Prevalence, patterns of multimorbidity and associations with health care utilization among middle-aged and older people in China

Multimorbidity has become one of the main challenges in health care system. The association between prevalence, patterns of multimorbidity and health care utilization is less often discussed in China. The purpose of this study is to examine this association among Chinese middle-aged and older adults and take into account different sociodemographic, behavioral and health characteristics. Based on this, implications of current evidence and effective intervention on multimorbidity and health care utilization can be identified and put into practice.

The wave 4 in 2018 of the China Health and Retirement Longitudinal Study (CHARLS) was used in the study. Multimorbidity was defined as the co-occurrence of two or more chronic medical condition of a list of fourteen chronic diseases in one person. The presence of chronic diseases was assessed through self-report. Health care utilization include whether the respondents received outpatient service last month and inpatient service in the past year. Latent Class Analysis was conducted to identify the clustering pattern of chronic diseases. Logistic regressions were employed to explore the association between prevalence, patterns of multimorbidity and health care utilization. Analyses were weighted using individual sample weights, adjusted for non-response of individual and household.

Among 19,559 participants aged 45 and older, 23.10% were aged above 70 years and 52.42% were female. The prevalence of multimorbidity was 56.73%. Four patterns were identified: relatively healthy class, respiratory class, stomach-arthritis class and vascular class. Multimorbid individuals used more outpatient services (OR = 1.89, 95%CI = 1.65-2.17) and more inpatient services (OR = 2.52, 95%CI = 2.22-2.86) compared to their no-multimorbid counterparts. Compared to relatively healthy class, the respondents classified into respiratory class, stomach-arthritis class and vascular class used more outpatient services (OR = 1.90, 95%CI = 1.57-2.30; OR = 2.39, 95%CI = 2.06-2.78; OR = 1.53, 95%CI = 1.32-1.79 respectively) and more inpatient services (OR = 2.19, 95%CI = 1.83-2.62; OR = 2.93, 95%CI = 2.53-3.40; OR = 1.90, 95%CI = 1.65-2.19 respectively).

Our study provided evidence that multimorbidity is high among Chinese older adults and is associated substantially higher health care utilization in China. Four multimorbidity patters were identified. Policy should prioritize improving the management of individuals with multimorbidity to increase healthcare efficiency. Further research is necessary with special emphasis on the trajectory of multimorbidity and the role of health system in satisfying needs of multimorbid individuals.