Understanding multimorbidity to close the health disparity gap

Couple at the flower market

Multimorbidity — having two or more coexisting chronic conditions — is highly prevalent, costly and disabling to older adults. Across racial and ethnic groups, multimorbidity affects older adults disproportionately, and evidence shows that black and Hispanic adults are more likely to develop multiple chronic diseases with age.

Understanding the timing of chronic disease accumulation is useful in addressing this disparity gap. Groups that develop chronic diseases earlier, or accumulate conditions more quickly, are prime targets for interventional programs.

A new study, published in the journal PLOS ONE on June 17, 2019, examines when, and at what rate, U.S. adults are likely to develop chronic diseases across racial and ethnic subgroups. Authors found that black adults in their mid-to-late 50s developed two or more diseases about four years sooner than white adults. The team, led by Ana Quiñones, Ph.D. associate professor, Department of Family Medicine, School of Medicine, and OHSU-PSU School of Public Health, found that Hispanic adults also developed chronic disease at an earlier age than white adults.

Ensuring proper preventive health coverage is complex; racial and ethnic minority adults have lower rates of insurance coverage prior to Medicare eligibility age (65) and have lower rates of preventive and diagnostic services utilization — even after receiving Medicare.

“Our findings raise significant public health and healthcare system challenges for how best to prevent and delay further clinical complexity in old age,” says Quiñones. “Specifically, highlighting the need for proactive interventions and policies designed to preserve the ability of older adults to live independently, and delay institutionalization, particularly those from minority racial and ethnic backgrounds.”


This work was supported by: Grant Number: R01AG055681, National Institute on Aging of the National Institutes of Health to ARQ; Grant Number: R01AG047891, National Institute on Aging of the National Institutes of Health to HGA; Grant Number: P30AG021342, Yale Claude D. Pepper Older Americans Independence Center.

In addition to Quinones, authors from OHSU include Sheila Markwardt and David A. Dorr. Other co-authors include Heather G. Allore, Yale University; Anda Botoseneanu, University of Michigan; Jason T. Newsom, Portland State University; Corey L. Nagel, University of Arkansas.