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Lookup NU author(s): Professor Matthew Prina
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
ckground Unmet health needs have the potential to capture health inequality. Nevertheless, the course of healthcare needs fulfilment, and the role of multimorbidity in this process remains unclear. This study assessed the bidirectional transitions between met and unmet health needs and the transition to death and examined the effect of multimorbidity on transitions. Methods This study was based on the China Health and Retirement Longitudinal Study, a nationally representative survey in 2011-2015 among 18 075 participants aged 45 and above (average age 61.1; SD 9.9). We applied a multistate survival model to estimate the probabilities and the instantaneous risk of state transitions, and Gompertz hazard models were fitted to estimate the total, marginal and state-specific life expectancies (LEs). Results Living with physical multimorbidity (HR=1.85, 95% CI 1.58 to 2.15) or physical-mental multimorbidity (HR=1.45, 95% CI 1.15 to 1.82) was associated with an increased risk of transitioning into unmet healthcare needs compared with no multimorbidity. Conversely, multimorbidity groups had a decreased risk of transitioning out of unmet needs. Multimorbidity was also associated with shortened total life expectancy (TLEs), and the proportion of marginal LE for having unmet needs was more than two times higher than no multimorbidity. Conclusion Multimorbidity aggravates the risk of transitioning into having unmet healthcare needs in the middle and later life, leading to a notable reduction in TLEs, with longer times spent with unmet needs. Policy inputs on developing integrated person-centred services and specifically scaling up to target the complex health needs of ageing populations need to be in place.
Author(s): Gao Q, Graciela Muniz T, Mayston R, Prina M
Publication type: Article
Publication status: Published
Journal: Journal of Epidemiology & Community Health
Year: 2024
Volume: 78
Issue: 4
Pages: 212-219
Print publication date: 08/03/2024
Online publication date: 11/01/2024
Acceptance date: 23/12/2023
Date deposited: 21/08/2024
ISSN (print): 0143-005X
ISSN (electronic): 1470-2738
Publisher: BMJ Group
URL: https://doi.org/10.1136/jech-2023-220570
DOI: 10.1136/jech-2023-220570
Data Access Statement: Data are available upon reasonable request. The CHARLS data were obtained available through the CHARLS website (http://charls.pku.edu.cn/en).
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