Multimorbidity Patterns and the Disablement Process among Public Long-Term Care Insurance Claimants in the City of Yiwu (Zhejiang Province, China)

Multimorbidity patterns and influencing factors in older Chinese adults: a national population-based cross-sectional survey

Background

This study aims to develop specific multimorbidity relationships among the elderly and to explore the association of multidimensional factors with these relationships, thereby facilitating the formulation of personalised strategies for multimorbidity management.

Methods

Cluster analysis identified chronic conditions that tend to cluster together, and then association rule mining was used to investigate relationships within these identified clusters more closely. Stepwise logistic regression analysis was conducted to explore the relationship between influencing factors and different health statuses in older adults. The results of this study were presented by network graph visualisation.

Results

A total of 15 045 individuals were included in this study. The average age was 73.0 ± 6.8 years. The number of patients with multimorbidity was 7426 (49.4%). The most common binary disease combination was hypertension and depression. The four major multimorbidity clusters identified were the tumour-digestive disease cluster, the metabolic-circulatory disease cluster, the metal-psychological disease cluster, and the age-related degenerative disease cluster. Cluster analysis by sex and region revealed similar numbers and types of conditions in each cluster, with some variations. Gender and number of medications had a consistent effect across all disease clusters, while aging, body mass index (BMI), waist-to-hip ratio (WHR), cognitive impairment, plant-based foods, animal-based foods, highly processed foods and marital status had varying effects across different disease clusters.

Conclusions

Multimorbidity is highly prevalent in the older population. The impact of lifestyle varies between different clusters of multimorbidity, and there is a need to implement different strategies according to different clusters of multimorbidity rather than an integrated approach to multimorbidity management.

Multimorbidity patterns and function among adults in low- and middle-income countries: a scoping review

OBJECTIVES

To map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in low- and middle-income countries (LMICs), and describe methods used.

DESIGN

Scoping review guided by a five-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.

DATA SOURCES

PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL) and Cochrane databases were searched from January 1976 to March 2023, plus reference lists of included studies.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Peer-reviewed full-text articles or conference proceedings of any design, published in English or Afrikaans, involving adults (>18 years) with multimorbidity living in LMICs. Studies had to refer to associations between multimorbid patterns of co-occurrence and functioning. Multimorbidity was defined as the coexistence of ≥2 diseases, including any combination of non-communicable, infectious and mental health conditions.

DATA EXTRACTION AND SYNTHESIS

Data were extracted independently by two reviewers using a piloted form. Findings were synthesised according to methodological approaches, multimorbidity-pattern epidemiology, evidence gaps/limitations and recommendations for future research. The International Classification of Functioning, Disability and Health framework was used to classify functional problems.

RESULTS

Nine studies (total sample size: 62 003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination and functioning outcome measures. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. Mobility limitations, instrumental activities of daily living, self-care and bowel/bladder problems were consistently linked to all pattern domains.

CONCLUSIONS

The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures and incorporate diverse samples to inform tailored interventions and policies.

Patterns of Comorbidity, Disability, and Home Health Care Service for Older Adults With Physical Disability: A Latent Class Analysis and Visualized Illustration

Understanding the relationships between comorbidity, disability, and home health-care services aids in user-centered care design. This study identifies patterns of these factors among older adults with physical disability living at home and explores their associations. This cross-sectional study included community-dwelling older adults assessed for Long-term Care Insurance from September 1 to December 31, 2018, in Yiwu, Zhejiang, China. We analyzed deidentified data on sociodemographics, physical disability, chronic conditions, and care plans for 1882 participants using latent class analysis and multinomial logistic regression. Five comorbidity patterns (other sporadic diseases, cancer comorbidity, other sporadic comorbidities, coronary atherosclerotic heart disease, and fracture) and four home health-care service patterns (assistance & facilitation of elimination, bedridden assistance & stoma care, bedside assistance & stoma care, and assistance & tube feeding) were identified. Four disability patterns emerged (bedridden without incontinence, bedridden & with upper limb mobility, off-bed & ADLs limited, and bedridden with incontinence). Complex associations between these patterns were observed. The study highlights the heterogeneity and complexity of the above patterns, emphasizing the importance of person-centered home health-care services and technology-supported care strategies.

Life expectancy, long-term care demand and dynamic financing mechanism simulation: an empirical study of Zhejiang Pilot, China

BACKGROUND

China has piloted Long-Term Care Insurance (LTCI) to address increasing care demand. However, many cities neglected adjusting LTCI premiums since the pilot, risking the long-term sustainability of LTCI. Therefore, using Zhejiang Province as a case, this study simulated mortality-adjusted long-term care demand and the balance of LTCI funds through dynamic financing mechanism under diverse life expectancy and disability scenarios.

METHODS

Three-parameter log-quadratic model was used to estimate the mortality from 1990 to 2020. Mortality with predicted interval from 2020 to 2080 was projected by Lee-Carter method extended with rotation. Cohort-component projection model was used to simulate the number of older population with different degrees of disability. Disability data of the older people is sourced from China Health and Retirement Longitudinal Study 2018. The balance of LTCI fund was simulated by dynamic financing actuarial model.

RESULTS

Life expectancy of Zhejiang for male (female) is from 80.46 (84.66) years in 2020 to 89.39 [86.61, 91.74] (91.24 [88.90, 93.25]) years in 2080. The number of long-term care demand with severe disability in Zhejiang demonstrates an increasing trend from 285 [276, 295] thousand in 2023 to 1027 [634, 1657] thousand in 2080 under predicted mean of life expectancy. LTCI fund in Zhejiang will become accumulated surplus from 2024 to 2080 when annual premium growth rate is 5.25% [4.20%, 6.25%] under various disability scenarios, which is much higher than the annual growth of unit cost of long-term care services (2.25%). The accumulated balance of LTCI fund is sensitive with life expectancy.

CONCLUSIONS

Dynamic growth of LTCI premium is essential in dealing with current deficit around 2050 and realizing Zhejiang's LTCI sustainability in the long-run. The importance of dynamic monitoring disability and mortality information is emphasized to respond immediately to the increase of premiums. LTCI should strike a balance between expanding coverage and controlling financing scale. This study provides implications for developing countries to establish or pilot LTCI schemes.

A scoping review finds a growing trend in studies validating multimorbidity patterns and identifies five broad types of validation methods

OBJECTIVES

Multimorbidity, the presence of two or more long-term conditions, is a growing public health concern. Many studies use analytical methods to discover multimorbidity patterns from data. We aimed to review approaches used in published literature to validate these patterns.

STUDY DESIGN AND SETTING

We systematically searched PubMed and Web of Science for studies published between July 2017 and July 2023 that used analytical methods to discover multimorbidity patterns.

RESULTS

Out of 31,617 studies returned by the searches, 172 were included. Of these, 111 studies (64%) conducted validation, the number of studies with validation increased from 53.13% (17 out of 32 studies) to 71.25% (57 out of 80 studies) in 2017-2019 to 2022-2023, respectively. Five types of validation were identified: assessing the association of multimorbidity patterns with clinical outcomes (n = 79), stability across subsamples (n = 26), clinical plausibility (n = 22), stability across methods (n = 7) and exploring common determinants (n = 2). Some studies used multiple types of validation.

CONCLUSION

The number of studies conducting a validation of multimorbidity patterns is clearly increasing. The most popular validation approach is assessing the association of multimorbidity patterns with clinical outcomes. Methodological guidance on the validation of multimorbidity patterns is needed.

Typologies of dependency, household characteristics, and disparity in formal and informal care use: analysis of community-dwelling long-term care insurance claimants in an urban municipality of China

BACKGROUND

A comprehensive understanding of subgroups of community-dwelling older adults and their long-term care (LTC) utilization can help to promote equality in the long-term services and support system. Dependency and household characteristics were found to affect the LTC utilization of homebound older adults. However, few studies considered the typologies of dependency of older populations according to co-occurring limitations, and little is known about differences in LTC use among elderly of typologies of dependency under distinct household conditions.

METHODS

We aimed to identify typologies of dependency of older adults living at home and explore the disparities in formal care and informal care use among typologies of dependency by income and living situation. In this cross-sectional study, we used the public long-term care insurance (LTCI) database of Yiwu, Zhejiang Province, China, and included 1675 individuals aged ≥ 60 years living at home. Cluster analysis was conducted to determine typologies of dependency among older adults. A two-step multilevel analysis was used to examine disparities in formal and informal care use related to household income and living status among typologies of dependency.

RESULTS

Seven dependency clusters were identified. Pro-wealthy inequalities in both formal and informal care use were found in the least dependent cluster and the limited-locomotion cluster. Pro-poor inequalities in formal care use were found in the fully dependent cluster without impaired vision and the cluster with intact continence and vision. Living with family members was positively associated with receiving formal care for the fully dependent cluster. Older adults in most clusters were more likely to use informal care when living with family members, except for the least dependent cluster and the limited-locomotion cluster.

CONCLUSIONS

Our findings suggest that household inequalities in LTC use varied among typologies of dependency of older adults, which may provide insights for researchers and policymakers to develop tailored LTC and targeted LTCI programs for older adults living at home and their family caregivers, considering both typologies of dependency and household characteristics.

Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model

BACKGROUND

Older adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults.

OBJECTIVE

The purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home.

METHODS

This was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance.

RESULTS

Education and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support).

CONCLUSIONS

The present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.