Prevalence of Multimorbidity Associated With Sleep Quality, Socioeconomic Status

A study published in Frontiers in Public Health found that the prevalence of multimorbidity in older adults was linked with sleep quality and socioeconomic status. A higher risk of multimorbidity was found in older adults with lower socioeconomic status and poorer sleep quality.

The study took place in Shanxi Province in China from June to August 2019. A multistage random sampling method was used to find participants for the study. All 11 prefecture-level cities in the province were included in the sampling units in the first stage, which was reduced to 2 districts in the second stage, 2 administrative villages in the third stage, and 1 or 2 residential communities in the fourth stage.

Permanent residents of Shanxi Province who were 60 years or older, had no serious cognitive impairment, had no communication impairment, and voluntarily participated in the survey were included in the study.

Questionnaires were distributed to participants, all of which were anonymous. The Pittsburgh Sleep Quality Index was used to measure sleep quality. Socioeconomic status was determined by assessing education level, occupation before retirement, and personal monthly income. There 26 chronic diseases that were included in the questionnaire for older adults to self-report their diagnoses, if applicable. Multimorbidity was defined as the coexistence of 2 or more chronic conditions in an individual.

There were 3250 adults who completed the survey and were included in the study. There were 1515 (46.62%) male participants, and 54.43% of participants were aged 60 to 70 years. A total of 30.31% of participants suffered from multimorbidity and 48.83% had poor sleep quality.

There were significant differences in gender, age, marital status, empty nest status, family history of diseases, smoking status, and sleep quality across the chronic diseases that were reported in the survey. Female participants, those 80 years and older, the unmarried, obese participants, and those with an empty nest, a family history of diseases, low physical activity, a past of drinking, a past of smoking, and poor sleep quality had a higher prevalence of multimorbidity compared with their counterparts.

There were significant differences in education level, occupation before retirement, personal monthly income, and socioeconomic status in the types of chronic diseases, with the prevalence of multimorbidity higher in older adults who had no formal education, were peasants before retirement, had low personal monthly income, and were of low socioeconomic status.

A multiple logistic regression model was used to assess the association of sleep quality and socioeconomic status with multimorbidity. The adjusted odds ratios of multimorbidity in those with high socioeconomic status, low socioeconomic status, and very low socioeconomic status were 0.920 (95% CI, 0.713-1.188), 1.195 (95% CI, 0.943-1.515), and 1.440 (95% CI, 1.083-1.913) compared with participants with very high socioeconomic status. Poor sleep quality had an adjusted odds ratio of multimorbidity of 2.445 (95% CI, 2.043-2.927) compared with good sleep quality.

Older adults with low socioeconomic status and poor sleep quality had the highest risk of prevalence of multimorbidity (odds ratio, 3.139; 95% CI, 2.288-4.307) when compared with participants with very high socioeconomic status and good sleep quality.

There were some limitations to this study. The cross-sectional design prevents evaluation of a causal relationship between sleep quality, socioeconomic status, and multimorbidity. The results may be unique due to all participants coming from 1 province of China and being 60 years and older. A clinical diagnosis of poor sleep quality was not needed for this study, which may have influenced the results.

The researchers concluded that the risk of multimorbidity increased when socioeconomic status and sleep quality decreased in older adults. Sleep quality could be effective in promoting better health for most older adults, they wrote.

Reference

Xue B, Xue Y, Dong F, et al. The impact of socioeconomic status and sleep quality on the prevalence of multimorbidity in older adults. Front Public Health. Published online September 26, 2022. doi:10.3389/fpubh.2022.959700