The Prevalence of Multimorbidity Among Foreign-born Adults in the United States Open Access

Tasnim, Lubaba (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/s7526d67z?locale=en
Published

Abstract

Objective: Although foreign-born adults are a growing population in the United States (US), little is known about the prevalence of multimorbidity, the presence of two or more chronic conditions in an individual, and factors associated with multimorbidity in this population. The objective of this study was to assess the prevalence of multimorbidity involving nine selected chronic conditions among foreign-born adults in the US by socio-demographic factors such as age, sex, and place of origin. 

Methods: Data were analyzed on 8,174 adult immigrants from the New Immigrant Survey (NIS), a nationally representative study of adult immigrants with newly acquired legal permanent residence (LPR). Self-reported chronic diseases used to assess multimorbidity in this study were: hypertension, heart problems, stroke, chronic lung disease, asthma, diabetes, cancer, arthritis, and obesity. Descriptive statistics and Pearson’s chi-square tests were used to show differences in multimorbidity prevalence across sociodemographic variables. Multinomial regression models were used to evaluate the association of sociodemographic characteristics and covariates such as length of stay in the US and healthcare utilization with multimorbidity. All of the analyses were adjusted by survey-weights, to generate nationally represented estimates.

Results: The overall prevalence of multimorbidity was approximately 6.0% in this study compared to 25% in the native US population. The prevalence of multimorbidity increased with age and was highest among populations from the Latin America and Caribbean region. The most common dyad and triad of chronic conditions among both men and women were hypertension-obesity and diabetes-hypertension-obesity, respectively. The diabetes-hypertension dyad was common among men, whereas the arthritis-hypertension dyad was common among women, especially at older age group. Age, socioeconomic status, health utilization, and length of stay in the US were significant predictors of multimorbidity.

Conclusion: This study found a lower prevalence of multimorbidity among US foreign-born adults (6%) relative to the published literature (9%-38%). Multimorbidity prevalence increased with age, had different patterns in men and women, and varied by place of origin. While these levels of multimorbidity are quite low, an emphasis should be placed on monitoring foreign-born populations particularly among those categories with higher odds of multimorbidity (places of origin; age), identified in this work.

Table of Contents

I. INTRODUCTION………………………..1

Background………………………..1

Objective and Research Question………………………..2

II. LITERATURE REVIEW………………………..4

Multimorbidity Definitions and Patterns………………………..4

Prevalence of Multimorbidity………………………..6

Prevalence in the United States………………………..6

Major Findings Across Studies………………………..7

Risk Factors for Multimorbidity………………………..8

Consequences of Multimorbidity………………………..10

Migration in the United States………………………..11

The Health of the Foreign-born Population………………………..11

Prevalence of Multimorbidity Among the Foreign-born Population ………………………..13

Conceptual Framework………………………..16

Study Significance………………………..16

Factors Associated with Multimorbidity………………………..17

Chronic Disease to Multimorbidity………………………..20

Study Variable Selection Based on Conceptual Framework………………………..21

Representation of Conceptual Framework………………………..24

III. DATA AND METHODS………………………..25

Study Background………………………..25

Data Source………………………..25

Data Collection………………………..26

Variables………………………..26

Independent Variables of Interest………………………..26

Other Independent Variables ………………………..27

Dependent Variables………………………..28

Data Preparation………………………..29

Sample Creation………………………..29

Data Filtering and Variable Selection………………………..30

Creation of Chronic Diseases Dyad and Triad Variable………………………..31

Data Cleaning and Coding………………………..31

Statistical Analyses………………………..32

Descriptive Analyses………………………..32

Modelling………………………..33

IV. RESULTS    36

Descriptive Statistics Results………………………..36

Univariate Analyses………………………..36

Prevalence of Chronic Diseases………………………..36

Prevalence of Individual Chronic Diseases………………………..37

Prevalent Chronic Disease Dyads and Triads………………………..38

Bivariate and Multivariate Association of Sociodemographic Factors with Multimorbidity………………………..39

Sociodemographic Factors and One Chronic Condition………………………..39

Sociodemographic Factors and Multiple Chronic Conditions………………………..40

V. DISCUSSION………………………..42

Strengths and Limitations………………………..47

Conclusion………………………..48

VI. REFERENCES………………………..49

VII. TABLES AND FIGURES………………………..59

Table 1. Prevalence of Chronic Conditions Among US Adults by Age and Sex (N=27,157) ………59

Table 2. Leading Causes of Mortality Among US Foreign-born Population……..59

Table 3. Sample Characteristics of Foreign-born Adults in the US (N=8,174) ……..60

Table 4. Prevalence of Number of Chronic Diseases* Among Foreign-born Adults in the US within Each Sex by Age Group (N=8,174)   ……..61

Table 5. Prevalence of Chronic Diseases by Place of Origin among Foreign-born Adults in the US (N=8,174) ……..62

Table 6. Most Prevalent Dyads of Chronic Diseases by Sex and Age among Foreign-born Adults in the US with 2 Chronic Conditions (N=387) ……..63

Table 7. Most Prevalent Triads of Chronic Conditions by Sex and Age among Foreign-born Adults in the US with 3 Chronic Conditions (N=98) ……..64

Table 8. Results of the Multinomial Logistic Regression Analysis (Sociodemographic and Other Characteristics), Multimorbidity Being the Dependent Variable Categorized by Number of Chronic Conditions (N=8,174) ……..65

Figure 1. Prevalence of Multimorbidity a by Age Group among Foreign-born Adults in the US (N=8,174) 1……..66

Figure 2. Prevalence of Multimorbidity by Place of Origin among Foreign-born Adults in the US (N=8,174) 1……..66

VIII. APPENDICES………………………..67

Table 1. Prevalence of Multimorbidity Among US Foreign-born Adults by Sex, Age, and Place of Origin (N=8,174) ……..67

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