title: Socioeconomic Determinants of Multimorbidity: A Population-Based Household Survey of Hong Kong Chinese.
abstract: BACKGROUND
  Multimorbidity has been well researched in terms of consequences and healthcare implications. Nevertheless, its risk factors and determinants, especially in the Asian context, remain understudied. We tested the hypothesis of a negative relationship between socioeconomic status and multimorbidity, with contextually different patterns from those observed in the West.
  
  
  METHODS
  We conducted our study in the general Hong Kong (HK) population. Data on current health conditions, health behaviours, socio-demographic and socioeconomic characteristics was obtained from HK Government's Thematic Household Survey. 25,780 individuals aged 15 or above were sampled. Binary logistic and negative binomial regression analyses were conducted to identify risk factors for presence of multimorbidity and number of chronic conditions, respectively. Sub-analysis of possible mediation effect through financial burden borne by private housing residents on multimorbidity was also conducted.
  
  
  RESULTS
  Unadjusted and adjusted models showed that being female, being 25 years or above, having an education level of primary schooling or below, having less than HK$15,000 monthly household income, being jobless or retired, and being past daily smoker were significant risk factors for the presence of multimorbidity and increased number of chronic diseases. Living in private housing was significantly associated with higher chance of multimorbidity and increased number of chronic diseases only after adjustments.
  
  
  CONCLUSIONS
  Less advantaged people tend to have higher risks of multimorbidity and utilize healthcare from the public sector with poorer primary healthcare experience. Moreover, middle-class people who are not eligible for government subsidized public housing may be of higher risk of multimorbidity due to psychosocial stress from paying for the severely unaffordable private housing.
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Roger Y
authors.initials: RY
authors.lastname: Chung
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Stewart
authors.initials: S
authors.lastname: Mercer
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Francisco T T
authors.initials: FT
authors.lastname: Lai
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Benjamin H K
authors.initials: BH
authors.lastname: Yip
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Samuel Y S
authors.initials: SY
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology*; D015897:Comorbidity; D003695:Delivery of Health Care; D005191:Family Characteristics; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011153:Population; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000191:economics; D055815:Young Adult