Contextual and individual inequalities of multimorbidity in Brazilian adults: a cross-sectional national-based study

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.