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RACIAL INEQUALITIES IN MULTIMORBIDITY: BASELINE OF THE BRAZILIAN LONGITUDINAL STUDY OF ADULT HEALTH (ELSA‑BRASIL)
Doença crônica
Acúmulo de doenças
Desigualdades raciais em saúde
Determinantes sociais da saúde
Chronic disease
Disease accumulation
Racial inequalities in health
Social determinants of health
Author
Affilliation
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Educação em Ambiente e Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Universidade Federal de Minas Gerais. Departamento de Prevenção e Medicina Social. Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais. Hospital das Clínicas/EBSERH. Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais. Departamento de Prevenção e Medicina Social. Belo Horizonte, MG, Brasil.
Universidade de São Paulo. Instituto do Coração. São Paulo, SP, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Programa de Computação Científica. Programa de Computação Científica
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Educação em Ambiente e Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Universidade Federal de Minas Gerais. Departamento de Prevenção e Medicina Social. Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais. Hospital das Clínicas/EBSERH. Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais. Departamento de Prevenção e Medicina Social. Belo Horizonte, MG, Brasil.
Universidade de São Paulo. Instituto do Coração. São Paulo, SP, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Programa de Computação Científica. Programa de Computação Científica
Abstract
Background: Evidence of multimorbidity has come mainly from high-income regions, while disparities among racial
groups have been less explored. This study examined racial differences in multimorbidity in the multiracial cohort of
the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto), ELSA-Brasil.
Methods: The study examined baseline (2008–2010) data for 14 099 ELSA-Brasil participants who self-reported being
white, mixed-race, or black. A list of 16 morbidities was used to evaluate multimorbidity, operationalised by simple
count into ≥ 2, ≥ 3, ≥ 4, ≥ 5 and ≥ 6 morbidities, in addition to evaluating the number of coexisting conditions. Prevalence
ratios (PR) were estimated from logistic models and a quantile model was used to examine racial differences
graphically in the distribution quantiles for the number of morbidities.
Results: Overall prevalence of multimorbidity (≥ 2 morbidities) was 70% and, after controlling for age and sex, was
greater among mixed-race and black participants – by 6% (PR: 1.06; 95% CI: 1.03–1.08) and 9% (PR: 1.09; 95% CI:
1.06–1.12), respectively – than among white participants. As the cutoff value for defining multimorbidity was raised,
so the strength of the association increased, especially among blacks: if set at ≥ 6 morbidities, the prevalence was 27%
greater for those of mixed-race (PR: 1.27; 95% CI: 1.07–1.50) and 47% greater for blacks (PR: 1.47; 95% CI: 1.22–1.76)
than for whites. The disparities were smaller in the lower morbidity distribution quantiles and larger in the upper
quantiles, indicating a heavier burden of disease, particularly on blacks.
Conclusions: Multimorbidity was common among adults and older adults in a Brazilian cohort, but important racial
inequalities were found. Raising the cutoff point for defining multimorbidity revealed stronger associations between
race/skin colour and multimorbidity, indicating a higher prevalence of multimorbidity among mixed-race and black
individuals than among whites and that the former groups coexisted more often with more complex health situations
(with more coexisting morbidities). Interventions to prevent and manage the condition of multimorbidity that consider
the social determinants of health and historically discriminated populations in low- and middle-income regions
are necessary.
Keywords in Portuguese
MultimorbidadeDoença crônica
Acúmulo de doenças
Desigualdades raciais em saúde
Determinantes sociais da saúde
Keywords
MultimorbidityChronic disease
Disease accumulation
Racial inequalities in health
Social determinants of health
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