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

Figures & data

Table 1. Characteristics of participants by number of chronic diseases

Characteristic	Total sample		Zero disease			One disease			Multimorbidity
	N	%	%	95% CI		%	95% CI		%	95% CI
Total	11,167	100.0	7.8	7.2	8.4	23.5	22.4	24.5	68.8	67.6	69.9
Age (year)
45–54	3,358	30.1	8.8	7.8	10.0	29.2	27.0	31.6	62.0	59.6	64.3
55–64	4,134	37.0	8.7	7.7	9.8	22.2	20.7	23.8	69.1	67.3	70.8
65–74	2,788	25.0	5.9	5.1	6.9	19.7	18.1	21.5	74.4	72.5	76.2
75 and above	8,96	8.0	5.5	3.9	7.6	19.2	16.3	22.4	75.3	71.8	78.6
Gender
Male	5,285	47.3	7.4	6.6	8.2	24.3	22.7	26.0	68.3	66.6	70.0
Female	5,891	52.7	8.1	7.3	9.0	22.7	21.4	24.0	69.2	67.7	70.6
Marital status
Married and partnered	9,753	87.3	8.0	7.4	8.6	23.7	22.6	24.8	68.3	67.1	69.5
Unmarried and other	1,423	12.7	6.4	5.1	8.1	22.0	19.6	24.5	71.6	68.8	74.2
Education status
Illiterate	4,828	43.2	7.3	6.5	8.2	23.0	21.6	24.4	69.8	68.3	71.2
Primary school	2,911	26.1	5.8	4.9	6.9	20.0	18.3	21.8	74.2	72.2	76.0
Secondary school	2,293	20.5	10.1	8.7	11.6	26.7	24.2	29.3	63.3	60.5	65.9
College & above	1,144	10.2	9.6	7.9	11.6	26.8	23.1	30.9	63.6	59.5	67.6
Residence place
Urban	4,103	36.7	6.8	5.9	7.8	22.6	20.8	24.5	70.6	68.5	72.6
Rural	7,073	63.3	8.5	7.9	9.2	24.1	23.1	25.2	67.3	66.1	68.5
Region
East	4,163	37.3	8.8	7.8	9.9	25.1	23.2	27.1	66.1	63.9	68.1
Central	4,278	38.3	7.4	6.6	8.4	21.7	20.3	23.2	70.8	69.3	72.4
West	2,735	24.5	6.5	5.6	7.6	23.4	21.6	25.2	70.1	68.2	72.0
PCE, quartile
Q1, the lowest	2,803	25.1	9.0	7.8	10.3	22.5	20.8	24.3	68.5	66.5	70.5
Q2	2,785	24.9	8.0	6.9	9.3	26.0	23.9	28.3	66.0	63.6	68.2
Q3	2,794	25.0	7.1	6.2	8.2	22.2	20.4	24.2	70.7	68.6	72.7
Q4 (the highest)	2,794	25.0	7.2	6.1	8.5	23.1	21.0	25.4	69.7	67.2	72.0
Social health insurance
No	1,664	14.9	4.5	3.4	5.8	18.2	15.8	20.8	77.4	74.6	79.9
Yes	9,512	85.1	8.4	7.8	9.0	24.4	23.3	25.5	67.2	66.0	68.4

The values are unweighted counts and weighted percentages unless otherwise indicated.

Table 2. Functional limitations and productivity loss by number of chronic diseases and residence

Variables	Total			Rural			Urban
	Mean	95% CI		Mean	95% CI		Mean	95% CI
Limitation of ADL, %
Overall	19.2	18.3	20.2	22.6	21.5	23.6	14.9	13.3	16.5
Zero	7.5	5.7	9.3	8.3	6.1	10.6	6.1	3.1	9.1
One	12.6	11.2	14.0	15.8	13.9	17.7	8.1	6.1	10.0
Multimorbidity	22.8	21.6	24.1	26.8	25.5	28.2	17.9	15.8	20.1
Limitation of IADL, %
Overall	21.9	20.9	22.8	26.6	25.5	27.7	15.8	14.2	17.4
Zero	14.3	11.9	16.7	18.5	15.3	21.7	7.6	4.4	10.8
One	16.5	15.0	18.1	20.7	18.5	22.8	10.9	8.8	12.9
Multimorbidity	24.6	23.3	25.8	29.8	28.4	31.2	18.2	16.0	20.3
Limited work due to health problems, %
Overall	14.1	13.3	14.8	17.4	16.4	18.3	9.8	8.8	10.8
Zero	6.0	4.1	7.9	7.7	4.9	10.5	3.4	1.4	5.3
One	9.7	8.5	10.9	12.3	10.6	14.0	6.1	4.5	7.6
Multimorbidity	16.5	15.5	17.4	20.4	19.2	21.7	11.6	10.3	12.9
Early retirement, %
Overall	17.3	14.3	20.3	18.3	13.7	23.0	17.1	13.7	20.5
Zero	14.2	6.2	22.2	6.2	−5.7	18.1	15.2	6.3	24.1
One	17.5	12.2	22.8	16.5	6.8	26.1	17.7	11.7	23.6
Multimorbidity	17.4	13.7	21.2	19.6	14.1	25.2	17.1	12.7	21.4
Sick leave at agricultural work, days
Overall	17.0	15.7	18.2	18.4	16.9	19.9	11.6	9.5	13.7
Zero	10.2	6.1	14.2	11.2	6.4	16.0	5.1	1.1	9.1
One	11.4	9.6	13.2	12.0	9.9	14.1	9.1	5.8	12.3
Multimorbidity	20.2	18.5	21.8	22.0	20.0	24.0	13.3	10.4	16.1
Sick leave at employed non-agricultural work, days
Overall	2.5	1.8	3.3	2.6	1.5	3.8	2.4	1.5	3.4
Zero	1.7	−0.5	3.9	1.5	−0.8	3.8	1.9	−1.5	5.3
One	2.0	0.6	3.5	2.5	−0.3	5.4	1.6	0.6	2.5
Multimorbidity	2.8	1.9	3.8	2.9	1.6	4.2	2.8	1.6	4.1

The employed non-agricultural work includes self-employed non-agricultural work.

Figure 1. The percentage of functional difficulties and productivity loss among Chinese adults in 2015, by number of chronic diseases

Table 3. Association of functional limitations with multimorbidity and socio-demographic factors

Variables	Limitation of ADL				Limitation of IADL
	OR	P value	95% CI		OR	P value	95% CI
No. of chronic disease (single)
Multimorbidity	1.924	<0.001	1.656	2.236	1.522	<0.001	1.326	1.748
Age (45–54)
55–64	1.633	<0.001	1.306	2.042	1.775	<0.001	1.430	2.202
65–74	2.314	<0.001	1.917	2.793	2.563	<0.001	2.170	3.027
75 and above	3.234	<0.001	2.402	4.354	4.436	<0.001	3.362	5.854
Gender (male)
Female	1.445	<0.001	1.262	1.654	1.908	<0.001	1.685	2.160
Marital status (married)
Unmarried and other	1.140	0.157	0.951	1.367	1.056	0.505	0.899	1.241
Level of education (illiterate)
Primary school	0.764	0.003	0.638	0.914	0.519	<0.001	0.437	0.615
Secondary school	0.674	<0.001	0.569	0.799	0.451	<0.001	0.373	0.545
College & above	0.465	<0.001	0.348	0.620	0.242	<0.001	0.177	0.332
Residence place (urban)
Rural	1.496	<0.001	1.268	1.765	1.520	<0.001	1.291	1.788
Region (east)
Central	1.700	<0.001	1.430	2.020	1.539	<0.001	1.306	1.814
West	1.334	0.005	1.093	1.628	1.560	<0.001	1.277	1.906
PCE, quartile (Q1, the lowest)
Q2	1.025	0.796	0.849	1.237	0.895	0.204	0.755	1.062
Q3	0.910	0.338	0.750	1.104	0.798	0.015	0.666	0.957
Q4 (the highest)	0.851	0.064	0.717	1.010	0.768	0.002	0.651	0.906
Social health insurance (no)
Yes	1.238	0.026	1.025	1.494	1.166	0.086	0.978	1.390

Logistic regression models were used to examine the association of functional limitations with chronic conditions. The odds ratios estimated by adjusting for study variables, including age, gender, marital status, level of education, residence place, region, household economic level and health insurance status. ADL, activities of daily living; IADL, instrumental activities of daily living; OR, odds ratio; CI, confidence interval; PCE, per capita household consumption expenditure.

Table 4. Association of work productivity loss with multimorbidity and socio-demographic factors

Variables	Limited work due to health problems (n = 10,261)				Early retirement (n = 1,289)
	OR	P value	95% CI		OR	P value	95% CI
No. of chronic disease (single)
Multimorbidity	1.868	<0.001	1.601	2.178	1.090	0.681	0.721	1.648
Age (45–54)
55–64	1.062	0.462	0.905	1.245	0.551	0.052	0.301	1.006
65–74	1.012	0.898	0.843	1.214	0.636	0.277	0.281	1.439
75 and above	0.809	0.162	0.601	1.089	0.264	0.001	0.118	0.592
Gender (male)
Female	1.082	0.204	0.958	1.223	0.858	0.576	0.500	1.471
Marital status (married)
Unmarried and other	1.167	0.130	0.956	1.424	1.125	0.710	0.604	2.094
Level of education (illiterate)
Primary school	1.024	0.768	0.874	1.200	1.187	0.585	0.641	2.197
Secondary school	0.813	0.019	0.683	0.966	2.071	0.035	1.054	4.068
College & above	0.585	<0.001	0.443	0.774	1.927	0.024	1.091	3.403
Residence place (urban)
Rural	1.715	<0.001	1.457	2.018	1.110	0.643	0.712	1.731
Region (east)
Central	1.287	0.003	1.091	1.519	1.239	0.262	0.851	1.805
West	1.134	0.194	0.938	1.372	1.926	0.022	1.100	3.372
PCE, quartile (Q1, the lowest)
Q2	1.012	0.892	0.856	1.195	1.121	0.737	0.574	2.188
Q3	0.838	0.056	0.698	1.005	0.631	0.175	0.324	1.229
Q4 (the highest)	0.683	<0.001	0.564	0.827	1.169	0.631	0.618	2.210
Social health insurance (no)
Yes	1.296	0.010	1.065	1.576	1.134	0.677	0.626	2.057

Logistic regression models were used to assess the association of limited work due to health problems and early retirement with chronic conditions. The odds ratios estimated by adjusting for study variables, including age, gender, marital status, level of education, residence place, region, household economic level and health insurance status. OR, odds ratio; CI, confidence interval; PCE, per capita household consumption expenditure.

Table 5. Association of days of sick leave with multimorbidity and socio-demographic factors

Variables	Sick leave at agricultural work (n = 4,965)				Sick leave at employed non-agricultural work (n = 1,006)
	IRR	P value	95% CI		IRR	P value	95% CI
No. of chronic disease (single)
Multimorbidity	1.676	<0.001	1.390	2.020	2.418	0.009	1.245	4.696
Age (45–54)
55–64	1.111	0.277	0.919	1.343	0.671	0.201	0.364	1.238
65–74	1.331	0.010	1.072	1.654	-	-	-	-
−75 and above	1.259	0.231	0.863	1.835	-	-	-	-
Gender (male)
Female	1.272	0.004	1.080	1.498	0.740	0.297	0.419	1.306
Marital status (married)
Unmarried and other	1.041	0.782	0.784	1.382	2.442	0.181	0.658	9.056
Level of education (illiterate)
Primary school	0.998	0.985	0.809	1.232	2.185	0.073	0.930	5.131
Secondary school	0.702	0.002	0.562	0.876	2.366	0.007	1.262	4.437
College & above	0.830	0.389	0.542	1.270	1.422	0.387	0.640	3.160
Residence place (urban)
Rural	1.610	<0.001	1.301	1.993	1.011	0.969	0.589	1.736
Region (east)
Central	1.135	0.237	0.920	1.399	0.923	0.801	0.496	1.719
West	1.326	0.008	1.076	1.633	0.746	0.403	0.376	1.483
PCE, quartile (Q1, the lowest)
Q2	0.895	0.276	0.734	1.093	1.073	0.901	0.350	3.291
Q3	1.179	0.093	0.973	1.429	0.677	0.433	0.254	1.801
Q4 (the highest)	1.125	0.267	0.913	1.385	1.444	0.390	0.623	3.345
Social health insurance (no)
Yes	1.146	0.337	0.867	1.515	1.778	0.115	0.869	3.640

Negative binomial regression models were used to assess the association between days of sick leave at agricultural work and at employed non-agricultural work with chronic conditions. The incidence rate ratio estimated by adjusting for study variables, including age, gender, marital status, level of education, residence place, region, household economic level and health insurance status. IRR, incidence rate ratio; CI, confidence interval; PCE, per capita household consumption expenditure.

Figure 2. Association of multimorbidity with functional limitations and productivity loss by residence place