Elsevier

Public Health

Volume 139, October 2016, Pages 103-111
Public Health

Original Research
Association between body mass index and prevalence of multimorbidity: a cross-sectional study

https://doi.org/10.1016/j.puhe.2016.05.014Get rights and content

Highlights

  • We explored the prevalence of multimorbidity according to gender and BMI categories.

  • We examined the association between BMI and multimorbidity.

  • The prevalence of multimorbidity was significantly higher in women than in men.

  • Positive association was found between obesity and multimorbidity, and with overweight.

  • ORs for the prevalence of multimorbidity were the highest in obesity category III.

Abstract

Objectives

To explore the prevalence of multimorbidity in Serbia according to sex and body mass index (BMI) categories, and to examine the association between BMI and multimorbidity. In addition, this study examined the relationships between the main demographic and socio-economic characteristics of the population (age, settlement, education) and multimorbidity.

Study design

Secondary analysis of data from the 2013 Serbian National Health Survey.

Methods

This study analyzed data from 13,103 participants aged ≥20 years with BMI data. The associations between BMI, age, education and multimorbidity were analyzed by multivariate logistic regression.

Results

The overall prevalence of multimorbidity was higher than the overall prevalence of a single disease (26.9% vs 20.7%). The proportion of participants who reported two or more chronic diseases increased with each BMI category in both sexes, reaching the highest values in obese category III. Odds ratios (ORs) for the prevalence in all morbidity groups increased gradually with BMI category, and the highest OR values were found in obese category III. Males of obese category III were seven times more likely to have multimorbidity [OR 7.2, 95% confidence interval (CI) 4.2–12.6] than males of normal weight, whereas females of obese category III were nine and a half times more likely to have multimorbidity (OR 9.5, 95% CI 4.0–22.4) than females of normal weight. In the multivariable analysis, age (both sexes), low and middle level of education (males), and rural settlement and low level of education (females) were found to be predictors of multimorbidity.

Conclusions

This study found positive associations between obesity and multimorbidity and between overweight and multimorbidity. Recognizing these associations is of great importance from both clinical and public health perspectives because this could lead to an integrated approach for patients.

Introduction

Patients with chronic diseases, especially the elderly, often face multimorbidity, defined as the simultaneous presence of two or more chronic diseases.1, 2, 3 It is well documented that multiple chronic diseases are associated with impaired quality of life, risk of functional limitations,4 difficulties in treatment delivery,4 and increased need for healthcare services.5 A recent review from Scotland revealed that there were more people with multimorbidity than with a single chronic disease,6 indicating that multimorbidity is becoming the norm rather than the exception.6, 7 This is supported by findings which indicate that the prevalence of multimorbidity worldwide has risen substantially in recent decades.5 International estimates suggest that this trend will continue to rise in the coming years.8 The proportion of adults with a body mass index (BMI) ≥25 kg/m2 has also been increasing globally over the last three decades, affecting 36.9% of men and 38.0% of women in a study conducted in 2013.9 It has been determined that increased BMI is a major risk factor for a range of chronic diseases, including cardiovascular diseases, diabetes, musculoskeletal disorders and some cancers.10, 11 The determinants of multimorbidity continue to be studied. Factors that have been found to be associated with increased risk of multimorbidity include age, female sex, lower socio-economic status, lower education, unemployment and smoking.1, 4 The role of obesity as a risk factor for multimorbidity has been evaluated recently by various studies.12, 13, 14, 15

Serbia, like many other countries, is suffering from increasing prevalence of certain chronic diseases, in addition to increasing rates of obesity.16, 17 Several studies have contributed significantly to a better understanding of the overall disease burden and the subsection of this disease burden that is attributable to avoidable risk factors in Serbia.18, 19 However, information on the association between BMI and multimorbidity is still lacking.

Therefore, this study aimed to explore the prevalence of multimorbidity in Serbia according to sex and BMI categories, and to examine the association between BMI and multimorbidity. In addition, this study examined the relationships between the main demographic and socio-economic characteristics of the population (age, settlement, education) and multimorbidity.

Section snippets

Study design and participants

This study is a secondary data analysis of the 2013 National Health Survey (NHS 2013) undertaken by the Ministry of Health of Serbia and the Institute of Public Health of Serbia. People living in collective households and/or institutions, and residents of Kosovo and Metohija (under the United Nations Mission) were not included in the survey.

In order to provide statistically reliable estimates for this survey at national level, a two-staged representative sample of the Serbian population was

Results

The baseline characteristics of the study population are listed in Table 1. There were slightly more women (52.5%) than men (47.5%) in the study. Compared with men, women were significantly older, less educated, urban dwellers and were more frequently of normal weight, with lower mean BMI. However, women had a higher mean number of chronic diseases and more frequently suffered from two or more diseases compared with men. The overall prevalence of multimorbidity was higher than the overall

Discussion

Multimorbidity was present in almost three out of 10 respondents, and was more common than a single chronic disease in both sexes. The prevalence of multimorbidity increased substantially with BMI. Age was independently associated with multimorbidity in both sexes, and low and middle educational level was independently associated with multimorbidity in females.

Numerous studies regarding the prevalence of multimorbidity have been conducted in Europe, the Middle East, Australia, the USA and

Acknowledgements

The authors acknowledge the Ministry of Health of the Republic of Serbia, because the study is part of NHS 2013 for the population of Serbia conducted by the Ministry of Health of the Republic of Serbia and Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut.’ Data were obtained from NHS 2013 with agreement of the Institute of Public Health of Serbia and Ministry of Health of the Republic of Serbia.

Ethical approval

Ethical approval was received from the Review Board of the Ministry of Health of

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