Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province

Qinfeng Zhao, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Jingjie Sun, Chen Jiao, Lizheng Xu and Anli Leng
Additional contact information
Qinfeng Zhao: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
Jian Wang: Dong Fureng Institute of Economics and Social Development, Wuhan University, No. 54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China
Stephen Nicholas: Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh, NSW 2015, Australia
Elizabeth Maitland: School of Management, University of Liverpool, Chatham Building, Chatham Street, Liverpool L697ZH, UK
Jingjie Sun: Shandong Health Commission Medical Management Service Center, Jinan 250012, China
Chen Jiao: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
Lizheng Xu: UNSW Medicine, UNSW Sydney, Sydney, NSW 2052, Australia
Anli Leng: School of Political Science and Public Administration, Institute of Governance, Shandong University, 72 Binhai Rd, Qingdao 266237, China

IJERPH, 2020, vol. 17, issue 24, 1-13

Abstract: (1) Background: The management of multiple chronic diseases challenges China’s health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants’ HRQOL, and χ 2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old ( P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases ( P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants ( P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants ( P < 0.001), and daily tooth-brushing for middle ( P < 0.05) and young-old participants ( P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients ( P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.

Keywords: China; multimorbidity; middle-aged and old-aged adults (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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