Abstract

BACKGROUND : With ageing populations and increasing exposure to risk factors of chronic diseases, the prevalence of chronic disease multimorbidity is rising globally. There is little evidence on the determinants of multimorbidity and its impact on healthcare utilisation and out-of-pocket spending using nationally representative data from multiple middle income and European countries. METHODS : Secondary analyses of cross-sectional data from adult participants in the WHO Study on Global Ageing and Adult Health (SAGE), and Survey of Health, Ageing and Retirement in Europe (SHARE). We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Associations between the number of chronic diseases and healthcare utilisation as well as out-of-pocket spending were assessed using logistic, negative binominal and log-linear models. RESULTS : Among the participants who were aged over 50, more than 30% in the SAGE , and over 50% in the SHARE , had reported multimorbidity. The number of chronic conditions was associated with greater health care utilisation in both primary and secondary care settings. Multimorbidity was associated with higher out-of-pocket expenditures per outpatient visit in India and China. Medication costs constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88∙3% for outpatient, 55∙9% for inpatient visit in China) in most SAGE countries analysed. CONCLUSION : Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in both developed and developing countries. Our study supports the WHO call for universal health insurance and health service coverage, particularly for vulnerable groups such as the elderly who are more likely to have multimorbidity.