Socioeconomic differentials in multimorbidity prevalence, health and social care expenditure among persons 65 years and older in region Stockholm, Sweden: a population-based study
Megan Doheny, Bo Burström, Janne Agerholm, Ann LiljasObjectives
This study aims to assess socioeconomic differentials in the prevalence of multimorbidity among adults ≥65 years, health and social care expenditure and its effect on total care expenditure.
Design
Population-based cross-sectional register study.
Setting
Region Stockholm, Sweden.
Participants
Persons ≥65 years (N=371 583), in Region Stockholm in 2019.
Primary outcome
Total health and social care expenditure per individual in 2019.
Secondary outcome
Prevalence and sociodemographic patterns of multimorbidity, differences in care expenditure across socioeconomic groups and the composition of services used.
Results
Multimorbidity prevalence was 62.6% among adults aged ≥65 years (N=371 583), increasing with age and occurring earlier in lower income groups. Average total care expenditure increased from 34 346 Swedish Kronor (SEK) among individuals with no chronic conditions and 55 606 SEK among those with one condition to 143 063 SEK among those with ≥4 chronic conditions. Social care expenditure exceeded healthcare expenditure from age 80 years onwards. In adjusted gamma regression models, multimorbidity was associated with 11.6% higher total care expenditure (cost ratio (CR) 1.116, CI 1.114 to 1.118). Compared with the highest income group, expenditure was also higher among those in the lowest (CR: 1.038, CI 1.036 to 1.040) and second-lowest income groups (CR: 1.011, CI 1.009 to 1.013).
Conclusions
Multimorbidity is increasingly prevalent in older ages and is associated with higher health and social care expenditure. This poses a challenge to organising and financing healthcare, and critically, social care services, in the future. More resources should be allocated to health promotion and prevention to delay onset, targeting lower socioeconomic groups. Alternative approaches to organising care that balance quality, equity and cost-effectiveness should be explored.