Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics

RESEARCH ARTICLE Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics Januse Nogueira de Carvalho1*, Ângelo Giuseppe Roncalli1, Marianna de Camargo Cancela2, Dyego Leandro Bezerra de Souza1¤ 1 Collective Health Program, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brasil, 2 Division of Population Research, Brazilian National Cancer Institute, Rio de Janeiro, Brasil a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Carvalho JNd, Roncalli ÂG, Cancela MdC, Souza DLBd (2017) Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics. PLoS ONE 12(4): e0174322. https://doi.org/ 10.1371/journal.pone.0174322 Editor: Andrea Icks, Heinrich-Heine-Universitat Dusseldorf Medizinische Fakultat, GERMANY Received: October 24, 2016 Accepted: March 7, 2017 Published: April 6, 2017 Copyright: © 2017 Carvalho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data are from the study “National Health Survey”, and are available to public consult on: http://www.ibge.gov.br/home/ estatistica/populacao/pns/2013/default_xls.shtm. ¤ Current address: Universidade Federal do Rio Grande do Norte / Federal University of Rio Grande do Norte. Programa de Pós-Graduação em Saúde Coletiva / Graduate Program in Collective Health. Avenida Senador Salgado Filho, Lagoa Nova, Natal-RN, Brasil. * Abstract Knowledge on the occurrence of multimorbidity is important from the viewpoint of public policies, as this condition increases the consumption of medicines as well as the utilization and expenses of health services, affecting life quality of the population. The objective of this study was to estimate prevalence of self-reported multimorbidity in Brazilian adults (18 years old) according to socioeconomic and demographic characteristics. A descriptive study is presented herein, based on data from the National Health Survey, which was a household-based survey carried out in Brazil in 2013. Data on 60,202 adult participants over the age of 18 were included. Prevalences and its respective confidence intervals (95%) were estimated according to sex, age, education level, marital status, self-reported skin color, area of residence, occupation and federative units (states). Poisson regression models univariate and multivariate were used to evaluate the association between socioeconomic and demographic variables with multimorbidity. To observe the combinations of chronic conditions the most common groups in pairs, trios, quartets and quintets of chronic diseases were observed. The prevalence of multimorbidity was 23.6% and was higher among women, in individuals over 60 years of age, people with low educational levels, people living with partner, in urban areas and among unemployed persons. The states of the South and Southeast regions presented higher prevalence. The most common groups of chronic diseases were metabolic and musculoskeletal diseases. The results demonstrated high prevalence of multimorbidity in Brazil. The study also revealed that a considerable share of the economically active population presented two or more chronic diseases. Data of this research indicated that socioeconomic and demographic aspects must be considered during the planning of health services and development of prevention and treatment strategies for chronic diseases, and consequently, multimorbidity. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. PLOS ONE | https://doi.org/10.1371/journal.pone.0174322 April 6, 2017 1 / 13 Prevalence of multimorbidity in the Brazilian adult population Introduction Developing countries currently experience an epidemiological transition, with declines in infectious diseases and constant increases in non-communicable diseases (NCD). NCD are among the main global causes of death, with examples such as cardiovascular diseases, neoplasms, mental disorders and diabetes[1]. In Brazil, extended longevity has increased the prevalence of these diseases, which can cause functional dependence and require repetitive hospitalizations[2]. Therefore, monitoring NCD must be an essential component during the planning, implementation and evaluation of health services, besides aiding in the elaboration of control and prevention measures[3]. A chronic disease is a disease that persists throughout a period above three months, and remains during a long life period, such as diabetes, hypertension, asthma and cancer [4,5]. Chronic diseases are characterized by a long lasting period, necessity of continuous medical treatment, severe impact on the affected individual, besides presenting high prevalence in older age groups [6]. Prevention, treatment and management of chronic diseases are complex, being one of the main challenges faced by health services worldwide[4]. Several studies have examined the independent effects of chronic diseases and the occurrence of comorbidities, defined as any additional co-existing ailment in a patient with a particular index disease [7]. In recent years, scientific evidence revealed that interactions between chronic diseases cause greater damage in life quality of people, more than could be expected from the individual effects of these conditions[8]. When two or more chronic diseases occur simultaneously in an individual, this is referred to as multimorbidity [9]. Knowledge on the occurrence of multimorbidity is especially important in primary attention, where medical doctors frequently assist patients with multiple, coexistent conditions [10]. Such knowledge is also important from the point of view of public policies, as these are conditions that increase the consumption of medicines as well as the utilization and expenses associated with health services. Much has been learnt about the causes, prevention and treatment of NCDs over the past three decades, as important achievements have been made in reducing mortality in many countries; the evidence base for action is steadily mounting and global attention to the NCD epidemic is intensifying [11]. In this context, knowledge of multimorbidity becomes fundamental to subsidize health planning and conduct adequately combat chronic diseases. The objective of this study was to estimate the prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics. Methodology A descriptive sectional study is presented herein. Data on the National Health Survey (NHS) were utilized, which was carried out in Brazil in 2013, as a representative cross-sectional survey of the Brazilian adult popul (...truncated)