Social Determinants of Health and Multimorbidity Among Adults 50 Years and Older in the United States

Background Living with two or more chronic conditions simultaneously—known as multimorbidity—has become increasingly prevalent as the aging population continues to grow. However, the factors that influence the development of multimorbidity are still not fully understood. Objectives The purpose of this study was to investigate the prevalence of multimorbidity among U.S. adults 50 years and older and identify associated factors with multimorbidity. Methods We used data from four cycles from the National Health and Nutrition Examination Survey (2011–2018) to examine the associations between social determinants of health and multimorbidity among American adults aged 50 years and older. A set of variables on socioeconomic status and health behaviors was chosen based on the social determinants of health conceptual framework developed by the World Health Organization. In our study, 4,552 participants were included. All analyses were accounted for a complex survey design and the use of survey weights. Multiple logistic regression analyses were performed to examine the associated factors with multimorbidity. Results The average age was 63.1 years, and 52.9% were female. The average number of chronic conditions was 2.27. The prevalence of multimorbidity was 63.8%, with high cholesterol and hypertension being the most prevalent conditions. In the adjusted model, age, gender, household income, citizenship status, health insurance, healthcare access, body mass index, and smoking status were found to be associated with living with multimorbidity. Discussion Our results indicate that continued efforts aimed at promoting smoking cessation and maintaining a healthy weight will be beneficial in preventing the onset of chronic conditions. Additional research is warranted to gain a deeper understanding of the interrelationships between gender, race/ethnicity, household income, citizenship status, health insurance, and healthcare access as social determinants of health in the context of multimorbidity. Further research will help us develop targeted interventions and policies to address disparities and improve health outcomes for individuals with multimorbidity.

Health Social Networks of Black Women With Hypertension

Background The prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women. Objective This substudy aimed to examine health social networks and describe the peers’ characteristics, as reported by a convenience sample of Black women with hypertension. Methods In this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network. Results Collectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants’ health social network size (number of peers named) and their systolic blood pressure levels. Discussion The health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities.

Distinct Profiles of Morning and Evening Fatigue Co-Occurrence in Patients During Chemotherapy

Background Morning and evening fatigue are distinct and distressing symptoms experienced during chemotherapy that demonstrate a large amount of interindividual variability. Objectives The objectives of this study were to identify subgroups of patients with distinct morning and evening fatigue co-occurrence profiles and evaluate for differences among these subgroups in demographic, clinical, and symptom characteristics and quality of life. Methods Oncology patients (n = 1,334) completed the Lee Fatigue Scale to self-report morning and evening fatigue, six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning and evening physical fatigue profiles. Results Four distinct morning and evening fatigue profiles were identified (i.e., Both Low, Low Morning + Moderate Evening, Both Moderate, and Both High). Compared to the Both Low profile, the Both High profile was significantly younger, less likely to be married or partnered, more likely to live alone, had a higher comorbidity burden, and lower functional status. The Both High profile had higher levels of anxiety, depressive symptoms, sleep disturbance, and pain and lower levels of quality of life. Discussion The variability in the morning and evening severity scores among the four profiles supports the hypothesis that morning and evening fatigue are distinct but related symptoms. Clinically meaningful levels of both morning and evening fatigue were reported by 50.4% of our sample, which suggests that the co-occurrence of these two symptoms is relatively common. Patients in Both Moderate and Both High profiles experienced an extremely high symptom burden that warrants ongoing assessments and aggressive symptom management interventions.