Public Health Policy Evaluation Unit, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8R, UK.
Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
BMC Public Health. 2021 Jul 1;21(1):1287. doi: 10.1186/s12889-021-11328-0.
Evidence is limited on racial/ethnic group disparities in multimorbidity and associated health outcomes in low- and middle-income countries hampering effective policies and clinical interventions to address health inequalities.
This study assessed race/ethnic and socioeconomic disparities in the prevalence of multimorbidity and associated healthcare utilisation, costs and death in Rio de Janeiro, Brazil. A cross-sectional analysis was carried out of 3,027,335 individuals registered with primary healthcare (PHC) services. Records included linked data to hospitalisation, mortality, and welfare-claimant (Bolsa Família) records between 1 Jan 2012 and 31 Dec 2016. Logistic and Poisson regression models were carried out to assess the likelihood of multimorbidity (two or more diagnoses out of 53 chronic conditions), PHC use, hospital admissions and mortality from any cause. Interactions were used to assess disparities.
In total 13,509,633 healthcare visits were analysed identifying 389,829 multimorbid individuals (13%). In adjusted regression models, multimorbidity was associated with lower education (Adjusted Odds Ratio (AOR): 1.26; 95%CI: 1.23,1.29; compared to higher education), Bolsa Família receipt (AOR: 1.14; 95%CI: 1.13,1.15; compared to non-recipients); and black race/ethnicity (AOR: 1.05; 95%CI: 1.03,1.06; compared to white). Multimorbidity was associated with more hospitalisations (Adjusted Rate Ratio (ARR): 2.75; 95%CI: 2.69,2.81), more PHC visits (ARR: 3.46; 95%CI: 3.44,3.47), and higher likelihood of death (AOR: 1.33; 95%CI: 1.29,1.36). These associations were greater for multimorbid individuals with lower educational attainment (five year probability of death 1.67% (95%CI: 1.61,1.74%) compared to 1.13% (95%CI: 1.02,1.23%) for higher education), individuals of black race/ethnicity (1.48% (95%CI: 1.41,1.55%) compared to 1.35% (95%CI: 1.31,1.40%) for white) and individuals in receipt of welfare (1.89% (95%CI: 1.77,2.00%) compared to 1.35% (95%CI: 1.31,1.38%) for non-recipients).
The prevalence of multimorbidity and associated hospital admissions and mortality are greater in individuals with black race/ethnicity and other deprived socioeconomic groups in Rio de Janeiro. Interventions to better prevent and manage multimorbidity and underlying disparities in low- and middle-income country settings are needed.
在中低收入国家，种族/民族群体在多种疾病和相关健康结果方面的差异证据有限，这阻碍了制定有效政策和临床干预措施来解决健康不平等问题。
本研究评估了巴西里约热内卢的种族/民族和社会经济差异对多种疾病的患病率以及与医疗保健利用、成本和死亡相关的差异。对 3027335 名在初级保健 (PHC) 服务机构登记的个人进行了横断面分析。记录包括从 2012 年 1 月 1 日至 2016 年 12 月 31 日与住院、死亡率和福利申领者（Bolsa Família）记录相关联的数据。使用逻辑和泊松回归模型评估了多种疾病（53 种慢性疾病中的两种或多种诊断）、PHC 使用、住院和任何原因导致的死亡率的可能性。交互作用用于评估差异。
共分析了 13509633 次医疗保健访问，确定了 389829 名患有多种疾病的患者（13%）。在调整后的回归模型中，多种疾病与较低的教育程度（调整后的优势比（AOR）：1.26；95%CI：1.23，1.29；与较高的教育程度相比）、Bolsa Família 的领取（AOR：1.14；95%CI：1.13，1.15；与非领取者相比）和黑人种族/民族（AOR：1.05；95%CI：1.03，1.06；与白人相比）相关。多种疾病与更多的住院治疗（调整后的发病率比（ARR）：2.75；95%CI：2.69，2.81）、更多的 PHC 就诊（ARR：3.46；95%CI：3.44，3.47）和更高的死亡可能性（AOR：1.33；95%CI：1.29，1.36）相关。对于教育程度较低的多种疾病患者（五年死亡率概率为 1.67%（95%CI：1.61，1.74%），而教育程度较高的患者为 1.13%（95%CI：1.02，1.23%）），黑人种族/民族的患者（1.48%（95%CI：1.41，1.55%），而白人的患者为 1.35%（95%CI：1.31，1.40%））和福利领取者（1.89%（95%CI：1.77，2.00%），而非领取者为 1.35%（95%CI：1.31，1.38%）），这些关联更大。
在巴西里约热内卢，黑人种族/民族和其他贫困社会经济群体的多种疾病患病率以及与多种疾病相关的住院治疗和死亡率更高。需要制定干预措施，以更好地预防和管理多种疾病以及中低收入国家的潜在差异。
