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Epidemiology
Research
Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study
  1. Bruno P Nunes1,
  2. Alexandre D P Chiavegatto Filho2,
  3. Sanghamitra Pati3,
  4. Doralice S Cruz Teixeira4,
  5. Thaynã R Flores5,
  6. Fabio A Camargo-Figuera6,
  7. Tiago N Munhoz5,7,
  8. Elaine Thumé1,
  9. Luiz A Facchini1,5,
  10. Sandro R Rodrigues Batista8
  1. 1 Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
  2. 2 Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
  3. 3 Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, India
  4. 4 Municipal Health Department of São Paulo, São Paulo, Brazil
  5. 5 Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
  6. 6 School of Nursing, Universidad Industrial de Santander, Bucaramanga, Colombia
  7. 7 Department of Psychology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
  8. 8 Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
  1. Correspondence to Dr Bruno P Nunes; nunesbp{at}gmail.com

Abstract

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.

  • Comorbidity
  • Multimorbidity
  • Chronic disease
  • Statistical disease clustering
  • Multilevel Analysis.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-015885

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    Footnotes

    • Contributors BPN designed the article, obtained and analysed the data, drafted the first version and revised the manuscript. ADPCF and FACF analysed the data and drafted and revised the manuscript. SP, DSCT, TRF, TNM, ET and LAF drafted and revised the manuscript. SRRB designed the article, drafted and revised the manuscript. All authors approved the final version of the manuscript.

    • Funding There are no funding related to the production of the paper. The Brazilian Ministry of Health financed the PNS survey. The funder of the survey played no role in the study design; collection, analysis and interpretation of data; writing of the report; or the decision to submit the article for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All PNS data are available from the Brazilian Institute of Geography and Statistics website ().

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