Intersectional analysis of social determinants of health and their association with mortality in patients with multimorbidity

Background We aimed to analyse the association between social determinants of health (SDH) and mortality in patients with multimorbidity from an intersectional point of view. Methods We conducted a retrospective observational study in the EpiChron cohort (Aragon, Spain), including all patients with two or more chronic conditions in 2015, who were followed up until 2020, to analyse all-cause mortality. Logistic regressions models were performed to analyse the likelihood of mortality across 24 intersectional strata defined by gender, migration status/length of stay, residence area and socioeconomic class. The area under the receiver operator characteristics curve was estimated to evaluate the discriminatory accuracy of mortality. Results Nearly one in 10 people with multimorbidity died during the study period. The likelihood of mortality was higher in men, in people with lower annual gross income, and in those living in rural areas. The intersectional analysis showed that low-income migrant men with more than 15 years in Spain and living in rural settings had a 4.2 times higher risk of death than that observed in middle-high income, non-migrant, urban women (reference group). Women had a lower risk of mortality than men regardless of annual gross income, migration status and residence area. Migrants’ mortality risk varied depending on socioeconomic situation. All models had a large discriminatory accuracy, which increased across the intersectional analysis. Conclusions There is a clear association between SDH and mortality in patients with multimorbidity. The intersectional approach used in this study revealed some interactions among these determinants, illustrating the social disadvantage that underlies the need to implement policies to promote equitable health promotion

Polypharmacy in older adults – prevalence, risk factors, and associations with mortality – and the role of diabetes

Polypharmacy is common in ageing populations, but its impact on older adults’ health and the role of diabetes are uncertain. This PhD aimed to better understand the prevalence and risk factors of polypharmacy and its associations with mortality, and to explore the role of diabetes in those relationships. Using data from the English Longitudinal Study of Ageing (2004–05 to 2012–13), this work comprised four studies. The first investigated the prevalence and risk factors of undiagnosed diabetes. The prevalence of diagnosed (7.7% and 11.5%) and undiagnosed (2.4% and 3.4%) diabetes increased between 2004 and 2012. However, men aged 50–74 reported a stable prevalence of undiagnosed diabetes and improved awareness. The second examined the prevalence and risk factors of polypharmacy according to diabetes status (diagnosed and undiagnosed). Older adults with diabetes had a higher prevalence of polypharmacy (41.1% versus 14.8%) and heightened polypharmacy (5.8% versus 1.7%) compared with those without diabetes, even excluding antihyperglycemic drugs. People with diabetes who were men and obese were more likely to show polypharmacy and heightened polypharmacy. The third investigated associations between different levels of polypharmacy and all-cause and cause-specific mortality over six years. Polypharmacy and heightened polypharmacy showed dose-response relationships with all-cause (hazard ratio (HR) 1.51, 2.29) and cardiovascular disease (CVD) (subdistribution hazard ratio (SHR) 2.45, 3.67) mortality. Diabetes was a confounder in this relationship and independently related to all-cause mortality. The fourth explored associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. Older adults with polypharmacy who took mental health drugs, opioids and muscle relaxants were at higher risk of all-cause (HR 1.55) and CVD (SHR 2.11) mortality. These findings highlight the importance of greater awareness of polypharmacy among older adults in England, especially those on specific high-risk medications, and special care for older people with diabete

Sex differences in social support perceived by polymedicated older adults with multimorbidity. MULTIPAP study.

The beneficial effects of social support on morbidity, mortality, and quality of life are well known. Using the baseline data of the MULTIPAP study (n = 593), an observational, descriptive, cross-sectional study was carried out that analyzed the sex differences in the social support perceived by polymedicated adults aged 65 to 74 years with multimorbidity. The main outcome variable was social support measured through the Duke-UNC-11 Functional Social Support (DUFSS) questionnaire in its two dimensions (confident support and affective support). For both sexes, the perception of functional social support was correlated with being married or partnered and having a higher health-related quality of life utility index. In women, it was correlated with a higher level of education, living alone, and treatment adherence, and in men with higher monthly income, prescribed drugs and fewer diagnosed diseases