title: Social inequalities in patient-reported outcomes among older multimorbid patients--results of the MultiCare cohort study.
abstract: BACKGROUND
  In this article three research questions are addressed: (1) Is there an association between socioeconomic status (SES) and patient-reported outcomes in a cohort of multimorbid patients? (2) Does the association vary according to SES indicator used (income, education, occupational position)? (3) Can the association between SES and patient-reported outcomes (self-rated health, health-related quality of life and functional status) be (partly) explained by burden of disease?
  
  
  METHODS
  Analyses are based on the MultiCare Cohort Study, a German multicentre, prospective, observational cohort study of multimorbid patients from general practice. We analysed baseline data and data from the first follow-up after 15 months (N = 2,729). To assess burden of disease we used the patients' morbidity data from standardized general practitioner (GP) interviews based on a list of 46 groups of chronic conditions including the GP's severity rating of each chronic condition ranging from marginal to very severe.
  
  
  RESULTS
  In the cross-sectional analyses SES was significantly associated with the patient-reported outcomes at baseline. Associations with income were more consistent and stronger than with education and occupational position. Associations were partly explained (17% to 44%) by burden of disease. In the longitudinal analyses only income (but not education and occupational position) was significantly related to the patient-reported outcomes at follow-up. Associations between income and the outcomes were reduced by 18% to 27% after adjustment for burden of disease.
  
  
  CONCLUSIONS
  Results indicate social inequalities in self-rated health, functional status and health related quality of life among older multimorbid patients. As associations with education and occupational position were inconsistent, these inequalities were mainly due to income. Inequalities were partly explained by burden of disease. However, even among patients with a similar disease burden, those with a low income were worse off in terms of the three patient-reported outcomes under study.
authors.affiliation: Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. o.knesebeck@uke.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: von dem Knesebeck
authors.affiliation: Department of Psychiatry, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. h.bickel@lrz.tu-muenchen.de.
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.affiliation: Institute of General Practice, University of Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany. Angela.Fuchs@med.uni-duesseldorf.de.
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: Institute of General Practice, University Hospital Jena, Bachstraße 18, 07743, Jena, Germany. jochen.gensichen@med.uni-jena.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Gensichen
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany. w.maier@uni-bonn.de.
authors.forename: Susanne
authors.initials: S
authors.lastname: Höfels
authors.affiliation: Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany. ries@medizin.uni-leipzig.de.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.affiliation: Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. h.koenig@uke.de.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.affiliation: Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. Mergenthal@allgemeinmedizin.uni-frankfurt.de.
authors.forename: Karola
authors.initials: K
authors.lastname: Mergenthal
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. G.Schoen@uke.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. k.wegscheider@uke.uni-hamburg.de.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J 5, 68159, Mannheim, Germany. Siegfried.Weyerer@zi-mannheim.de.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.affiliation: Institute for General Practice, WG Medical Statistics and IT-Infrastructure, Hannover Medical School, 30623, Hannover, Germany. Wiese.Birgitt@MH-Hannover.de.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. m.scherer@uke.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. bussche@uke.uni-hamburg.de.
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. in.schaefer@uke.de.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000191:economics* / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires