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    Original Investigation
    Public Health
    November 13, 2019

    Epidemiologic Characteristics of Multimorbidity and Sociodemographic Factors Associated With Multimorbidity in a Rapidly Aging Asian Country

    Author Affiliations
    • 1Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
    • 2Health Services and Research Evaluation, SingHealth Regional Health System, Singapore
    • 3Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
    • 4Duke-NUS Medical School, Singapore
    • 5Medicine Academic Clinical Program, Singapore General Hospital, Singapore
    JAMA Netw Open. 2019;2(11):e1915245. doi:10.1001/jamanetworkopen.2019.15245
    Key Points español 中文 (chinese)

    Question  What epidemiologic characteristics and sociodemographic factors are associated with multimorbidity in Singapore?

    Findings  In this cross-sectional study of 1 181 024 patients, increasing age, lower socioeconomic status, female sex, and increasing number of mental disorders were significantly associated with increasing multimorbidity.

    Meaning  Epidemiologic characteristics and sociodemographic factors must be taken into consideration when developing public health policies, and greater efficacy in managing multimorbidity may be derived from preventive health programs.


    Importance  Multimorbidity is a growing health care problem in aging societies and is strongly associated with epidemiologic characteristics and sociodemographic factors. Knowledge of these associations is important for the design of effective preventive and management strategies.

    Objectives  To determine the association between multimorbidity and sociodemographic factors (age, socioeconomic status [SES], sex, and race/ethnicity) and the association between mental health diseases and physical diseases, as well as their implications for the types and costs of health care use.

    Design, Setting, and Participants  This population-based cross-sectional study used deidentified Singapore Eastern Regional Health System data collected between January 1, 2012, and December 31, 2016. Patients who were alive as of January 1, 2016, and residing in the Regional Health System region in 2016 (N = 1 181 024) were included. Patients who had no year of birth records (n = 573), were born in 2017 (n = 93), or died before January 1, 2016 (n = 47 322), were excluded.

    Main Outcomes and Measures  Multimorbidity, age, sex, SES, mental health, race/ethnicity, and health care use.

    Results  In the study population of 1 181 024 individuals, the mean (SD) age was 39.6 (22.1) years, 51.2% were women, 70.1% were Chinese, 7.1% were Indian, 13.5% were Malayan, and 9.3% were other races/ethnicities. Multimorbidity, present in 26.2% of the population, was more prevalent in female (26.8%; 95% CI, 26.7%-26.9%) than in male (25.6%; 95% CI, 25.5%-25.7%) patients and among patients with low SES (41.6%) than those with high SES (20.1%). Mental health diseases were significantly more prevalent among individuals with low SES (5.2%; 95% CI, 5.1%-5.2%) than high SES (2.1%; 95% CI, 2.0%-2.1%; P < .001). The 3 most prevalent disease combinations were chronic kidney disease and hypertension, chronic kidney disease and lipid disorders, and hypertension and lipid disorders. Although chronic kidney disease, hypertension, lipid disorders, and type 1 and/or type 2 diabetes–related diseases had a low cost per capita, the large number of patients with these conditions caused the overall proportion of the cost incurred by health care use to be more than twice that incurred in other diseases.

    Conclusions and Relevance  These findings emphasize the association between multimorbidity and sociodemographic factors such as increasing age, lower SES, female sex, and increasing number of mental disorders. Health care policies need to take sociodemographic factors into account when tackling multimorbidity in a population.