A new cross-national study comparing multi-morbidity disease cluster patterns, prevalence, and health risk factors in Ireland, England, the United States, and Canada reveals significant findings that could have health policy implications. The study looks at the lifetime prevalence of ten common chronic, cardiovascular, and mental health conditions in 62,111 older adults aged 52-85 years old from four countries, and it reveals how differences in demographics, socioeconomic status, and health behaviors affect the combination of diseases within and across four countries.
TILDA: the Irish Longitudinal Study on Ageing’s study provides new insights to help health officials better understand the complex nature of multi-morbidity (the co-occurrence of two or more chronic diseases), as well as identify and improve appropriate prevention and management strategies for treating these diseases across countries. All four countries were ranked in the top 14 of the 2018 UN Human Development Index, allowing for appropriate comparison across the range of North American and European public healthcare delivery systems.
The study looks at the lifetime prevalence of ten common chronic, cardiovascular, and mental health conditions in 62,111 older adults aged 52-85 years old from four countries, and it reveals how differences in demographics, socioeconomic status, and health behaviors affect the combination of diseases within and across four countries. The findings are encouraging for Ireland, which had the lowest prevalence of six out of ten diseases when compared to the other countries.
A new cross-national study comparing multi-morbidity disease cluster patterns, prevalence, and health risk factors across Ireland, England, The United States, and Canada, reveals important findings that could have health implications for public health policy.
Multi-morbidity refers to conditions that affect people who have two or more long-term or chronic diseases and are linked to poor health outcomes such as physical and functional decline, mortality, decreased quality of life, and increased healthcare use and cost.
WHAT DID THE STUDY SHOW?
According to the study, multimorbidity was highest in the United States, at 60.7 percent, and lowest in Ireland, at 38.6 percent. The study identified five predominant multimorbidity patterns for each country, with researchers discovering socioeconomic disparities across all four countries, with those with higher levels of education and income in general having better health. Elevated BMI has also been identified as a risk factor for high disease burden and multimorbidity across all countries.
KEY FINDINGS
- The prevalence of hypertension, stroke, angina, heart attacks, arthritis, cancer, lung disease, and psychiatric illnesses was significantly higher in the United States.
- Despite the fact that the United States spends more per capita on health care than Ireland, Canada, and England, it has the highest prevalence for 9 of 10 common chronic, cardiovascular, and mental health conditions when compared to Ireland.
- When compared to the other countries, Ireland had the lowest prevalence for six out of ten diseases.
- Even after adjusting for age, gender, BMI, income, employment status, education, alcohol consumption, and smoking history, the United States had a higher prevalence of multi-morbidity.
- Even after controlling for age, gender, education, income, employment status, BMI, smoking, and alcohol consumption, the odds of having diabetes in the United States were twice that of Ireland or England.
- The link between health and wealth was present in all four countries, but it was most pronounced in the United States, where higher income and education levels were associated with lower disease prevalence and a lower probability of multimorbidity clusters.
Because the world’s population is rapidly aging and expanding, identifying early disease treatment and management is a top priority for healthcare policymakers and providers. While patients with multi-morbidity frequently have complex medical needs, this can pose challenges to global health system capacity, necessitating significant healthcare resources to meet cost and provide care. It is critical to develop sustainable and safe models of care by preventing and improving how multi-morbidity and age-related diseases are managed and treated.
Dr Belinda Hernandez, senior research fellow at TILDA, and lead author said:
“Chronic diseases are the leading cause of death in the world. These conditions rarely occur alone and are more commonly found together, a condition known as multi-morbidity. This is a critical issue for our health-care system and public health policy in aging societies because multi-morbid people have more complex health-care needs and poorer health outcomes, such as reduced physical functioning and higher mortality rates. The study’s findings can be used to better understand the complex nature of multi-morbidity and to identify appropriate prevention and management strategies for treating the unique patterns of noncommunicable disease in these countries.”
Professor Rose Anne Kenny, Principal Investigator of TILDA and co- author said:
“The study’s findings clearly outline the health concerns that affect our aging population and are especially relevant for those tasked with strengthening healthcare delivery in Ireland and elsewhere.” A better understanding of the complex nature of multi-morbidity and disease can be gained by having an informed understanding of disease patterns in a given country.”
Furthermore, research indicates that preventing the development of chronic diseases may be beneficial in delaying or preventing the development of dementia-related disease or cognitive impairment. We already know that Ireland has the second highest obesity rate in the EU, and dementia rates are expected to more than double in the next 25 years, reaching over 150,000 by 2045. This study clearly demonstrates why targeted health interventions and campaigns are required to encourage healthier habits and behaviors in order to help prevent or delay the development of disease, while also supporting better health and longevity for those who are aging.
