strategies are focused on single diseases, yet two thirds of healthcare costs are spent on patients with MM. The risk of an avoidable inpatient admission increases dramatically in persons with MM. We assessed associations between MM and health care utilisation/health outcomes in elderly people in Europe using nationally representative, crosscountry data. Methods We used cross-sectional data of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2011-2012, which collected socioeconomic and health information of respondents , aged 50 years and older from 16 European nations. MM was defined as the presence of two or more self-reported physical chronic diseases. Health care utilisation was measured by number of medical doctor visits and number of general practitioner visits in the past year, as well as number and length of hospitalizations. Health outcomes were self-perceived health, depression and limitation with movement. Negative binomial and logistic models were used to assess the association between MM and our outcome measures. Results In pooled analyses, the number of medical doctor and general practitioner visits increased with increasing number of chronic conditions (coeff 0.23 95%CI = 0.21-0.24 p < 0.001; coeff 0.21; 95%CI = 0.19-0.23 p < 0.001), with the largest effect seen in Italy (coeff 0.27 95%CI = 0.23-0.31 p < 0.001; coeff 0.26 95%CI = 0.22-0.30 p < 0.001). In pooled analyses, a higher number of chronic conditions was associated with a higher likelihood of hospitalization (AOR 1.39 95%CI = 1.33-1.44 p < 0.001) and a longer mean length of stay (coeff 0.41; 95%CI = 0.36-0.46 p < 0.001). The Netherlands has the highest risk of hospital admission associated with MM (AOR 1.48 95%CI = 1.34-1.65 p < 0.001). Respondents with MM were more likely to report fair/poor health status (AOR 1.93 95%CI = 1.85-2.02 p < 0.001), to be depressed (AOR 1.42 95%CI = 1.37-1.47 p < 0.001) and to be limited with movement (AOR 1.88 95%CI = 1.81-1.96 p < 0.001). Conclusions MM is associated with higher health care utilisation, worse self reported health status and depression in European countries, challenging the single-disease framework by which most of healthcare is configured. Key messages Multimorbidity is consistently associated with increased primary care utilization, hospital admissions and greater length of the hospitalization, in European countries. People with MM are more likely to have worse self-perceived health, depression and limitation with movement. Healthcare systems need to better manage persons with MM to improve their health outcomes.