Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

Social determinants of health and emergency department visits among older adults with multimorbidity: insight from 2010 to 2018 National Health Interview Survey

Authors: Arum Lim, Chitchanok Benjasirisan, Xiaoyue Liu, Oluwabunmi Ogungbe, Cheryl Dennison Himmelfarb, Patricia Davidson, Binu Koirala

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

Multimorbidity is prevalent among older adults and is associated with adverse health outcomes, including high emergency department (ED) utilization. Social determinants of health (SDoH) are associated with many health outcomes, but the association between SDoH and ED visits among older adults with multimorbidity has received limited attention. This study aimed to examine the association between SDoH and ED visits among older adults with multimorbidity.

Methods

A cross-sectional analysis was conducted among 28,917 adults aged 50 years and older from the 2010 to 2018 National Health Interview Survey. Multimorbidity was defined as the presence of two or more self-reported diseases among 10 common chronic conditions, including diabetes, hypertension, asthma, stroke, cancer, arthritis, chronic obstructive pulmonary disease, and heart, kidney, and liver diseases. The SDoH assessed included race/ethnicity, education level, poverty income ratio, marital status, employment status, insurance status, region of residence, and having a usual place for medical care. Logistic regression models were used to examine the association between SDoH and one or more ED visits.

Results

Participants’ mean (± SD) age was 68.04 (± 10.66) years, and 56.82% were female. After adjusting for age, sex, and the number of chronic conditions in the logistic regression model, high school or less education (adjusted odds ratio [AOR]: 1.10, 95% confidence interval [CI]: 1.02–1.19), poverty income ratio below the federal poverty level (AOR: 1.44, 95% CI: 1.31–1.59), unmarried (AOR: 1.19, 95% CI: 1.11–1.28), unemployed status (AOR: 1.33, 95% CI: 1.23–1.44), and having a usual place for medical care (AOR: 1.46, 95% CI 1.18–1.80) was significantly associated with having one or more ED visits. Non-Hispanic Black individuals had higher odds (AOR: 1.28, 95% CI: 1.19–1.38), while non-Hispanic Asian individuals had lower odds (AOR: 0.71, 95% CI: 0.59–0.86) of one or more ED visits than non-Hispanic White individuals.

Conclusion

SDoH factors are associated with ED visits among older adults with multimorbidity. Systematic multidisciplinary team approaches are needed to address social disparities affecting not only multimorbidity prevalence but also health-seeking behaviors and emergent healthcare access.
Literature
1.
2.
Mortality G. Causes of death collaborators global, regional, and national life expectancy, all-cause and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the global burden of Disease Study 2015. Lancet. 2016;388:1459–544.CrossRef
3.
Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. eClinicalMedicine 2023, 57.
4.
Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Reviews Disease Primers. 2022;8(1):48.CrossRefPubMed
5.
Lee JE, Haynes E, DeSanto-Madeya S, Kim YM. Social Determinants of Health and Multimorbidity among adults 50 years and older in the United States. Nurs Res. 2024;73(2):126–37.CrossRefPubMed
6.
Ansah JP, Chiu CT. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health. 2022;10:1082183.CrossRefPubMed
7.
Koirala B, Peeler A, Dennison Himmelfarb C, Davidson PM. Living with multiple chronic conditions: how we achieve holistic care and optimize health outcomes. J Adv Nurs. 2023;79(2):e7–9.CrossRefPubMed
8.
Thanakiattiwibun C, Siriussawakul A, Virotjarumart T, Maneeon S, Tantai N, Srinonprasert V, Chaiwat O, Sriswasdi P. Multimorbidity, healthcare utilization, and quality of life for older patients undergoing surgery: a prospective study. Med (Baltim). 2023;102(13):e33389.CrossRef
9.
Koroukian SM, Warner DF, Owusu C, Given CW. Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions. Prev Chronic Dis 2015, 12.
10.
Palladino R, Tayu Lee J, Ashworth M, Triassi M, Millett C. Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries. Age Ageing. 2016;45(3):431–5.CrossRefPubMedPubMedCentral
11.
Heins M, Korevaar J, Schellevis F, Rijken M. Identifying multimorbid patients with high care needs - a study based on electronic medical record data. Eur J Gen Pract. 2020;26(1):189–95.CrossRefPubMedPubMedCentral
12.
de Souto Barreto P, Lapeyre-Mestre M, Vellas B, Rolland Y. Multimorbidity type, hospitalizations and emergency department visits among nursing home residents: a preliminary study. J Nutr Health Aging. 2014;18(7):705–9.CrossRefPubMed
13.
14.
Schiøtz ML, Stockmarr A, Høst D, Glümer C, Frølich A. Social disparities in the prevalence of multimorbidity– a register-based population study. BMC Public Health. 2017;17(1):422.CrossRefPubMedPubMedCentral
15.
Caraballo C, Herrin J, Mahajan S, Massey D, Lu Y, Ndumele CD, Drye EE, Krumholz HM. Temporal trends in racial and ethnic disparities in multimorbidity prevalence in the United States, 1999–2018. Am J Med. 2022;135(9):1083–92. e1014.CrossRefPubMed
16.
Northwood M, Ploeg J, Markle-Reid M, Sherifali D. Integrative review of the social determinants of health in older adults with multimorbidity. J Adv Nurs. 2018;74(1):45–60.CrossRefPubMed
17.
von dem Knesebeck O, Bickel H, Fuchs A, Gensichen J, Höfels S, Riedel-Heller SG, König H-H, Mergenthal K, Schön G, Wegscheider K. Social inequalities in patient-reported outcomes among older multimorbid patients–results of the MultiCare cohort study. Int J Equity Health. 2015;14:1–11.
18.
19.
Sangal RB, Su H, Khidir H, Parwani V, Liebhardt B, Pinker EJ, Meng L, Venkatesh AK, Ulrich A. Sociodemographic Disparities in Queue Jumping for Emergency Department Care. JAMA Netw Open. 2023;6(7):e2326338–2326338.CrossRefPubMedPubMedCentral
20.
National Center for Health Statistics. NHIS - Data, Questionnaires and Related Documentation. 2020.
21.
Parsons V, Moriarity C, Jonas K, Moore T, Davis K, Tompkins L. Design and Estimation for the National Health Interview Survey, 2006–2015. Vital Health Stat Ser 2 Data Evaluation Methods Res 2014(165):1–53.
22.
Hartnett KP. Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019–May 30, 2020. MMWR Morbidity and mortality weekly report 2020, 69.
23.
Caraballo C, Herrin J, Mahajan S, Massey D, Lu Y, Ndumele CD, Drye EE, Krumholz HM. Temporal trends in racial and ethnic disparities in Multimorbidity Prevalence in the United States, 1999–2018. Am J Med. 2022;135(9):1083–e10921014.CrossRefPubMed
24.
Drye EE, Altaf FK, Lipska KJ, Spatz ES, Montague JA, Bao H, Parzynski CS, Ross JS, Bernheim SM, Krumholz HM. Defining multiple chronic conditions for quality measurement. Med Care. 2018;56(2):193–201.CrossRefPubMed
25.
Huang Y-q, Gou R, Diao Y-s, Yin Q-h, Fan W-x, Liang Y-p, Chen Y, Wu M, Zang L, Li L. Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy. J Zhejiang Univ Sci B. 2014;15:58–66.CrossRefPubMedPubMedCentral
26.
Lim A, Choi M, Jang Y, Lee H. Preoperative frailty based on laboratory data and postoperative health outcomes in patients undergoing coronary artery bypass graft surgery. Heart Lung. 2022;56:1–7.CrossRefPubMed
27.
Ingram DD, Malec DJ, Makuc DM, Kruszon-Moran D, Gindi RM, Albert M, Beresovsky V, Hamilton BE, Holmes J, Schiller JS. National center for health statistics guidelines for analysis of trends. 2018.
28.
29.
Pandey KR, Yang F, Cagney KA, Smieliauskas F, Meltzer DO, Ruhnke GW. The impact of marital status on health care utilization among Medicare beneficiaries. Med (Baltim). 2019;98(12):e14871.CrossRef
30.
Kruse JA, Low LK, Seng JS. Validation of alternative indicators of social support in perinatal outcomes research using quality of the partner relationship. J Adv Nurs. 2013;69(7):1562–73.CrossRefPubMed
31.
Vlachantoni A. Unmet need for social care among older people. Ageing Soc. 2019;39(4):657–84.CrossRef
32.
Barrenetxea J, Tan KB, Tong R, Chua K, Feng Q, Koh W-P, Chen C. Emergency hospital admissions among older adults living alone in the community. BMC Health Serv Res. 2021;21(1):1192.CrossRefPubMedPubMedCentral
33.
Lloyd T, Crellin E, Brine RJ, Shen JY, Wolters AT. Association between household context and emergency hospital use in older people: a retrospective cohort study on indicators for people living alone or living with somebody with frailty, developed from routine healthcare data in England. BMJ Open. 2022;12(5):e059371.CrossRefPubMedPubMedCentral
34.
Tora Grauers W, Volkert S, Dagny Ros N, Dorte J, Ann Dorrit G, Susanne R, Rasmus K-R. Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark. BMJ Open. 2021;11(4):e041877.CrossRef
35.
Chen YH, Karimi M, Rutten-van Mölken M. The disease burden of multimorbidity and its interaction with educational level. PLoS ONE. 2020;15(12):e0243275.CrossRefPubMedPubMedCentral
36.
Bos-Touwen I, Schuurmans M, Monninkhof EM, Korpershoek Y, Spruit-Bentvelzen L, Ertugrul-van der Graaf I, de Wit N, Trappenburg J. Patient and Disease Characteristics Associated with activation for self-management in patients with diabetes, Chronic Obstructive Pulmonary Disease, Chronic Heart failure and chronic renal disease: a cross-sectional survey study. PLoS ONE. 2015;10(5):e0126400.CrossRefPubMedPubMedCentral
37.
Schmaderer MS, Zimmerman L, Hertzog M, Pozehl B, Paulman A. Correlates of patient activation and Acute Care utilization among Multimorbid patients. West J Nurs Res. 2016;38(10):1335–53.CrossRefPubMed
38.
Laba T-L, Cheng L, Kolhatkar A, Law MR. Cost-related nonadherence to medicines in people with multiple chronic conditions. Res Social Administrative Pharm. 2020;16(3):415–21.CrossRef
39.
Larkin J, Foley L, Smith SM, Harrington P, Clyne B. The experience of financial burden for people with multimorbidity: a systematic review of qualitative research. Health Expect. 2021;24(2):282–95.CrossRefPubMed
40.
James L, Louise F, Shane T, Tony H, Barbara C, Patricia H, Susan MS. How do people with Multimorbidity Prioritise Healthcare when faced with Financial constraints? A choice experiment. medRxiv 2023:2023.2004.2010.23288383.
41.
Selby S, Wang D, Murray E, Lang E. Emergency departments as the Health Safety Nets of Society: a descriptive and Multicenter Analysis of Social Worker support in the emergency room. Cureus. 2018;10(9):e3247.PubMedPubMedCentral
42.
43.
Molina M, Evans J, Montoy JC, Cawley C, Graham-Squire D, Perez K, Raven M, Kanzaria HK. Analysis of Emergency Department Encounters among High Users of Health Care and Social Service systems before and during the COVID-19 pandemic. JAMA Netw Open. 2022;5(10):e2239076–2239076.CrossRefPubMedPubMedCentral
44.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.CrossRefPubMed
45.
Melis R, Marengoni A, Angleman S, Fratiglioni L. Incidence and predictors of multimorbidity in the elderly: a population-based longitudinal study. PLoS ONE. 2014;9(7):e103120.CrossRefPubMedPubMedCentral
46.
Gassmann D, Cheetham M, Siebenhuener K, Holzer BM, Meindl-Fridez C, Hildenbrand FF, Virgini V, Martin M, Battegay E. The multimorbidity interaction severity index (MISI): a proof of concept study. Medicine 2017, 96(8).
47.
Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: a critical review of Clinimetric Properties. Psychother Psychosom. 2022;91(1):8–35.CrossRefPubMed
48.
Roffman C, Buchanan J, Allison G. Charlson comorbidities index. J Physiotherapy 2016, 62(3).
Metadata
Title
Social determinants of health and emergency department visits among older adults with multimorbidity: insight from 2010 to 2018 National Health Interview Survey
Authors
Arum Lim
Chitchanok Benjasirisan
Xiaoyue Liu
Oluwabunmi Ogungbe
Cheryl Dennison Himmelfarb
Patricia Davidson
Binu Koirala
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18613-8

Other articles of this Issue 1/2024

BMC Public Health 1/2024 Go to the issue

Publisher Correction

Correction to: Impact of COVID-19 on mental health of health care workers in Spain: a mix-methods study

Research

A cross-sectional study determining prevalence and factors associated with ST-segment elevation myocardial infarction and non-ST segment elevation myocardial infarction in Iran: results from fasa registry on acute myocardial infarction (FaRMI)

Research

Using online search activity for earlier detection of gynaecological malignancy

Research

Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study

Research

Assessing the modifiable and non-modifiable risk factors associated with multimorbidity in reproductive aged women in India

Research

Knowledge, protective behaviours, and perception of Lyme disease in an area of emerging risk: results from a cross-sectional survey of adults in Ottawa, Ontario