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Health gap for multimorbidity: comparison of models combining uniconditional health gap

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Abstract

Purpose

The aim of this study is to identify the best-fitting model in predicting the health gap of multimorbid status based on the health gap of uniconditional status.

Methods

This study analyzed data of adults aged 50 years or older derived from the cross-sectional, nationally representative 6th Korean National Health and Nutrition Examination Survey (KNHANES). We translated the EQ-5D utility score assessed from the KNHANES using the Korean EQ-5D-3L into the health gap by subtracting the EQ-5D utility score from one. The predicted health gap of multimorbid status was calculated based on the health gap of uniconditional status using the additive, multiplicative, and maximum limit models. We assessed the performance of the multimorbidity adjustment models based on the root mean square error and mean absolute error. We also examined the impact of multimorbidity adjustment on the estimated disease burden in the best-fitting model.

Results

Of the three approaches, the multiplicative adjustment model had the smallest root mean square error between the predicted and observed health gap of multimorbid status. The total number of prevalence-based years lived with the disability after adjusting for multimorbid status using the multiplicative model decreased compared to that without adjustment for multimorbid status.

Conclusion

Using the appropriate methodology to adjust for multimorbidity in estimations of population health is becoming more important as the prevalence of multimorbidity increases, particularly in older populations. Further empirical research is required to develop additional general adjustment approaches that consider the independent co-occurrence of multiple diseases, and to understand how multimorbidity influences health gap.

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Data availability

The datasets supporting the conclusions of this article are available in the Korea Centers for Disease Control and Prevention website (https://knhanes.cdc.go.kr/knhanes/sub03/sub03_02_02.do).

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Funding

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI18C0446). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Preventive Medicine, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea

    Bomi Park, Bohyun Park & Hyesook Park

  2. National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea

    Bomi Park

  3. Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea

    Minsu Ock

  4. Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Min-Woo Jo

  5. Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea

    Hye Ah Lee

  6. Department of Statistics, Ewha Womans University, Seoul, Republic of Korea

    Eun-Kyung Lee

Authors
  1. Bomi Park
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  2. Minsu Ock
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  7. Hyesook Park
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Contributions

BP1 participated in the study design, performed the primary data analysis, interpreted the data, and drafted the manuscript. MO and MWJ interpreted the data and provided guidance on data analytic approach. HAL and BP2 made contributions to the study design as well as critically revised the manuscript. EKL helped the statistical analysis and revised the manuscript. HP conceived of the study and participated substantially in its coordination. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hyesook Park.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the Institutional Review Board of Korea University (KU-IRB-18-EX-51-A-1). The informed consent was waived.

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Park, B., Ock, M., Jo, MW. et al. Health gap for multimorbidity: comparison of models combining uniconditional health gap. Qual Life Res 29, 2475–2483 (2020). https://doi.org/10.1007/s11136-020-02514-5

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