Implications of multimorbidity on healthcare utilisation and work productivity by socioeconomic groups: Cross-sectional analyses of Australia and Japan

• Published in: PloS one 2020-04, Vol.15 (4), p.e0232281-e0232281
• Main Authors: Sum, Grace, Ishida, Marie, Koh, Gerald Choon-Huat, Singh, Ankur, Oldenburg, Brian, Lee, John Tayu
• Format: Article
• Language: English
• Subjects: Alcohol use; Analysis; Asthma; Biology and Life Sciences; Blood pressure; Cardiovascular disease; Chronic illnesses; Communicable diseases; Comorbidity; Cross-sectional studies; Data collection; Datasets; Diabetes; Diseases; Early retirement; Education; Employment; Finance; Health care; Health care reform; Health services; Health services utilization; Households; Hypertension; Labor force; Labor market; Medical care utilization; Medicine and Health Sciences; Mental disorders; Multimorbidity; Osteoporosis; People and Places; Population; Production management; Productivity; Public health; Retirement; Retirement age; Social Sciences; Sociodemographics; Socioeconomics; Studies; Surveys; Type 2 diabetes
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232281

Multimorbidity, the presence of 2 or more non-communicable diseases (NCDs), is a major contributor to inequalities of health in Australia and Japan. We use nationally representative data to examine (i) the relationships between multimorbidity with healthcare utilisation and productivity loss and (ii) whether these relationships differed by socioeconomic groups. Cross-sectional analyses using the Household, Income, and Labour Dynamics in Australia (HILDA) and the Japanese Study of Aging and Retirement (JSTAR) surveys. We examined 6,382 (HILDA) and 3,503 (JSTAR) adults aged ≥50 years. We applied multivariable regression, logistic and negative binomial models. Prevalence of multimorbidity was overall 38.6% (46.0%, 36.1%, 28.9% amongst those in the lowest, middle and highest education group, respectively) in Australia, and 28.4% (33.9%, 24.6%, 16.6% amongst those in the lowest, middle and highest education group, respectively) in Japan. In Australia and Japan, more NCDs was associated with greater healthcare utilisation. In Australia and Japan, more NCDs was associated with higher mean number of sick leave days amongst the employed and lower odds of being employed despite being in the labour force. The association between multimorbidity and lower retirement age was found in Australia only. Having more NCDs pose significant economic burden to the health system and wider society in Australia and Japan. Targeted policies are critical to improve financial protection, especially for lower income groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment.