Association between multimorbidity and informal long-term care use in China: a nationwide cohort study

BackgroundThe impact of multimorbidity on long-term care (LTC) use is understudied, despite its well-documented negative effects on functional disabilities. The current study aims to assess the association between multimorbidity and informal LTC use in China. We also explored the socioeconomic and regional disparities.MethodsThe study included 10,831 community-dwelling respondents aged 45 years and older from the China Health and Retirement Longitudinal Study in 2011, 2015, and 2018 for analysis. We used a two-part model with random effects to estimate the association between multimorbidity and informal LTC use. Heterogeneity of the association by socioeconomic position (education and income) and region was explored via a subgroup analysis. We further converted the change of informal LTC hours associated with multimorbidity into monetary value and calculated the 95% uncertainty interval (UI).ResultsThe reported prevalence of multimorbidity was 60 center dot 0% (95% CI: 58 center dot 9%, 61 center dot 2%) in 2018. We found multimorbidity was associated with an increased likelihood of receiving informal LTC (OR = 2 center dot 13; 95% CI: 1 center dot 97, 2 center dot 30) and more hours of informal LTC received (IRR = 1 center dot 20; 95% CI: 1 center dot 06, 1 center dot 37), ceteris paribus. Participants in the highest income quintile received more hours of informal LTC care (IRR = 1 center dot 62; 95% CI: 1 center dot 31, 1 center dot 99). The estimated monetary value of increased informal LTC hours among participants with multimorbidity was equivalent to 3 center dot 7% (95% UI: 2 center dot 2%, 5 center dot 4%) of China's GDP in 2018.ConclusionOur findings substantiate the threat of multimorbidity to LTC burden. It is imperative to strengthen LTC services provision, especially among older adults with multimorbidity and ensure equal access among those with lower income.