Thomas Hone|Jonathan Stokes|Anete Trajman|Valéria Saraceni|Cláudia Medina Coeli|Davide Rasella|Betina Durovni|Christopher Millett
Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals
Imperial College London|Charing Cross Hospital|Manchester Academic Health Science Centre|University of Manchester|Universidade Federal do Rio de Janeiro|Secretaria Municipal de Saúde|Universidade Federal do Rio de Janeiro|Universidade Federal da Bahia|Instituto de Saúde|Secretaria Municipal de Saúde|Fundação Oswaldo Cruz
evidence limited racialethnic group disparities multimorbidity associated health outcomes low middleincome countries hampering effective policies clinical interventions address health inequalitiesthis study assessed raceethnic socioeconomic disparities prevalence multimorbidity associated healthcare utilisation costs death rio de janeiro brazil crosssectional analysis carried 3027335 individuals registered primary healthcare phc services records included linked data hospitalisation mortality welfareclaimant bolsa famlia records 1 jan 2012 31 dec 2016 logistic poisson regression models carried assess likelihood multimorbidity two diagnoses 53 chronic conditions phc use hospital admissions mortality cause interactions used assess disparitiesin total 13509633 healthcare visits analysed identifying 389829 multimorbid individuals 13 adjusted regression models multimorbidity associated lower education adjusted odds ratio aor 126 95ci 123129 compared higher education bolsa famlia receipt aor 114 95ci 113115 compared nonrecipients black raceethnicity aor 105 95ci 103106 compared white multimorbidity associated hospitalisations adjusted rate ratio arr 275 95ci 269281 phc visits arr 346 95ci 344347 higher likelihood death aor 133 95ci 129136 associations greater multimorbid individuals lower educational attainment five year probability death 167 95ci 161174 compared 113 95ci 102123 higher education individuals black raceethnicity 148 95ci 141155 compared 135 95ci 131140 white individuals receipt welfare 189 95ci 177200 compared 135 95ci 131138 nonrecipientsthe prevalence multimorbidity associated hospital admissions mortality greater individuals black raceethnicity deprived socioeconomic groups rio de janeiro interventions better prevent manage multimorbidity underlying disparities low middleincome country settings needed