Prevalence, patterns of multimorbidity and associations with health care utilization among middle-aged and older people in China

Background: Multimorbidity has become one of the main challenges in health care system. The association between prevalence, patterns of multimorbidity and health care utilization is less often discussed in China. The purpose of this study is to examine this association among Chinese middle-aged and older adults and take in account several sociodemographic characteristics. Methods: : This study consists of 19559 individuals aged 45 and older from the wave 4 of the China Health and Retirement Longitudinal Study (CHARLS) in 2018. Multimorbidity was defined as the co-occurrence of two or more chronic medical condition of a list of fourteen chronic diseases in one person. Health care utilization include whether the individuals received outpatient service last month and inpatient service in the past year. LCA (Latent Class Analysis) was conducted to identify the clustering pattern of chronic diseases. Logistic regressions were employed to explore the association between prevalence, patterns of multimorbidity and health care utilization. Analyses were weighted using individual sample weights, adjusted for non-response of individual and household. Results: : Among all participants, 23.10% were aged above 70 years and 52.42% were female. The mean number of chronic disease was 2.17 and the prevalence of multimorbidity was 56.73%. Four patterns were identified: relatively healthy class, respiratory class, stomach-arthritis class and vascular class. Multimorbid individuals used more outpatient services (OR=1.87, 95%CI=1.63-2.14) and more inpatient services (OR=2.50, 95%CI=2.20-2.83) compared to their no-multimorbid counterparts. The individuals classified into respiratory class, stomach-arthritis class and vascular class used more health service. Conclusions: Our study provided evidence that multimorbidity is high among Chinese older adults and is associated substantially higher health care utilization in China. Policy should prioritize improving the management of individuals with multimorbidity to increase healthcare efficiency. Further research is necessary with special emphasis on the trajectory of multimorbidity and the role of health system in satisfying needs of multimorbid individuals.