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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Social inequalities in patient-reported outcomes among older multimorbid patients – results of the MultiCare cohort study

Authors: Olaf von dem Knesebeck, Horst Bickel, Angela Fuchs, Jochen Gensichen, Susanne Höfels, Steffi G Riedel-Heller, Hans-Helmut König, Karola Mergenthal, Gerhard Schön, Karl Wegscheider, Siegfried Weyerer, Birgitt Wiese, Martin Scherer, Hendrik van den Bussche, Ingmar Schäfer

Published in: International Journal for Equity in Health | Issue 1/2015

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Abstract

Introduction

In this article three research questions are addressed: (1) Is there an association between socioeconomic status (SES) and patient-reported outcomes in a cohort of multimorbid patients? (2) Does the association vary according to SES indicator used (income, education, occupational position)? (3) Can the association between SES and patient-reported outcomes (self-rated health, health-related quality of life and functional status) be (partly) explained by burden of disease?

Methods

Analyses are based on the MultiCare Cohort Study, a German multicentre, prospective, observational cohort study of multimorbid patients from general practice. We analysed baseline data and data from the first follow-up after 15 months (N = 2,729). To assess burden of disease we used the patients’ morbidity data from standardized general practitioner (GP) interviews based on a list of 46 groups of chronic conditions including the GP’s severity rating of each chronic condition ranging from marginal to very severe.

Results

In the cross-sectional analyses SES was significantly associated with the patient-reported outcomes at baseline. Associations with income were more consistent and stronger than with education and occupational position. Associations were partly explained (17% to 44%) by burden of disease. In the longitudinal analyses only income (but not education and occupational position) was significantly related to the patient-reported outcomes at follow-up. Associations between income and the outcomes were reduced by 18% to 27% after adjustment for burden of disease.

Conclusions

Results indicate social inequalities in self-rated health, functional status and health related quality of life among older multimorbid patients. As associations with education and occupational position were inconsistent, these inequalities were mainly due to income. Inequalities were partly explained by burden of disease. However, even among patients with a similar disease burden, those with a low income were worse off in terms of the three patient-reported outcomes under study.
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Metadata
Title
Social inequalities in patient-reported outcomes among older multimorbid patients – results of the MultiCare cohort study
Authors
Olaf von dem Knesebeck
Horst Bickel
Angela Fuchs
Jochen Gensichen
Susanne Höfels
Steffi G Riedel-Heller
Hans-Helmut König
Karola Mergenthal
Gerhard Schön
Karl Wegscheider
Siegfried Weyerer
Birgitt Wiese
Martin Scherer
Hendrik van den Bussche
Ingmar Schäfer
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0142-6

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