Association between Comorbidity Patterns and Disability for the Older Adults: Based on a Sampling Survey in Sichuan Province

Abstract

Background With the population aging, the number of patients with chronic diseases and disability is increasing, which brings a heavy burden on the medical system. While it is well established that comorbidity and disability are closely interconnected, there is a noticeable scarcity of studies addressing the relationship between different patterns of comorbidity and disability. Objective To explore the common comorbidity patterns and their associations with disability among the older adults in China taking Sichuan as an example. Methods A total of 501 older adults, aged 60 and above, were selected using quota sampling in Sichuan from August to Novermber 2022. Detailed data on chronic diseases, disability, and general demographics were collected. Comorbidity patterns among the older adults were identified using a two-step clustering method that combined self-organizing maps and K-Means. The association between patterns of comorbidity and disability was explored using a logistic regression model, employing the National Disability Assessment Scale for the Long-term Care issued by the National Healthcare Security Administration of China in 2021. Results In this survey, The prevalence of comorbidity 62.3% (312/501) and the prevalence of disability was 74.3% (372/501). We identified six comorbidity patterns: Arthritis/Rheumatism and Hypertension diseases, Cardiovascular and Metabolic diseases, Kidney and Arthritis/Rheumatism diseases, Cancer and Arthritis/Rheumatism diseases, Asthma, Hypertension, and Gastrointestinal diseases, Emotional/Mental and Memory-related diseases. The results of binomial logistic regression showed that the risk of disability was 6.3 times higher when people suffering from two or more chronic diseases at the same time (OR=6.3, 95%CI=3.9-10.3, P<0.05). The results of multinomial logistic regression showed that the risk of disability was increased in all six comorbidity patterns (P<0.05). Compared to the population without comorbidities, the comorbid group with the emotional/mental and memory-related diseases pattern has a 10.7 times risk with more severe disability (OR=10.7, 95%CI=1.7-63.6), which had the greatest impact on disability. Next is the Cancer and Arthritis/Rheumatism pattern (OR=7.8, 95%CI=2.4-24.8) . Conclusion The incidence of comorbidity among the older adults in Sichuan is high, and there is a significant association between several comorbidity patterns and disability, especially for the Emotional/Mental and Memory-related diseases pattern and Cancer and Arthritis/Rheumatism pattern. The health care system should focus on the older adults with comorbidity, formulate accurate and effective long-term care policies and strategies based on different comorbidity patterns to prevent and reduce the occurrence of disability, improve the well-being of the older adults, and save social medical resources.

Keywords

• multiple chronic conditions|comorbidity patterns|disability|aged|self-organizing map|two-step clustering method|sichuan province