Abstract
Introduction: Rise in ageing population and its implications raise concerns of pre-old and middle-aged adults ' health status. NHMS 2019 showed notable prevalence of known diabetes, hypertension and hyperlipidemia among adults aged 40-44, with these figures quadrupling among the oldest age group. With NCDs presenting prior to older age, living with complications longer and developing poor health status earlier can be inevitable. Moreover, ""multimorbidity"", the presence of ?2 NCDs simultaneously, is common for older adults; nevertheless, its prevalence among middle-aged and pre-old is less widely known. This analysis seeks to elucidate the status of multimorbidity of adults aged ?40 to understand its trends across the age spectrum and their patterns of healthcare utilisation. Methods: Secondary data analysis on all adults aged ?40 from the 2019 National Health and Morbidity Survey Healthcare Demand (NHMS HCD) module was conducted. Adults aged ?40 years (n=6691) were included to depict the age spectrum of middle-age (40-49), pre-old (50-59) and older adults (young-old for 60-69, middle-old for 70-79, old-old for age ?80). Multimorbidity comprised 3 conditions: diabetes, hypertension and hyperlipidemia. Healthcare services comprised outpatient, inpatient, community pharmacy and domiciliary care. Analysis was conducted using STATA 14 and sampling weight applied.
Results: Prevalence of NCDs multimorbidity increased with age; prevalence of 9.7% (95%CI 8.04-11.76) among middle-aged adults doubled among pre-old adults (23.9%, 95%CI 21.30-26.68), and was at least four-fold in older adults (36.4%, 95%CI 33.05-39.93; 47.2%, 95%CI 41.33-53.19; 40.9%, 95%CI 32.51-49.95; for young-old, middle-old and old-old adults, respectively). When assessed by degree of multimorbidity (3 co-existing NCDs), prevalence was highest in the middle-old group (21.5%, 95%CI 15.92-27.10). In terms of healthcare utilisation, the most frequent users of inpatient, outpatient and domiciliary care were young-old adults (37.1%, 95%CI 27.67-47.73; 30.6%, 95%CI 23.94-38.25; 37.6%, 95%CI 18.28-61.78; respectively). Community pharmacy utilisation was highest by the pre-old (37.3%, 95%CI 27.24-48.49), whereas for domiciliary care, middle-aged adults comprised more than a quarter of the adults who utilised the services (27.5%, 95%CI 9.3-58.37). Use of services were lowest by the old-old adults for inpatient, outpatient and community pharmacy (3.2%, 95%CI 1.32-7.39; 5.3%, 95%CI 2.73-9.87; 1.6%, 95%CI 0.56-4.44; respectively). A consistent pattern of utilising the public sector for inpatient and outpatient services was noted for multimorbid adults across all age groups.
Discussion: The findings denote that NCDs multimorbidity does not only afflict older adults, hence suggesting that clients utilising healthcare services have multiple health issues where care provided for a multimorbid middle-aged or pre-old adult may be as complex as that for older adults. As reported by other studies, utilisation of healthcare services is often by older adults, however this study also found that middle-age and pre-old adults also comprise a substantial proportion. Healthcare utilisation was lower in the old-old, raising questions of possible access issues. In this analysis, conditions only included NCDs, whereas older adults are likely to have other conditions which cause morbidity. Finding that multimorbid adults across the age spectrum have a preponderance for the public sector also has implications on the readiness and responsiveness of the health system.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-39.pdf
- https://apcph.cphm.my/events/oral-session-6-ballroom-C/
BibTeX (Download)
@proceedings{APCPH2022-O-39,
title = {Multiple Non-Communicable Diseases-Prevalence and Patterns of Healthcare Utilisation from the 2019 National Health and Morbidity Survey},
author = {Awatef Amer Nordin and Suhana Jawahir and Iqbal Ab Rahim and Adilius Manual and Jabrullah Ab Hamid and Sarah Nurain Mohd Noh and Nur Elina Abdul Mutalib},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-39.pdf
https://apcph.cphm.my/events/oral-session-6-ballroom-C/},
year = {2022},
date = {2022-08-01},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: Rise in ageing population and its implications raise concerns of pre-old and middle-aged adults ' health status. NHMS 2019 showed notable prevalence of known diabetes, hypertension and hyperlipidemia among adults aged 40-44, with these figures quadrupling among the oldest age group. With NCDs presenting prior to older age, living with complications longer and developing poor health status earlier can be inevitable. Moreover, ""multimorbidity"", the presence of ?2 NCDs simultaneously, is common for older adults; nevertheless, its prevalence among middle-aged and pre-old is less widely known. This analysis seeks to elucidate the status of multimorbidity of adults aged ?40 to understand its trends across the age spectrum and their patterns of healthcare utilisation. Methods: Secondary data analysis on all adults aged ?40 from the 2019 National Health and Morbidity Survey Healthcare Demand (NHMS HCD) module was conducted. Adults aged ?40 years (n=6691) were included to depict the age spectrum of middle-age (40-49), pre-old (50-59) and older adults (young-old for 60-69, middle-old for 70-79, old-old for age ?80). Multimorbidity comprised 3 conditions: diabetes, hypertension and hyperlipidemia. Healthcare services comprised outpatient, inpatient, community pharmacy and domiciliary care. Analysis was conducted using STATA 14 and sampling weight applied.
Results: Prevalence of NCDs multimorbidity increased with age; prevalence of 9.7% (95%CI 8.04-11.76) among middle-aged adults doubled among pre-old adults (23.9%, 95%CI 21.30-26.68), and was at least four-fold in older adults (36.4%, 95%CI 33.05-39.93; 47.2%, 95%CI 41.33-53.19; 40.9%, 95%CI 32.51-49.95; for young-old, middle-old and old-old adults, respectively). When assessed by degree of multimorbidity (3 co-existing NCDs), prevalence was highest in the middle-old group (21.5%, 95%CI 15.92-27.10). In terms of healthcare utilisation, the most frequent users of inpatient, outpatient and domiciliary care were young-old adults (37.1%, 95%CI 27.67-47.73; 30.6%, 95%CI 23.94-38.25; 37.6%, 95%CI 18.28-61.78; respectively). Community pharmacy utilisation was highest by the pre-old (37.3%, 95%CI 27.24-48.49), whereas for domiciliary care, middle-aged adults comprised more than a quarter of the adults who utilised the services (27.5%, 95%CI 9.3-58.37). Use of services were lowest by the old-old adults for inpatient, outpatient and community pharmacy (3.2%, 95%CI 1.32-7.39; 5.3%, 95%CI 2.73-9.87; 1.6%, 95%CI 0.56-4.44; respectively). A consistent pattern of utilising the public sector for inpatient and outpatient services was noted for multimorbid adults across all age groups.
Discussion: The findings denote that NCDs multimorbidity does not only afflict older adults, hence suggesting that clients utilising healthcare services have multiple health issues where care provided for a multimorbid middle-aged or pre-old adult may be as complex as that for older adults. As reported by other studies, utilisation of healthcare services is often by older adults, however this study also found that middle-age and pre-old adults also comprise a substantial proportion. Healthcare utilisation was lower in the old-old, raising questions of possible access issues. In this analysis, conditions only included NCDs, whereas older adults are likely to have other conditions which cause morbidity. Finding that multimorbid adults across the age spectrum have a preponderance for the public sector also has implications on the readiness and responsiveness of the health system.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: ORAL PRESENTATION; Organisation: Centre for Health Equity Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia},
keywords = {healthcare utilisation, multimorbidity, Older adults},
pubstate = {published},
tppubtype = {proceedings}
}