title: Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China.
abstract: BACKGROUND
  China, like other countries, is facing a growing burden of chronic disease but the prevalence of multimorbidity and implications for the healthcare system have been little researched. We examined the epidemiology of multimorbidity in southern China in a large representative sample. The effects of multimorbidity and other factors on usual source of healthcare were also examined.
  
  
  METHODS
  We conducted a large cross-sectional survey among approximately 5% (N = 162,464) of the resident population in three prefectures in Guangdong province, southern China in 2011. A multistage, stratified random sampling was adopted. The study population had many similar characteristics to the national census population. Interviewer-administered questionnaires were used to collect self-report data on demographics, socio-economics, lifestyles, healthcare use, and health characteristics from paper-based medical reports.
  
  
  RESULTS
  More than one in ten of the total study population (11.1%, 95% confidence interval (CI) 10.6 to 11.6) had two or more chronic conditions from a selection of 40 morbidities. The prevalence of multimorbidity increased with age (adjusted odds ratio (aOR) = 1.36, 95% CI 1.35 to 1.38 per five years). Female gender (aOR = 1.70, 95% CI 1.64 to 1.76), low education (aOR = 1.26, 95% CI 1.23 to 1.29), lack of medical insurance (aOR = 1.79, 95% CI 1.71 to 1.89), and unhealthy lifestyle behaviours were independent predictors of multimorbidity. Multimorbidity was associated with the regular use of secondary outpatient care in preference to primary care.
  
  
  CONCLUSIONS
  Multimorbidity is now common in China. The reported preferential use of secondary care over primary care by patients with multimorbidity has many major implications. There is an urgent need to further develop a strong and equitable primary care system.
authors.forename: Harry H X
authors.initials: HH
authors.lastname: Wang
authors.forename: Jia Ji
authors.initials: JJ
authors.lastname: Wang
authors.forename: Samuel Y S
authors.initials: SY
authors.lastname: Wong
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.forename: Fang Jian
authors.initials: FJ
authors.lastname: Li
authors.forename: Pei Xi
authors.initials: PX
authors.lastname: Wang
authors.forename: Zhi Heng
authors.initials: ZH
authors.lastname: Zhou
authors.forename: Chun Yan
authors.initials: CY
authors.lastname: Zhu
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003625:Data Collection; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data