Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study
Objectives The study aims to evaluate the magnitude of multimorbidity in Brazilian adults, as well to measure their association with individual and contextual factors stratified by Brazilian states and regions.Methods A national-based cross-sectional study was carried out in 2013 with Brazilian adul...
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BMJ Publishing Group
2017-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/6/e015885.full |
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| author | Bruno P Nunes Tiago N Munhoz Sanghamitra Pati Elaine Thumé Alexandre D P Chiavegatto Filho Doralice S Cruz Teixeira Thaynã R Flores Fabio A Camargo-Figuera Luiz A Facchini Sandro R Rodrigues Batista |
| author_facet | Bruno P Nunes Tiago N Munhoz Sanghamitra Pati Elaine Thumé Alexandre D P Chiavegatto Filho Doralice S Cruz Teixeira Thaynã R Flores Fabio A Camargo-Figuera Luiz A Facchini Sandro R Rodrigues Batista |
| author_sort | Bruno P Nunes |
| collection | DOAJ |
| description | Objectives The study aims to evaluate the magnitude of multimorbidity in Brazilian adults, as well to measure their association with individual and contextual factors stratified by Brazilian states and regions.Methods A national-based cross-sectional study was carried out in 2013 with Brazilian adults. Multimorbidity was evaluated by a list of 22 physical and mental morbidities (based on self-reported medical diagnosis and Patient Health Questionnaire-9 for depression). The outcome was analysed taking ≥2 and ≥3 diseases as cut-off points. Factor analysis (FA) was used to identify disease patterns and multilevel models were used to test association with individual and contextual variables.Results The sample comprised 60 202 individuals. Multimorbidity frequency was 22.2% (95% CI 21.5 to 22.9) for ≥2 morbidities and 10.2% (95% CI 9.7 to 10.7) for ≥3 morbidities. In the multilevel adjusted models, females, older people, those living with a partner and having less schooling presented more multiple diseases. No linear association was found according to wealth index but greater outcome frequency was found in individuals with midrange wealth index. Living in states with higher levels of education and wealthier states was associated with greater multimorbidity. Two patterns of morbidities (cardiometabolic problems and respiratory/mental/muscle–skeletal disorders) explained 92% of total variance. The relationship of disease patterns with individual and contextual variables was similar to the overall multimorbidity, with differences among Brazilian regions.Conclusions In Brazil, at least 19 million adults had multimorbidity. Frequency is similar to that found in other Low and and Middle Income Countries. Contextual and individual social inequalities were observed. |
| format | Article |
| id | doaj-art-911eb4f5fb2446dda317f7e49e5ff7e2 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-911eb4f5fb2446dda317f7e49e5ff7e22025-08-20T02:48:42ZengBMJ Publishing GroupBMJ Open2044-60552017-06-017610.1136/bmjopen-2017-015885Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based studyBruno P Nunes0Tiago N Munhoz1Sanghamitra Pati2Elaine Thumé3Alexandre D P Chiavegatto Filho4Doralice S Cruz Teixeira5Thaynã R Flores6Fabio A Camargo-Figuera7Luiz A Facchini8Sandro R Rodrigues Batista91 Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil5 Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil3 Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, IndiaDepartment of Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil, Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil, Department of Epidemiology and Public Health, University College London, London, UK, Department of Community Health Sciences and Department of Health Policy and Management Departments, University of California, Los Angeles, EUA, Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil, Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil2 Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil4 Municipal Health Department of São Paulo, São Paulo, Brazil5 Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil6 School of Nursing, Universidad Industrial de Santander, Bucaramanga, Colombia1 Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil8 Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, BrazilObjectives The study aims to evaluate the magnitude of multimorbidity in Brazilian adults, as well to measure their association with individual and contextual factors stratified by Brazilian states and regions.Methods A national-based cross-sectional study was carried out in 2013 with Brazilian adults. Multimorbidity was evaluated by a list of 22 physical and mental morbidities (based on self-reported medical diagnosis and Patient Health Questionnaire-9 for depression). The outcome was analysed taking ≥2 and ≥3 diseases as cut-off points. Factor analysis (FA) was used to identify disease patterns and multilevel models were used to test association with individual and contextual variables.Results The sample comprised 60 202 individuals. Multimorbidity frequency was 22.2% (95% CI 21.5 to 22.9) for ≥2 morbidities and 10.2% (95% CI 9.7 to 10.7) for ≥3 morbidities. In the multilevel adjusted models, females, older people, those living with a partner and having less schooling presented more multiple diseases. No linear association was found according to wealth index but greater outcome frequency was found in individuals with midrange wealth index. Living in states with higher levels of education and wealthier states was associated with greater multimorbidity. Two patterns of morbidities (cardiometabolic problems and respiratory/mental/muscle–skeletal disorders) explained 92% of total variance. The relationship of disease patterns with individual and contextual variables was similar to the overall multimorbidity, with differences among Brazilian regions.Conclusions In Brazil, at least 19 million adults had multimorbidity. Frequency is similar to that found in other Low and and Middle Income Countries. Contextual and individual social inequalities were observed.https://bmjopen.bmj.com/content/7/6/e015885.full |
| spellingShingle | Bruno P Nunes Tiago N Munhoz Sanghamitra Pati Elaine Thumé Alexandre D P Chiavegatto Filho Doralice S Cruz Teixeira Thaynã R Flores Fabio A Camargo-Figuera Luiz A Facchini Sandro R Rodrigues Batista Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study BMJ Open |
| title | Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study |
| title_full | Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study |
| title_fullStr | Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study |
| title_full_unstemmed | Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study |
| title_short | Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study |
| title_sort | contextual and individual inequalities of multimorbidity in brazilian adults a cross sectional national based study |
| url | https://bmjopen.bmj.com/content/7/6/e015885.full |
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