Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women

Franken, Débora Luiza; Olinto, Maria Teresa Anselmo; Dias-da-Costa, Juvenal Soares; Bairros, Fernanda Souza de; Paniz, Vera Maria Vieira

doi:10.1590/1980-549720220007

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Epidemiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. bras. Epidemiol. 25 • 2022 • https://doi.org/10.1590/1980-549720220007 copy

Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil.

Methods:

We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20–69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity.

Results:

The prevalence of multimorbidity was 21.7% (95%CI 19.3–24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51–2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09–2.15) and 76% (PR 1.76; 95%CI 1.27–2.45) more likely to have multimorbidity than eutrophic women.

Conclusion:

Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.

Keywords:
Multimorbidity; Multiple chronic conditions; Chronic disease; Risk factors; Women

Chronic conditions (ATC classification)	n	Prevalence% (95%CI)^* * 95%CI: 95% confidence interval; CMD: common mental disorders; ADHD: attention deficit hyperactivity disorder.
Arterial hypertension (C02, C03, C07–C09)	262	23.23 (20.80–25.80)
CMD (N05, N06)	152	13.48 (11.54–15.61)
Acid-related digestive disorders (A02, A03)	98	8.69 (7.11–10.49)
Dyslipidemia (C10)	97	8.60 (7.03–10.39)
Thyroid diseases (H03)	65	5.76 (4.48–7.29)
Diabetes (A10)	60	5.32 (4.08–6.80)
Circulatory disorders (B01, C05)	55	4.88 (3.69–6.30)
Chronic pain (M01, H02, N02, M03)	45	3.99 (2.92–5.30)
Osteoporosis/osteopenia (M05, A12, A11)	36	3.19 (2.25–4.39)
Rheumatic diseases (M01, L04, H02, M03)	26	2.30 (1.51–3.36)
Asthma/bronchitis (R03)	22	1.95 (1.23–2.94)
Other heart disease (C09, B01, C07, C01)	20	1.77 (1.10–2.73)
Chronic headache/migraine (M01, N02)	12	1.06 (0.55–1.85)
Labyrinthitis (N07)	12	1.06 (0.55–1.85)
Allergic diseases (R06, R03)	9	0.80 (0.37–1.51)
Epilepsy (N03)	9	0.80 (0.37–1.51)
HIV/AIDS (J05)	9	0.80 (0.37–1.51)
Acne (J01, D10)	4	0.35 (0.10–0.91)
Cancer (L02, L01)	4	0.35 (0.10–0.91)
Inflammatory bowel diseases (L04, H02, A07)	3	0.27 (0.05–0.78)
Glaucoma (C07, S01)	3	0.27 (0.05–0.78)
Gout (M04)	2	0.18 (0.02–0.64)
Lupus (H02)	2	0.18 (0.02–0.64)
Parkinson's disease (N04)	1	0.09 (0.00–0.49)
Sjögren's syndrome (M01)	1	0.09 (0.00–0.49)
ADHD (N06)	1	0.09 (0.00–0.49)

Variables		n (%)	% Multimorbidity (95%CI)	p-value
Age (years)
	20–29	216 (19.2)	1.4 (0.3–4.0)	<0.001^* * p-value of the chi-square test for linear trend;
	30–39	244 (21.7)	4.5 (2.3–7.9)
	40–49	276 (24.5)	16.3 (12.1–21.2)
	50–59	228 (20.2)	39.0 (32.7–45.7)
	60–69	164 (14.5)	59.2 (51.2–66.7)
Skin color
	White	840 (74.5)	21.4 (18.7–24.4)	0.420^‡ ‡ p-value of the chi-square test for heterogeneity of proportions.
	Parda^† † Brazilians of mixed ethnic ancestries;	181 (16.1)	25.4 (19.2–32.4)
	Black	84 (7.5)	20.2 (12.3–30.4)
	Indigenous	11 (1.0)	9.1 (0.2–41.3)
	Yellow	12 (1.7)	8.3 (0.2–38.5)
Marital status
	Not having a partner	408 (36.2)	21.8 (17.9–26.1)	0.954^‡ ‡ p-value of the chi-square test for heterogeneity of proportions.
	Having a partner	720 (63.8)	21.7 (18.7–24.9)
Education (years)
	≥15	110 (9.8)	13.6 (7.8–21.5)	<0.001^* * p-value of the chi-square test for linear trend;
	11–14	360 (32.0)	12.8 (9.5–16.7)
	8–10	199 (17.7)	18.6 (13.4–24.7)
	5–7	253 (22.5)	26.5 (21.2–32.4)
	0–4	204 (18.1)	38.2 (31.5–45.3)
Economic class
	A+B (high)	390 (34.8)	19.0 (15.2–23.2)	0.226^* * p-value of the chi-square test for linear trend;
	C	596 (53.1)	23.2 (19.8–26.8)
	D+E (low)	136 (12.1)	22.1 (15.4–30.0)
Household income per capita (quartiles)
	I (low)	273 (25.0)	17.2 (12.9–22.2)	0.058^* * p-value of the chi-square test for linear trend;
	II	273 (25.0)	23.1 (18.2–28.5)
	III	273 (25.0)	22.0 (17.2–27.4)
	IV (high)	272 (25.0)	24.6 (19.6–30.2)
Occupation
	Employed	654 (58.1)	11.6 (9.3–14.3)	<0.001^‡ ‡ p-value of the chi-square test for heterogeneity of proportions.
	Unemployed	472 (41.9)	35.8 (31.5–40.3)
Consumption of fruits and vegetables
	Adequate	492 (43.7)	28.5 (24.5–32.7)	<0.001^‡ ‡ p-value of the chi-square test for heterogeneity of proportions.
	Inadequate	634 (56.3)	16.6 (13.8–19.7)
Physical activity
	Active	162 (14.4)	18.5 (12.9–25.4)	0.286^‡ ‡ p-value of the chi-square test for heterogeneity of proportions.
	Inactive	966 (85.6)	22.3 (19.7–25.0)
Alcohol consumption
	Does not consume	346 (33.2)	33.2 (28.3–38.5)	<0.001^* * p-value of the chi-square test for linear trend;
	Moderate consumption	637 (61.1)	14.8 (12.1–17.8)
	Excessive consumption	60 (5.8)	3.3 (0.4–11.5)
Smoking status
	Non-smoker	661 (58.6)	19.5 (16.6–22.7)	<0.001^‡ ‡ p-value of the chi-square test for heterogeneity of proportions.
	Former smoker	259 (23.0)	31.7 (26.0–37.7)
	Current smoker	208 (18.4)	16.4 (11.6–22.1)
Nutritional status
	Eutrophy	380 (33.9)	10.5 (7.6–14.1)	<0.001^* * p-value of the chi-square test for linear trend;
	Overweight	373 (33.2)	23.6 (19.4–28.2)
	Obesity	369 (32.9)	31.4 (26.7–36.4)
	Class I obesity	205 (18.3)	28.8 (22.7–35.5)
	Class II obesity	94 (8.4)	31.9 (22.7–42.3)
	Class III obesity	70 (6.2)	38.6 (27.2–51.0)

Variables			Multimorbidity
Variables			Crude PR (95%CI)	p-value	Adjusted PR (95%CI)	p-value
Level 1^* * variables adjusted to each other;
	Age (years)
		20–29	1.0	<0.001^† † wald's test for linear trend;	1.0	<0.001^† † wald's test for linear trend;
		30–39	3.24 (0.91–11.49)		3.39 (0.96–12.04)
		40–49	11.74 (3.70–37.28)		10.63 (3.32–34.06)
		50–59	28.12 (9.03–87.51)		22.03 (7.07–68.64)
		60–69	42.59 (13.74–132.01)		26.48 (8.55–82.03)
	Education (years)
		^≥15	1.0	<0.001^† † wald's test for linear trend;	1.0	<0.011^† † wald's test for linear trend;
		11–14	0.94 (0.54–1.61)		1.28 (0.75–2.19)
		8–10	1.36 (0.78–2.37)		1.57 (0.92–2.68)
		5–7	1.94 (1.16–3.24)		1.60 (0.95–2.68)
		0–4	2.80 (1.70–4.63)		1.73 (1.03–2.89)
	Household income per capita (quartiles)
		I (low)	1.0	<0.055^† † wald's test for linear trend;	1.0	<0.011^† † wald's test for linear trend;
		II	1.34 (0.96–1.89)		1.14 (0.85–1.53)
		III	1.3 (0.91–1.80)		1.16 (0.86–1.58)
		IV (high)	1.4 (1.03–2.00)		1.51 (1.11–2.05)
	Occupation
		Employed	1.0	<0.001^‡ ‡ wald's test for heterogeneity of proportions;	1.0	<0.001^‡ ‡ wald's test for heterogeneity of proportions;
		Unemployed	3.08 (2.42–3.93)	<0.001^‡ ‡ wald's test for heterogeneity of proportions;	1.95 (1.51–2.52)	<0.001^‡ ‡ wald's test for heterogeneity of proportions;
Level 2^§ § variables adjusted to each other and to those of the level above;
	Consumption of fruits and vegetables
		Adequate	1.0	<0.001^‡ ‡ wald's test for heterogeneity of proportions;	1.0	<0.153^‡ ‡ wald's test for heterogeneity of proportions;
		Inadequate	0.58 (0.47–0.73)	<0.001^‡ ‡ wald's test for heterogeneity of proportions;	0.86 (0.69–1.06)	<0.153^‡ ‡ wald's test for heterogeneity of proportions;
	Alcohol consumption
		No	1.0	<0.001^‡ ‡ wald's test for heterogeneity of proportions;	1.0	<0.001^‡ ‡ wald's test for heterogeneity of proportions;
		Yes	0.41 (0.33–0.53)	<0.001^‡ ‡ wald's test for heterogeneity of proportions;	0.67 (0.54–0.85)	<0.001^‡ ‡ wald's test for heterogeneity of proportions;
	Smoking status
		Non-smoker	1.0	<0.001^‡ ‡ wald's test for heterogeneity of proportions;	1.0	<0.785^‡ ‡ wald's test for heterogeneity of proportions;
		Former smoker	1.62 (1.28–2.06)		1.23 (0.99–1.54)
		Current smoker	0.84 (0.59–1.18)		0.91 (0.64–1.29)
Level 3^// // variable adjusted to those of the above levels.
	Nutritional status
		Eutrophy	1.0	<0.001^† † wald's test for linear trend;	1.0	<0.001^† † wald's test for linear trend;
		Overweight	2.24 (1.59–3.17)		1.53 (1.09–2.15)
		Obesity	2.99 (2.15–4.15)		1.76 (1.27–2.45)

Associação Brasileira de Saúde Coletiva Av. Dr. Arnaldo, 715 - 2º andar - sl. 3 - Cerqueira César, 01246-904 São Paulo SP Brasil , Tel./FAX: +55 11 3085-5411 - São Paulo - SP - Brazil
E-mail: revbrepi@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding Author: Débora Luiza Franken. Universidade do Vale do Rio dos Sinos (Unisinos), Programa de Pós-Graduação em Saúde Coletiva, Avenida Unisinos, 950, CEP: 93022-750, São Leopoldo (RS), Brazil. E-mail: nutdeborafk@gmail.com.