Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort

Background: Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnic...

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Autores: Moreno-Juste, Aida, Gimeno-Miguel, Antonio, Poblador-Plou, Beatriz, Calderón-Larrañaga, Amaia, Cano Del Pozo, Mabel, Forjaz, Maria João, Prados-Torres, Alexandra, Gimeno-Feliú, Luis A
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Instituto de Salud Carlos III (ISCIII)
Repositorio:Repisalud
Idioma:inglés
OAI Identifier:oai:repisalud.isciii.es:20.500.12105/16914
Acceso en línea:http://hdl.handle.net/20.500.12105/16914
Access Level:acceso abierto
Palabra clave:Multimorbidity
Intersectional Framework
Middle Aged
Male
Humans
Female
Aged
Cross-Sectional Studies
Social Determinants of Health
Socioeconomic Factors
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spelling Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron CohortMoreno-Juste, AidaGimeno-Miguel, AntonioPoblador-Plou, BeatrizCalderón-Larrañaga, AmaiaCano Del Pozo, MabelForjaz, Maria JoãoPrados-Torres, AlexandraGimeno-Feliú, Luis AMultimorbidityIntersectional FrameworkMiddle AgedMaleHumansFemaleAgedCross-Sectional StudiesSocial Determinants of HealthSocioeconomic FactorsBackground: Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnicity, residence area and socioeconomic class). Methods: We conducted a cross-sectional observational study of all individuals who presented with at least one chronic disease in 2019 (n = 1 086 948) from the EpiChron Cohort (Aragon, Spain). Applying intersectional analysis, the age-adjusted likelihood of multimorbidity was investigated across 36 intersectional strata defined by gender, ethnicity, residence area and socioeconomic class. We calculated odds ratios (OR) 95% confidence interval (CI) using high-income urban non-migrant men as the reference category. The area under the receiver operator characteristics curve (AUC) was calculated to evaluate the discriminatory accuracy of multimorbidity. Results: The prevalence of multimorbidity increased with age, female gender and low income. Young and middle-aged low-income individuals showed rates of multimorbidity equivalent to those of high-income people aged about 20 years older. The intersectional analysis showed that low-income migrant women living in urban areas for >15 years were particularly disadvantaged in terms of multimorbidity risk OR = 3.16 (95% CI = 2.79-3.57). Being a migrant was a protective factor for multimorbidity, and newly arrived migrants had lower multimorbidity rates than those with >15 years of stay in Aragon, and even non-migrants. Living in rural vs. urban areas was slightly protective against multimorbidity. All models had a large discriminatory accuracy (AUC = 0.7884-0.7895); the largest AUC was obtained for the model including all intersectional strata. Conclusions: Our intersectional approach uncovered the large differences in the prevalence of multimorbidity that arise due to the synergies between the different socioeconomic and demographic exposures, beyond their expected additive effects.Edinburgh University Global Health SocietyInstituto de Salud Carlos IIIMinisterio de Ciencia e Innovación (España)Unión Europea. Comisión Europea. NextGenerationEU20242024-01-1020232023-02-0320232023-02-03research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/20.500.12105/16914reponame:Repisaludinstname:Instituto de Salud Carlos III (ISCIII)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Atribución 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repisalud.isciii.es:20.500.12105/169142026-06-12T12:43:37Z
dc.title.none.fl_str_mv Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
title Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
spellingShingle Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
Moreno-Juste, Aida
Multimorbidity
Intersectional Framework
Middle Aged
Male
Humans
Female
Aged
Cross-Sectional Studies
Social Determinants of Health
Socioeconomic Factors
title_short Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
title_full Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
title_fullStr Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
title_full_unstemmed Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
title_sort Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
dc.creator.none.fl_str_mv Moreno-Juste, Aida
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
Calderón-Larrañaga, Amaia
Cano Del Pozo, Mabel
Forjaz, Maria João
Prados-Torres, Alexandra
Gimeno-Feliú, Luis A
author Moreno-Juste, Aida
author_facet Moreno-Juste, Aida
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
Calderón-Larrañaga, Amaia
Cano Del Pozo, Mabel
Forjaz, Maria João
Prados-Torres, Alexandra
Gimeno-Feliú, Luis A
author_role author
author2 Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
Calderón-Larrañaga, Amaia
Cano Del Pozo, Mabel
Forjaz, Maria João
Prados-Torres, Alexandra
Gimeno-Feliú, Luis A
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Instituto de Salud Carlos III
Ministerio de Ciencia e Innovación (España)
Unión Europea. Comisión Europea. NextGenerationEU
dc.subject.none.fl_str_mv Multimorbidity
Intersectional Framework
Middle Aged
Male
Humans
Female
Aged
Cross-Sectional Studies
Social Determinants of Health
Socioeconomic Factors
topic Multimorbidity
Intersectional Framework
Middle Aged
Male
Humans
Female
Aged
Cross-Sectional Studies
Social Determinants of Health
Socioeconomic Factors
description Background: Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnicity, residence area and socioeconomic class). Methods: We conducted a cross-sectional observational study of all individuals who presented with at least one chronic disease in 2019 (n = 1 086 948) from the EpiChron Cohort (Aragon, Spain). Applying intersectional analysis, the age-adjusted likelihood of multimorbidity was investigated across 36 intersectional strata defined by gender, ethnicity, residence area and socioeconomic class. We calculated odds ratios (OR) 95% confidence interval (CI) using high-income urban non-migrant men as the reference category. The area under the receiver operator characteristics curve (AUC) was calculated to evaluate the discriminatory accuracy of multimorbidity. Results: The prevalence of multimorbidity increased with age, female gender and low income. Young and middle-aged low-income individuals showed rates of multimorbidity equivalent to those of high-income people aged about 20 years older. The intersectional analysis showed that low-income migrant women living in urban areas for >15 years were particularly disadvantaged in terms of multimorbidity risk OR = 3.16 (95% CI = 2.79-3.57). Being a migrant was a protective factor for multimorbidity, and newly arrived migrants had lower multimorbidity rates than those with >15 years of stay in Aragon, and even non-migrants. Living in rural vs. urban areas was slightly protective against multimorbidity. All models had a large discriminatory accuracy (AUC = 0.7884-0.7895); the largest AUC was obtained for the model including all intersectional strata. Conclusions: Our intersectional approach uncovered the large differences in the prevalence of multimorbidity that arise due to the synergies between the different socioeconomic and demographic exposures, beyond their expected additive effects.
publishDate 2023
dc.date.none.fl_str_mv 2023
2023-02-03
2023
2023-02-03
2024
2024-01-10
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/20.500.12105/16914
url http://hdl.handle.net/20.500.12105/16914
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución 4.0 Internacional
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución 4.0 Internacional
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Edinburgh University Global Health Society
publisher.none.fl_str_mv Edinburgh University Global Health Society
dc.source.none.fl_str_mv reponame:Repisalud
instname:Instituto de Salud Carlos III (ISCIII)
instname_str Instituto de Salud Carlos III (ISCIII)
reponame_str Repisalud
collection Repisalud
repository.name.fl_str_mv
repository.mail.fl_str_mv
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