TY - JOUR
T1 - Neighborhood socioeconomic disadvantage is associated with multimorbidity in a geographically-defined community
AU - Chamberlain, Alanna M.
AU - Finney Rutten, Lila J.
AU - Wilson, Patrick M.
AU - Fan, Chun
AU - Boyd, Cynthia M.
AU - Jacobson, Debra J.
AU - Rocca, Walter A.
AU - St Sauver, Jennifer L.
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2020/1/6
Y1 - 2020/1/6
N2 - Background: Persons with low socioeconomic status may be disproportionately at risk for multimorbidity. Methods: Adults aged ≥20 years on 4/1/2015 from 7 counties in Minnesota were identified using the Rochester Epidemiology Project (population-based sample). A composite measure of neighborhood socioeconomic disadvantage, the area deprivation index (ADI), was estimated at the census block group level (n = 251). The prevalence of 21 chronic conditions was obtained to calculate the proportion of persons with multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥5 chronic conditions). Hierarchical logistic regression was used to estimate the association of ADI with multimorbidity and severe multimorbidity using odds ratios (OR). Results: Among 198,941 persons (46.7% male, 30.6% aged ≥60 years), the age- and sex-standardized (to the United States 2010 census) median prevalence (Q1, Q3) was 23.4% (21.3%, 25.9%) for multimorbidity and 4.8% (4.0%, 5.7%) for severe multimorbidity. Compared with persons in the lowest quintile of ADI, persons in the highest quintile had a 50% increased risk of multimorbidity (OR 1.50, 95% CI 1.39-1.62) and a 67% increased risk of severe multimorbidity (OR 1.67, 95% CI 1.51-1.86) after adjusting for age, sex, race, and ethnicity. Associations were stronger after further adjustment for individual level of education; persons in the highest quintile had a 78% increased risk of multimorbidity (OR 1.78, 95% CI 1.62-1.96) and a 92% increased risk of severe multimorbidity (OR 1.92, 95% CI 1.72-2.13). There was evidence of interactions between ADI and age, between ADI and sex, and between ADI and education. After age 70 years, no difference in the risk of multimorbidity was observed across quintiles of ADI. The pattern of increasing multimorbidity with increasing ADI was more pronounced in women. Finally, there was less variability across quintiles of ADI for the most highly educated group. Conclusions: Higher ADI was associated with increased risk of multimorbidity, and the associations were strengthened after adjustment for individual level of education, suggesting that neighborhood context plays a role in health above and beyond individual measures of socioeconomic status. Furthermore, associations were more pronounced in younger persons and women, highlighting the importance of interventions to prevent chronic conditions in younger women, in particular.
AB - Background: Persons with low socioeconomic status may be disproportionately at risk for multimorbidity. Methods: Adults aged ≥20 years on 4/1/2015 from 7 counties in Minnesota were identified using the Rochester Epidemiology Project (population-based sample). A composite measure of neighborhood socioeconomic disadvantage, the area deprivation index (ADI), was estimated at the census block group level (n = 251). The prevalence of 21 chronic conditions was obtained to calculate the proportion of persons with multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥5 chronic conditions). Hierarchical logistic regression was used to estimate the association of ADI with multimorbidity and severe multimorbidity using odds ratios (OR). Results: Among 198,941 persons (46.7% male, 30.6% aged ≥60 years), the age- and sex-standardized (to the United States 2010 census) median prevalence (Q1, Q3) was 23.4% (21.3%, 25.9%) for multimorbidity and 4.8% (4.0%, 5.7%) for severe multimorbidity. Compared with persons in the lowest quintile of ADI, persons in the highest quintile had a 50% increased risk of multimorbidity (OR 1.50, 95% CI 1.39-1.62) and a 67% increased risk of severe multimorbidity (OR 1.67, 95% CI 1.51-1.86) after adjusting for age, sex, race, and ethnicity. Associations were stronger after further adjustment for individual level of education; persons in the highest quintile had a 78% increased risk of multimorbidity (OR 1.78, 95% CI 1.62-1.96) and a 92% increased risk of severe multimorbidity (OR 1.92, 95% CI 1.72-2.13). There was evidence of interactions between ADI and age, between ADI and sex, and between ADI and education. After age 70 years, no difference in the risk of multimorbidity was observed across quintiles of ADI. The pattern of increasing multimorbidity with increasing ADI was more pronounced in women. Finally, there was less variability across quintiles of ADI for the most highly educated group. Conclusions: Higher ADI was associated with increased risk of multimorbidity, and the associations were strengthened after adjustment for individual level of education, suggesting that neighborhood context plays a role in health above and beyond individual measures of socioeconomic status. Furthermore, associations were more pronounced in younger persons and women, highlighting the importance of interventions to prevent chronic conditions in younger women, in particular.
KW - Area deprivation index
KW - Geocoding
KW - Multimorbidity
KW - Socioeconomic status
KW - US Census
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U2 - 10.1186/s12889-019-8123-0
DO - 10.1186/s12889-019-8123-0
M3 - Article
C2 - 31906992
AN - SCOPUS:85077527997
SN - 1471-2458
VL - 20
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 13
ER -