Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil)

Nunes, Bruno Pereira; Batista, Sandro Rogério Rodrigues; Andrade, Fabíola Bof de; Souza Junior, Paulo Roberto Borges de; Lima-Costa, Maria Fernanda; Facchini, Luiz Augusto

doi:10.11606/S1518-8787.2018052000637

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Sumário

Supplement ELSI-Brazil, Original Article • Rev. Saúde Pública 52 (Suppl 2) • 2018 • https://doi.org/10.11606/S1518-8787.2018052000637 copy

Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate the occurrence and factors associated with multimorbidity among Brazilians aged 50 years and over.

METHODS

This is a cross-sectional study in a nation-based cohort of the non-institutionalized population in Brazil. Data were collected between 2015 and 2016. Multimorbidity was assessed from a list of 19 morbidities, which were categorized into ≥ 2 and ≥ 3 diseases. The analysis included the calculation of frequencies and the most frequent 10 pairs and triplets of combinations of diseases. The crude and adjusted analyses evaluated the demographic, socioeconomic, behavioral, and contextual variables (area of residence, geopolitical region, and coverage of the Family Health Strategy) using Poisson regression.

RESULTS

From the total of 9,412 individuals, 67.8% (95%CI 65.6–69.9) and 47.1% (95%CI 44.8–49.4) showed ≥ 2 and ≥ 3 diseases, respectively. In the adjusted analysis, women, older persons, and those who did not consume alcohol had increased multimorbidity. There were no associations with race, area of residence, geopolitical region, and coverage of the Family Health Strategy. The 10 pairs (frequencies observed between 11.6% and 23.2%) and the 10 triplets (frequencies observed between 4.9% and 9.5%) of the most frequent diseases mostly included back problems (15 times) and systemic arterial hypertension (11 times). All combinations were statistically higher than expected by chance.

CONCLUSIONS

The occurrence of multimorbidity was high even among younger individuals (50 to 59 years). Approximately two in three (≥ 2 diseases) and one in two (≥ 3 diseases) individuals aged 50 years and over presented multimorbidity, which represents 26 and 18 million persons in Brazil, respectively. We observed high frequencies of combinations of morbidities.

Aged; Multimorbidity; Comorbidity; Health Surveys

Variable	Category	n*	%
Sex	Female	5,314	54.0
Age (years)	50–59	3,980	47.6
	60–69	2,875	29.7
	70–79	1,782	15.6
	80 and over	775	7.1
Race	White	3,590	42.7
	Black	887	9.7
	Brown	4,283	44.7
	Yellow/Indigenous	310	2.9
	Does not know	342	3.4
Education level (years of study)	Zero	1,530	13.3
	1–4	3,638	38.2
	5–8	1,878	21.6
	9 or more	2,304	26.9
Index of goods (quartiles)	1st (lowest)	2,693	25.1
	2nd	2,421	24.9
	3rd	2,211	25.0
	4th (highest)	2,029	25.0
Smoking	Never smoked	4,259	45.6
	Current smoker	1,604	17.1
	Former smoker	3,546	37.3
Consumption of alcoholic beverages	Never	6,909	70.9
	< once a month	544	6.0
	≥ once a month	1,952	23.1
Area of residence	Urban	7,935	84.7
Geopolitical region	North	743	5.6
	Northeast	2,549	24.1
	Southeast	3,922	47.2
	South	1,278	16.6
	Midwest	920	6.6
Household covered by the FHS	No	2,358	25.8
	Yes	6,487	68.9
	Does not know/No answer	567	5.3

Total		9,412	100

Morbidities	%	Mean associated morbidities
Systemic arterial hypertension	52.2	3.5
Back problems	40.8	3.9
High cholesterol	30.5	3.8
Cataract	24.9	4.0
Arthritis or rheumatism	21.0	4.5
Depression	18.6	4.5
Diabetes	15.8	4.2
Osteoporosis	15.8	4.8
Heart problem	11.7	4.8
Glaucoma	8.4	4.5
Emphysema, chronic bronchitis, or COPD	6.0	4.7
Cerebrovascular accident	5.3	4.6
Cancer	5.3	4.2
Asthma	4.9	4.8
Chronic kidney disease	4.5	5.1
Diabetic retinopathy	1.9	5.9
Macular Degeneration	1.5	5.3
Alzheimer’s disease	0.8	5.7
Parkinson’s disease	0.7	4.9

Variable	Category	Multimorbidity

		≥ 2		≥ 3

		%	95%CI	%	95%CI
Sex			p < 0.001		p < 0.001
	Male	58.9	56.4–61.5	36.2	33.9–38.5
	Female	75.5	73.4–77.4	56.5	54.3–58.7
Age (years)			p < 0.001		p < 0.001
	50–59	58.8	56.1–61.5	37.1	34.5–39.7
	60–69	73.4	70.7–75.8	51.6	49.1–54.2
	70–79	79.0	75.9–81.7	61.1	57.3–64.7
	80 and over	82.4	78.5–85.7	66.7	62.1–71.0
Race			p = 0.112		p = 0.167
	White	68.5	65.7–71.2	48.4	45.7–51.1
	Black	71.4	65.8–76.4	50.1	44.1–56.1
	Brown	66.2	63.3–69.0	45.3	42.6–47.9
	Yellow/Indigenous	74.1	65.8–80.9	56.7	39.5–53.9
Education level (years of study)			p < 0.001		p < 0.001
	Zero	68.2	64.2–72.0	50.8	46.6–55.0
	1–4	71.9	69.2–74.4	50.4	47.5–53.3
	5–8	66.1	63.3–68.9	45.9	42.8–49.0
	9 or more	63.2	59.8–66.4	41.4	38.6–44.2
Index of goods (quartiles)			p = 0.010		p = 0.012
	1st (lowest)	64.0	61.0–67.0	44.6	41.1–48.1
	2nd	70.4	67.9–72.7	50.5	47.4–53.6
	3rd	69.1	65.3–72.6	48.2	45.2–51.3
	4th (highest)	67.7	64.4–70.9	45.0	41.5–48.5
Smoking			p < 0.001		p < 0.001
	Never smoked	68.4	66.0–70.7	48.2	45.6–50.8
	Current smoker	60.1	56.4–63.6	39.1	35.6–42.7
	Former smoker	70.6	67.9–73.1	49.4	46.7–52.0
Consumption of alcoholic beverages			p < 0.001		p < 0.001
	Never	71.3	69.1–73.4	51.4	49.0–53.8
	< once a month	63.5	57.9–68.8	43.1	38.1–48.3
	≥ once a month	58.5	55.6–61.4	35.3	32.5–38.3
Area of residence			p = 0.040		p = 0.083
	Rural	63.6	59.2–67.8	43.6	39.8–47.6
	Urban	68.8	66.1–70.9	47.7	45.1–50.3
Geopolitical region			p = 0.124		p = 0.130
	North	64.1	55.2–72.1	43.2	36.9–49.7
	Northeast	64.0	61.5–66.5	44.5	31.4–47.7
	Southeast	69.1	65.2–72.6	47.1	43.0–51.3
	South	70.7	65.7–75.2	51.7	48.0–55.3
	Midwest	69.0	63.2–74.2	48.3	42.7–54.0
Household covered by the FHS			p = 0.960		p = 0.639
	No	67.5	64.0–70.8	46.8	43.7–50.0
	Yes	67.9	65.2–70.5	47.0	44.2–49.7
	Does not know/No answer	68.0	62.0–73.4	50.1	44.6–55.5

Total		67.8	65.6–69.9	47.1	44.8–49.4

Variable	Multimorbidity

	≥ 2				≥ 3

	Crude analysis		Adjusted analysis		Crude analysis		Adjusted analysis

	PR	95%CI	PR	95%CI	PR	95%CI	PR	95%CI
Sex (ref: male)
Female	1.28	1.23–1.33	1.26	1.22–1.30	1.56	1.48–1.65	1.49	1.41–1.58
Age (ref: 50–59)
60–69	1.25	1.19–1.31	1.22	1.17–1.28	1.39	1.29–1.50	1.36	1.26–1.46
70–79	1.34	1.27–1.41	1.30	1.23–1.37	1.65	1.51–1.80	1.56	1.43–1.69
80 and over	1.40	1.31–1.50	1.34	1.26–1.43	1.80	1.64–1.97	1.66	1.50–1.83
Race (ref: white)
Black	1.04	0.96–1.14	1.08	0.99–1.17	1.03	0.92–1.16	1.07	0.98–1.18
Brown	0.97	0.93–1.01	1.01	0.97–1.05	0.93	0.88–0.99	0.99	0.93–1.04
Yellow/Indigenous	1.08	0.97–1.21	1.10	0.99–1.21	0.96	0.83–1.12	0.96	0.83–1.12
Education level (ref: zero)
1–4	1.05	1.00–1.11	1.07	1.02–1.12	0.99	0.92–1.07	1.04	0.97–1.12
5–8	0.97	0.91–1.03	1.04	0.98–1.10	0.90	0.82–0.99	1.04	0.95–1.14
9 or more	0.93	0.86–1.00	0.97	0.91–1.05	0.81	0.74–0.90	0.93	0.85–1.03
Index of goods (ref: 1st)
2nd	1.10	1.04–1.16	1.10	1.05–1.15	1.13	1.03–1.24	1.13	1.04–1.24
3rd	1.08	1.01–1.15	1.10	1.04–1.16	1.08	0.99–1.18	1.11	1.02–1.23
4th (highest)	1.06	0.99–1.13	1.13	1.07–1.19	1.01	0.91–1.12	1.12	1.01–1.24
Smoking (ref: never smoked)
Current smoker	0.88	0.83–0.93	0.97	0.92–1.02	0.81	0.75–0.87	0.97	0.90–1.04
Former smoker	1.03	1.00–1.07	1.09	1.06–1.13	1.02	0.98–1.07	1.13	1.08–1.18
Consumption of alcoholic beverages (ref: never)
< once a month	0.89	0.82–0.97	0.93	0.86–1.02	0.84	0.74–0.94	0.92	0.82–1.02
≥ once a month	0.82	0.79–0.86	0.91	0.87–0.95	0.69	0.64–0.74	0.83	0.77–0.89
Area of residence (ref: rural)
Urban	1.08	1.00–1.16	1.05	0.99–1.12	1.09	0.99–1.21	1.09	1.00–1.18
Geopolitical region (ref: North)
Northeast	1.00	0.87–1.15	0.98	0.86–1.11	1.03	0.87–1.22	0.99	0.86–1.14
Southeast	1.08	0.93–1.25	1.04	0.91–1.18	1.09	0.92–1.30	1.04	0.90–1.20
South	1.10	0.95–1.28	1.06	0.92–1.22	1.19	1.01–1.41	1.13	0.97–1.31
Midwest	1.08	0.93–1.25	1.05	0.93–1.19	1.12	0.93–1.34	1.08	0.94–1.24
Household covered by the FHS (ref: no)
Yes	1.01	0.95–1.07	1.01	0.95–1.07	1.00	0.93–1.08	0.98	0.92–1.06
Does not know/No answer	1.01	0.91–1.11	0.98	0.88–1.08	1.07	0.93–1.22	1.01	0.88–1.17

Pairs and triplets of morbidities	Observed (O)	Expected (E)	O/E	95%CIz

	%	%
Pairs
SAH/Back problems	23.2	21.3	1.09	1.06–1.12
SAH/High cholesterol	18.9	15.9	1.19	1.15–1.23
SAH/Cataract	14.8	13.0	1.14	1.09–1.18
Back problems/High cholesterol	14.8	12.4	1.19	1.14–1.24
Back problems/Arthritis or rheumatism	14.5	8.6	1.69	1.62–1.77
Back problems/Cataract	12.0	10.2	1.18	1.13–1.23
SAH/Arthritis or rheumatism	12.3	11.0	1.12	1.07–1.17
Back problems/Osteoporosis	11.2	6.4	1.74	1.65–1.83
SAH/Depression	11.4	9.7	1.17	1.12–1.23
Back problems/Depression	11.6	7.6	1.53	1.46–1.60
Triplets
SAH/Back problems/High cholesterol	9.5	6.5	1.46	1.39–1.54
SAH/Back problems/Arthritis or rheumatism	8.6	4.5	1.93	1.81–2.05
SAH/Back problems/Cataract	7.5	5.3	1.41	1.33–1.49
SAH/Back problems/Depression	7.2	3.4	1.81	1.70–1.93
SAH/Back problems/Osteoporosis	6.7	4.0	1.99	1.85–2.13
Back problems/Arthritis or rheumatism/Osteoporosis	6.5	1.4	4.76	4.32–5.26
Back problems/High cholesterol/Arthritis or rheumatism	5.8	4.0	2.21	2.05–2.39
Back problems/Arthritis or rheumatism/Depression	5.8	2.6	3.63	3.30–3.98
SAH/High cholesterol/Cataract	5.4	1.6	1.36	1.27–1.46
Back problems/Cataract/Arthritis or rheumatism	4.9	2.1	2.28	2.10–2.49

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[1] Correspondence: Bruno P. Nunes. Rua Gomes Carneiro, 1 - Centro 96010-610 Pelotas, RS, Brasil E-mail: nunesbp@gmail.com