Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients

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Abstract

Background

Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases.

Methods

We included adult patients with CKD stages 1–5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, considering them globally and stratified by age and sex, using multinomial logistic regression and latent class analysis, respectively.

Results

Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25–2.33) for two comorbidities to 2.71 (2.00–3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16–2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, bur tended to be different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases.

Conclusions

Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy is not associated with patterns of multimorbidity in younger patients, but a difference was observed in older ones. Improving low health literacy could be an intervention efficient also in decreasing multimorbidity in CKD patients.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40620-021-01229-1.

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Most cited references 34

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Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)

Karen Kristine Sørensen, Jürgen Pelikan, Florian Röthlin … (2015)

Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. Methods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. Results: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

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Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.

Caroline S. Fox, Kunihiro Matsushita, Mark Woodward … (2012)

Chronic kidney disease is characterised by low estimated glomerular filtration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modified by diabetes is unknown. We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and end-stage renal disease (ESRD) associated with eGFR and albuminuria in individuals with and without diabetes. We analysed data for 1,024,977 participants (128,505 with diabetes) from 30 general population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and high-risk cohorts with data for all-cause mortality, 75,306 deaths occurred during a mean follow-up of 8·5 years (SD 5·0). In the 23 studies with data for cardiovascular mortality, 21,237 deaths occurred from cardiovascular disease during a mean follow-up of 9·2 years (SD 4·9). In the general and high-risk cohorts, mortality risks were 1·2-1·9 times higher for participants with diabetes than for those without diabetes across the ranges of eGFR and albumin-to-creatinine ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes groups, HR of mortality outcomes according to lower eGFR and higher ACR were much the same in participants with and without diabetes (eg, for all-cause mortality at eGFR 45 mL/min per 1·73 m(2) [vs 95 mL/min per 1·73 m(2)], HR 1·35; 95% CI 1·18-1·55; vs 1·33; 1·19-1·48 and at ACR 30 mg/g [vs 5 mg/g], 1·50; 1·35-1·65 vs 1·52; 1·38-1·67). The overall interactions were not significant. We identified much the same findings for ESRD in the chronic kidney disease cohorts. Despite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes. US National Kidney Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies

Concepció Violan, Quintí Foguet-Boreu, Gemma Flores-Mateo … (2014)

Introduction Multimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care. Methods Systematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase) and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa = 0.86). Results We identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46), and lower socioeconomic status (OR, 1.20 to 1.91). Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions. Conclusions Well-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this phenomenon, and is a necessary immediate step.

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Author and article information

Contributors

M. S. Gurgel do Amaral:

ORCID: https://orcid.org/0000-0002-8830-4687

m.silva.gurgel.do.amaral@umcg.nl

S. A. Reijneveld:

ORCID: https://orcid.org/0000-0002-1206-7523

s.a.reijneveld@umcg.nl

L. M. G. Meems:

ORCID: https://orcid.org/0000-0001-8627-7139

l.m.g.meems@umcg.nl

J. Almansa:

ORCID: https://orcid.org/0000-0001-9724-9328

j.almansa.ortiz@umcg.nl

G. J. Navis: g.j.navis@umcg.nl

A. F. de Winter:

ORCID: https://orcid.org/0000-0002-9380-4889

a.f.de.winter@umcg.nl

Journal

Journal ID (nlm-ta): J Nephrol

Journal ID (iso-abbrev): J Nephrol

Title: Journal of Nephrology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1121-8428

ISSN (Electronic): 1724-6059

Publication date (Electronic): 5 January 2022

Publication date PMC-release: 5 January 2022

Publication date (Print): 2022

Volume: 35

Issue: 6

Pages: 1709-1719

Affiliations

[1 ]GRID grid.4494.d, ISNI 0000 0000 9558 4598, Department of Health Sciences, Community and Occupational Medicine, , University of Groningen, University Medical Center Groningen, ; Hanzeplein 1, Building 3217, room 617, 9713GZ Groningen, The Netherlands

[2 ]GRID grid.4494.d, ISNI 0000 0000 9558 4598, Department of Cardiology, , University of Groningen, University Medical Center Groningen, ; Groningen, The Netherlands

[3 ]GRID grid.4494.d, ISNI 0000 0000 9558 4598, Department of Nephrology, , University of Groningen, University Medical Center Groningen, ; Groningen, The Netherlands

Author information

M. S. Gurgel do Amaral https://orcid.org/0000-0002-8830-4687

S. A. Reijneveld https://orcid.org/0000-0002-1206-7523

L. M. G. Meems https://orcid.org/0000-0001-8627-7139

J. Almansa https://orcid.org/0000-0001-9724-9328

A. F. de Winter https://orcid.org/0000-0002-9380-4889

Article

Publisher ID: 1229

DOI: 10.1007/s40620-021-01229-1

PMC ID: 9300533

PubMed ID: 34985613

SO-VID: 243aae06-9c63-447c-b525-e43e9b24400b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 21 October 2021

Date accepted : 9 December 2021

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Keywords: health literacy,multimorbidity,patterns,chronic kidney disease,prevention

Data availability:

Keywords: health literacy, multimorbidity, patterns, chronic kidney disease, prevention

Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients

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Supplementary Information

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Most cited references 34

Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)

Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.

Prevalence, Determinants and Patterns of Multimorbidity in Primary Care: A Systematic Review of Observational Studies

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