Socio-demographic correlates of multimorbidity in SAGE countries.

<p>Notes</p><p>1. Multimorbidity defined as two or more chronic conditions in the same individual</p><p>2. Additional covariates included in the model in China: provinces; Ghana: ethnic groups (Akan, Ga-Adangbe, and others); India: states; South Africa: provinces, ethnic groups (back, white, coloured, and others).</p><p>3. Country dummy variables were included in the model to adjust for heterogeneity among countries in the pooled analysis.</p><p>Socio-demographic correlates of multimorbidity in SAGE countries.</p

Percentage of out-of-pocket spending for each type of outpatient service in persons with multimorbidity (Fig 5a); Percentage of out-of-pocket spending for each type of inpatient service in persons with multimorbidity (Fig 5b).

<p>Estimates presented here are based on respondent’s healthcare visit that was not free of charge.</p

Association between number of NCDs and out-of-pocket spending.

<p><b>Notes:</b> Figures in the last column are regression coefficients and 95% CI for the variable “number of NCD” from regression models adjusting for all covariates. Log-linear models is used to estimate both outpatient and inpatient out-of-pocket spending outcomes.</p><p>Association between number of NCDs and out-of-pocket spending.</p

Association between number of NCDs and healthcare utilisation.

<p>Association between number of NCDs and healthcare utilisation.</p

Proportion of respondents reporting that their last outpatient visit was free of charge (Fig 4a); Proportion of respondents reporting that their last inpatient visit was free of charge (Fig 4b).

<p>Data source World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) survey, wave 1.</p

Prevalence of multimorbidity by age groups in SAGE countries.

<p>Prevalence of multimorbidity by age groups in SAGE countries.</p

Association between number of NCDs and healthcare utilisation- any outpatient utilisation (Fig 2a); Association between number of NCDs and healthcare utilisation- number of outpatient visits (Fig 2b).

<p>Figures in the last column are coefficients and 95% CI for the variable “number of NCD” from regression models adjusting for all covariates. Logistic model is used to estimate any visit for outpatient/inpatient service, and negative binomial model is used for number of visit/ hospitalisation days outcome.</p

Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England's National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups. METHODS: Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively. RESULTS: Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs - namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p < 0.001) and mean proportion of 40-49 and 50-59 year olds was 9.98% and 3.58% higher (p < 0.0001 and p < 0.01 respectively) than the general population across 38 LAs. CONCLUSIONS: Community-based outreach providers effectively reach under-served groups by delivering preventive CVD services to younger, more deprived populations, and a representative proportion of ethnic minority groups. If the programme is successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities therein