The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis

Tianxin Pan; Stewart W Mercer; Yang Zhao; Barbara McPake; Allissa Desloge; Rifat Atun; Emily Susannah Grace Hulse; John Tayu Lee

doi:10.1186/s12889-021-10414-7

The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis

BMC Public Health. 2021 Feb 18;21(1):376. doi: 10.1186/s12889-021-10414-7.

Authors

Tianxin Pan¹, Stewart W Mercer², Yang Zhao^{3

4}, Barbara McPake⁵, Allissa Desloge⁵, Rifat Atun⁶, Emily Susannah Grace Hulse⁵, John Tayu Lee^{5

7}

Affiliations

¹ Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia. tianxin.pan1@unimelb.edu.au.
² Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
³ The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
⁴ WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Victoria, Australia.
⁵ Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia.
⁶ Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, USA.
⁷ Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.

Abstract

Background: The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China.

Methods: Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes.

Results: After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39; 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss.

Conclusion: Mental-physical multimorbidity poses substantial negative health and economic effects on individuals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China.

Keywords: China; Disability; Economic impact; Mental health conditions; Multimorbidity; Physical conditions; Productivity.

MeSH terms

China / epidemiology
Chronic Disease
Data Analysis
Humans
Longitudinal Studies
Middle Aged
Multimorbidity*
Social Participation*