Inequalities in Time Spent in Multimorbidity in Costa Rica and Mexico: A Multistate Modelling Approach

Anastasia Lam , University of St Andrews
Genevieve Cezard, University of St Andrews
Katherine Keenan , University of St Andrews

Multimorbidity – defined as the co-existence of two or more chronic diseases – is an important global public health issue, but our understanding of how it develops longitudinally, and in different low- and middle- income contexts is limited. We use nationally representative surveys from Mexico (Mexican Health and Aging Study) and Costa Rica (Costa Rican Study on Longevity and Healthy Aging) to investigate how time spent living with multimorbidity among those aged 60+ differed by gender and education, and if these differences could be explained by differential healthcare coverage and metabolic risk factors. Using discrete-time multistate modelling, we found that regardless of baseline health, BMI or socioeconomic status, Costa Ricans lived longer, and spent less time in multimorbidity than Mexicans. Time spent in multimorbidity in Mexico did not vary substantially by insurance status. People with hypertension in Mexico were more likely to transition into disease states than those in Costa Rica. Despite similar economic and demographic profiles, variations in multimorbidity are more likely driven by differential healthcare systems: Costa Rica has integrated universal healthcare, free at the point of delivery, better able to prevent, diagnose and manage chronic disease, compared with Mexico with a fragmented three-tier system and higher out-of-pocket expenditure. Future work will compare a third American country with heterogenous healthcare access, the United States. Debates about the expansion or compression of morbidity should consider multimorbidity an advanced morbid state of special policy and clinical concern, and refine healthy life expectancy estimates to take account of it.

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 Presented in Session 71. Flash Session: Inequalities in Life Expectancy, Disability and Health