000125897 001__ 125897
000125897 005__ 20240720100848.0
000125897 0247_ $$2doi$$a10.7189/13.04014
000125897 0248_ $$2sideral$$a133017
000125897 037__ $$aART-2023-133017
000125897 041__ $$aeng
000125897 100__ $$aMoreno Juste, Aida
000125897 245__ $$aMultimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort
000125897 260__ $$c2023
000125897 5060_ $$aAccess copy available to the general public$$fUnrestricted
000125897 5203_ $$aBackground: Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnicity, residence area and socioeconomic class). Methods: We conducted a cross-sectional observational study of all individuals who presented with at least one chronic disease in 2019 (n = 1 086 948) from the EpiChron Cohort (Aragon, Spain). Applying intersectional analysis, the age-adjusted likelihood of multimorbidity was investigated across 36 intersectional strata defined by gender, ethnicity, residence area and socioeconomic class. We calculated odds ratios (OR) 95% confidence interval (CI) using high-income urban non-migrant men as the reference category. The area under the receiver operator characteristics curve (AUC) was calculated to evaluate the discriminatory accuracy of multimorbidity. Results: The prevalence of multimorbidity increased with age, female gender and low income. Young and middle-aged low-income individuals showed rates of multimorbidity equivalent to those of high-income people aged about 20 years older. The intersectional analysis showed that low-income migrant women living in urban areas for >15 years were particularly disadvantaged in terms of multimorbidity risk OR = 3.16 (95% CI = 2.79-3.57). Being a migrant was a protective factor for multimorbidity, and newly arrived migrants had lower multimorbidity rates than those with >15 years of stay in Aragon, and even non-migrants. Living in rural vs. urban areas was slightly protective against multimorbidity. All models had a large discriminatory accuracy (AUC = 0.7884-0.7895); the largest AUC was obtained for the model including all intersectional strata. Conclusions: Our intersectional approach uncovered the large differences in the prevalence of multimorbidity that arise due to the synergies between the different socioeconomic and demographic exposures, beyond their expected additive effects.
000125897 536__ $$9info:eu-repo/grantAgreement/ES/DGA-FEDER/B01-20R$$9info:eu-repo/grantAgreement/ES/ISCIII-RICAPPS/RD21-0016-0019
000125897 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000125897 590__ $$a4.5$$b2023
000125897 592__ $$a1.093$$b2023
000125897 591__ $$aPUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH$$b43 / 403 = 0.107$$c2023$$dQ1$$eT1
000125897 593__ $$aPublic Health, Environmental and Occupational Health$$c2023$$dQ1
000125897 591__ $$aPUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH$$b43 / 403 = 0.107$$c2023$$dQ1$$eT1
000125897 593__ $$aHealth Policy$$c2023$$dQ1
000125897 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000125897 700__ $$0(orcid)0000-0002-5440-1710$$aGimeno Miguel, Antonio
000125897 700__ $$0(orcid)0000-0002-5119-5093$$aPoblador Plou, Beatriz
000125897 700__ $$0(orcid)0000-0001-9064-9222$$aCalderón Larrañaga, Amaia
000125897 700__ $$aCano del Pozo, Mabel
000125897 700__ $$aForjaz, Maria João
000125897 700__ $$0(orcid)0000-0002-5704-6056$$aPrados Torres, Alexandra
000125897 700__ $$0(orcid)0000-0003-2928-6623$$aGimeno Feliú, Luis A.$$uUniversidad de Zaragoza
000125897 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000125897 773__ $$g13 (2023), 04014 [10 pp.]$$pJournal of global health.$$tJournal of Global Health$$x2047-2978
000125897 8564_ $$s1095870$$uhttps://zaguan.unizar.es/record/125897/files/texto_completo.pdf$$yVersión publicada
000125897 8564_ $$s2750996$$uhttps://zaguan.unizar.es/record/125897/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000125897 909CO $$ooai:zaguan.unizar.es:125897$$particulos$$pdriver
000125897 951__ $$a2024-07-19-18:48:28
000125897 980__ $$aARTICLE