Multimorbidity and regional differences in care transitions: the 15-Year SNAC-study

Abstract Background As people age, having 2 or more chronic conditions (multimorbidity) becomes a major reason for increased use of healthcare services. This study synthesizes evidence from the Swedish National Study on Aging and Care (SNAC) to explore how multimorbidity and related characteristics affect transitions across living and care settings, hospital admission patterns, and the role of geographic context in shaping healthcare trajectories. Methods Data from over 3,000 adults aged 60+ across urban, semi-rural, and rural regions in Sweden were analyzed using multistate models. We assessed how multimorbidity, alongside cognitive and physical function, social circumstances, and geographic setting, influenced transitions across home, hospitals, post-acute care, and nursing homes, as well as avoidable and unavoidable hospital admissions. Results Multimorbidity consistently emerged as key factor driving increased healthcare use.It was associated with a higher volume of transitions between care settings and greater risk of hospitalizations-both avoidable and unavoidable-particularly in combination with polypharmacy and slow gait speed. While multimorbidity and functional decline predicted higher healthcare needs, the direction and nature of transitions were shaped by contextual variables: urban residents were more likely to receive home-based care, whereas rural residents faced higher risks of institutionalization. Conclusions Multimorbidity significantly amplifies the use of healthcare resources among older adults, but its impact is modulated by functional status, social support, and geographic context. Understanding these dynamics is essential for developing tailored, region-sensitive strategies to optimize continuity of care, reduce avoidable hospitalizations, and better align services with the complex needs of aging populations.