Multimorbidity patterns and determinants in Europe: a crossnational longitudinal perspective

ENG- Population ageing comes along with an increase in the presence of chronic diseases, with the subsequent impact on people having them as well as on society and healthcare systems. With the accumulation of chronic diseases, the so-called multimorbidity phenomenon appears. The study of how these diseases are grouped among people, which are their risk factors and consequences of belonging to these groups and how they evolve may help targeting efforts towards preventing their apparition, advance and impact. Therefore, this thesis aimed to characterize these patterns, their progression, and their associated risk factors, as well as their relationship with limitations, quality of life and healthcare use, and how these last relationships change according to the socioeconomic level of regions where people live. For this study, data from the SHARE survey was used, conducted at European level to adults aged 50 and over. Four classes were established in the analyses addressing changes and multimorbidity-related factors: the “healthy” class, the “metabolic” class, the “severely impaired" class and the “osteoarticular” (female-specific) and the “articular-COPD-ulcer” (male-specific) classes. More severe multimorbidity groups were related to age, smoke (with the articular-related classes in particular), material deprivation (notably to the “severely impaired”) and a high BMI, while education, being employed and physical activity were related to less multimorbidity. Changes were scarce and occurred from the “healthy” to the “metabolic” and the articular-related classes, and from the latter two to the “severely impaired” class. In the analysis addressing consequences, six multimorbidity groups were established. Limitations and healthcare utilization were lower in the “healthy”, the “metabolic” and the “osteoarticular” classes. Individuals within the “cardiovascular” class tend to be more hospitalized, and those in the “neuro-affective- ulcer” and the “several conditions” were the most likely to suffer from limitations. The association between multimorbidity and certain outcomes did differ according to the regional socioeconomic status, particularly those regarding limitations. In conclusion, the identified multimorbidity groups are characterized by distinct sociodemographic and lifestyle factors and have distinct associations with health-related outcomes and healthcare use, with more multimorbid groups being the most impaired. In addition, there were few changes in a 4-year period with the proposed models, happening from the healthiest groups to the groups with intermediate morbidity, and from these latter to the group with the highest accumulation of chronic conditions. Finally, not only is multimorbidity related to worse individual socioeconomic conditions and outcomes, but multimorbid individuals appear to have a larger impairment when living in regions with a lower socioeconomic status, even within the European Union