Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study

Background Many physical, psychological, and cognitive disorders are highly clustered among populations with low socioeconomic status. However, the extent to which socioeconomic status is associated with different combinations of these disorders is unclear, particularly outside high-income countries. We aimed to evaluate these associations in 33 countries including high-income countries, upper-middle-income countries, and one lower-middle-income country.Methods This cross-sectional multi-region study pooled individual-level data from seven studies on ageing between 2017 and 2020. Education and total household wealth were used to measure socioeconomic status. Physical disorder was defined as having one or more of the self-reported chronic conditions. Psychological and cognitive disorders were measured by study-specific instruments. The outcome included eight categories: no disorders, physical disorder, psychological disorder, cognitive disorder, and their four combinations. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for the associations of socioeconomic status with these outcomes separately for high-income countries, upper-middle-income countries, and the lower-middle-income country.Findings Among 167376 individuals aged 45 years and older, the prevalence of multimorbidity was 24<middle dot>5% in high-income countries, 33<middle dot>9% in upper-middle-income countries, and 8<middle dot>1% in the lower-middle-income country (India). Lower levels of education, household wealth, and a combined socioeconomic status score were strongly associated with physical, psychological, and cognitive multimorbidity in high-income countries and upper-middle-income countries, with ORs (low vs high socioeconomic status) for physical-psychological-cognitive multimorbidity of 12<middle dot>36 (95% CI 10<middle dot>29-14<middle dot>85; p<0<middle dot>0001) in high-income countries and of 23<middle dot>84 (18<middle dot>85-30<middle dot>14; p<0<middle dot>0001) in upper-middle-income countries. The associations in the lower-middle-income country were mixed. Participants with both a low level of education and low household wealth had the highest odds of multimorbidity (eg, OR for physical-psychological-cognitive multimorbidity 21<middle dot>21 [15<middle dot>95-28<middle dot>19; p<0<middle dot>0001] in high-income countries, 37<middle dot>07 [25<middle dot>66-53<middle dot>56; p<0<middle dot>0001] in upper-middle-income countries, and 54<middle dot>96 [7<middle dot>66-394<middle dot>38; p<0<middle dot>0001] in the lower-middle-income country)Interpretation In study populations from high-income countries, upper-middle-income countries, and the lower-middle-income country, the odds of multimorbidity, which included physical, psychological, and cognitive disorders, were more than ten times greater in individuals with low socioeconomic status. Equity-oriented policies and programmes that reduce social inequalities in multimorbidity are urgently needed to achieve Sustainable Development Goals.