The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Glob Health Action. 2021 Jan 1;14(1):1975921. doi: 10.1080/16549716.2021.1975921.
Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden.
This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships.
This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work.
68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656-2.236), IADL limitation (1.522, 1.326-1.748), limited work due to health problems (1.868, 1.601-2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390-2.020; for employed non-agricultural work, 2.418, 1.245-4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group.
Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society.
慢性病多病共存已成为卫生系统面临的主要挑战。尽管大量研究评估了多病共存对医疗保健利用和成本的直接经济负担，但对其对工作生产力和功能障碍的间接影响（作为疾病负担的指标）关注甚少。
本研究旨在调查中国成年人多病共存的患病率及其对功能障碍和工作生产力的影响。还研究了城乡之间这些关系的差异。
本研究使用了 2015 年中国健康与退休纵向研究（CHARLS）的数据，包括 11176 名 45 岁及以上的参与者。使用多变量逻辑回归模型估计多病共存对功能障碍（即日常生活活动（ADL）；工具性日常生活活动（IADL））和因健康问题导致的工作生产力损失的影响。使用负二项回归模型评估多病共存与农业工作和非农业就业病假缺勤的关系。
2015 年 CHARLS 中，中国总参与者中有 68.8%患有多病共存。农村地区患有多病共存的居民比城市居民报告的身体功能和病假天数更高。多病共存与 ADL 受限（优势比 1.924，95%置信区间 1.656-2.236）、IADL 受限（1.522，1.326-1.748）、因健康问题限制工作（1.868，1.601-2.178）和病假天数（农业工作，发病率比 1.676，95%置信区间 1.390-2.020；非农业就业，2.418，1.245-4.696）呈正相关。对于农村人群，多病共存对功能障碍和工作生产力损失的影响（除了提前退休）小于城市人群。
多病共存对功能健康和工作生产力构成重大挑战，对个人、中国卫生系统和社会都有重大的负面经济后果。
