Urban-rural differences in the impacts of multiple chronic disease on functional limitations and work productivity among Chinese adults

ABSTRACT

Background

Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden.

Objectives

This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships.

Method

This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work.

Results

68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656–2.236), IADL limitation (1.522, 1.326–1.748), limited work due to health problems (1.868, 1.601–2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390–2.020; for employed non-agricultural work, 2.418, 1.245–4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group.

Conclusions

Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society.

KEYWORDS:

• Multimorbidity
• functional limitations
• work productivity
• china

Responsible Editor

Jennifer Stewart Williams

Responsible Editor

Jennifer Stewart Williams

Acknowledgments

We gratefully acknowledge the China Health and Retirement Longitudinal Study team for providing data and training in using the datasets. We are grateful to the students who participated in the survey for their cooperation. The authors thank all volunteers and staff involved in this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

The Biomedical Ethics Review Committee of Peking University approved the CHARLS study, and informed consent was obtained from all interviewees prior to data collection. The ethical approval number was IRB00001052–11,015.

Paper context

Previous research has evaluated the direct economic burden of multimorbidity on health care utilization and cost. This nationally representative population-based study provides new evidence on the greater burden of functional disability and growing productivity loss due to multimorbidity in China, which is higher in rural residents than urban residents. Healthcare systems need to shift from single-disease models to new financing and service delivery models to more effectively manage multimorbidity and also address rural-urban disparities.

Supplementary material

Supplemental data for this article can be accessed here.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Li He

YZ and XL contributed to study design and data interpretation. YZ wrote the first draft of the paper. LH, CH, BO, GS, TH and XL contributed to manuscript editing. All authors reviewed and had final approval of the submitted and published versions.