Social inequalities in multimorbidity patterns in southern Spain: findings from the DEMMOCAD survey

Abstract Background Multimorbidity (MM) is associated with lower quality of life, greater disability, and higher use of health services. It is a complex problem that is difficult to capture due to the broad spectrum of concurrent chronic diseases involved. There is a need to identify and characterize patterns of chronic conditions in the local context of specific population groups. The DEMMOCAD project aims to respond to this knowledge gap by detecting patterns of MM and their inequalities in the province of Cadiz (Spain). Methods A cross-sectional study was carried out by means of telephone interviews with people over 50 years of age. The final sample was 1592 individuals with MM. A latent class analysis was carried out to identify patterns of MM from 31 chronic conditions. First, the appropriate number of classes was established, considering model fit indices, class size, and clinical interpretability. Subsequently, covariates were introduced into the model using the three-step approach, a technique that minimizes biases in the multinomial regression model. Results Preliminary analyses of the goodness-of-fit indices of the model derived five MM patterns (entropy = 0.727): (C1) mild MM; (C2) cardiovascular; (C3) musculoskeletal; (C4) musculoskeletal plus mental; and (C5) complex MM. Compared with class C1, persons in class C5 were significantly older and less educated, class C4 had a lower income, class C3 was smokers and disabled, and class C2 was characteristic among older males. All four classes also showed lower scores on mental and physical dimensions of the SF12 scale compared to class C1. Conclusions In addition to providing an adjusted characterization of the population of the area analyzed, these initial findings highlight the existence of social inequalities in multimorbidity at the local level that should be addressed by implementing policies targeting the most vulnerable groups in Cadiz (low socioeconomic status groups, people with disabilities, and the elderly). Key messages Five patterns of multimorbidity were identified in the province of Cadiz (Spain). Tailored policies are needed to reduce social inequalities in multimorbidity among vulnerable groups in this local area.


Background:
Multimorbidity (MM) is associated with lower quality of life, greater disability, and higher use of health services. It is a complex problem that is difficult to capture due to the broad spectrum of concurrent chronic diseases involved. There is a need to identify and characterize patterns of chronic conditions in the local context of specific population groups. The DEMMOCAD project aims to respond to this knowledge gap by detecting patterns of MM and their inequalities in the province of Cadiz (Spain).

Methods:
A cross-sectional study was carried out by means of telephone interviews with people over 50 years of age. The final sample was 1592 individuals with MM. A latent class analysis was carried out to identify patterns of MM from 31 chronic conditions. First, the appropriate number of classes was established, considering model fit indices, class size, and clinical interpretability. Subsequently, covariates were introduced into the model using the three-step approach, a technique that minimizes biases in the multinomial regression model.

Results:
Preliminary analyses of the goodness-of-fit indices of the model derived five MM patterns (entropy = 0.727): (C1) mild MM; (C2) cardiovascular; (C3) musculoskeletal; (C4) musculoskeletal plus mental; and (C5) complex MM. Compared with class C1, persons in class C5 were significantly older and less educated, class C4 had a lower income, class C3 was smokers and disabled, and class C2 was characteristic among older males. All four classes also showed lower scores on mental and physical dimensions of the SF12 scale compared to class C1.

Conclusions:
In addition to providing an adjusted characterization of the population of the area analyzed, these initial findings highlight the existence of social inequalities in multimorbidity at the local level that should be addressed by implementing policies targeting the most vulnerable groups in Cadiz (low socioeconomic status groups, people with disabilities, and the elderly).

Key messages:
Five patterns of multimorbidity were identified in the province of Cadiz (Spain). Tailored policies are needed to reduce social inequalities in multimorbidity among vulnerable groups in this local area.

Background:
People with migration history (PMH) are underrepresented within health monitoring at Robert Koch Institute (RKI). To better describe the health status of PHM, the RKI is currently conducting the health interview survey GEDA Fokus with different migrant groups. Aim of this contribution is to present which sub-groups in this sequential mixed-mode survey design are reached by which mode.

Methods:
People aged 18-70 years with Croatian (hr), Italian (it), Polish (pl), Syrian (sy) or Turkish (tr) nationality were drawn out of 99 residents' registration offices all over Germany (N = 33,436). Study persons were invited sequentially to participate online (saq-web), paper-based(saq-paper) and in person (CAPI) or by telephone (CATI) in Arabic, Croatian, German, Italian, Polish or Turkish. Saq-web was available in German only or bilingual. Data collection took place from November 2021 to April 2022. Per nationality, 1,200 participants were recruited.

Conclusions:
Preliminary results show that offering multiple modes of administration helps to reach different sub-groups. Personal contact contributes to reach those not directly taking part on their own initiative. The opportunity to utilize the bilingual version of the questionnaire was well accepted, especially among those with presumably shorter duration of residence in Germany.

Key messages:
Offering different modes of survey administration, including personal contact increases survey participation. In order to reach people with migration history in their heterogeneity the utilization of multilingual questionnaires is crucial.
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